# MARI Procedure — Marking Axillary Lymph Nodes With Radioactive Iodine Seeds (Original)

**Autores:** Donker M, Straver ME, Wesseling J, Loo CE, Schot M, Drukker CA, et al. (Netherlands Cancer Institute)
**Revista:** Annals of Surgery (2015)
**PMID:** 24743607 | **PMCID:** —
**DOI:** [10.1097/SLA.0000000000000558](https://doi.org/10.1097/SLA.0000000000000558)
**Fuente:** PubMed (abstract only — full text vía DOI/institución)

## Relevancia ⭐ PIVOTAL — origen de la técnica MARI
Artículo seminal del Netherlands Cancer Institute que introduce el **procedimiento MARI**: marcaje del ganglio axilar positivo (probado por biopsia) con **semilla de yodo-125** antes de iniciar NAC, y extracción dirigida post-NAC con sonda gamma. Identificación 97%, **FNR 7%**. Base de la posterior validación RISAS (MARI + SLNB).

## Abstract

The MARI procedure [marking the axillary lymph node with radioactive iodine (¹²⁵I) seeds] is a new minimal invasive method to assess the pathological response of nodal metastases after neoadjuvant systemic treatment (NST) in patients with breast cancer. This method allows axilla-conserving surgery in patients responding well to NST.

**Methods:** Prior to NST, proven tumor-positive axillary lymph nodes were marked with a ¹²⁵I seed. This marked lymph node is the so-called MARI-node. After NST, the MARI node was selectively removed using a γ-detection probe. A complementary axillary lymph node dissection was performed in all patients to assess whether pathological response in the MARI node was indicative for the pathological response in the additional lymph nodes.

**Results:** A tumor-positive axillary lymph node was marked with a ¹²⁵I seed in 100 patients. The MARI node was successfully identified in **97 of 100 patients (identification rate 97%)**. Two patients did not undergo subsequent ALND, leaving 95 patients for further analysis. The MARI node contained residual tumor cells in 65/95 patients. In the other 30 patients, the MARI node was free of tumor, but additional positive lymph nodes were found in 5 patients. Thus, the MARI procedure correctly identified 65 of 70 patients with residual axillary tumor activity (**false negative rate 5/70 = 7%**).

**Conclusion:** Marking and selectively removing metastatic lymph nodes after NST has a **high identification rate and low FNR**. The tumor response in the marked lymph node may be used to tailor further axillary treatment after NST.

## Acceso
Artículo no disponible en PMC. Acceder vía [DOI](https://doi.org/10.1097/SLA.0000000000000558) o suscripción institucional.

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*Datos de PubMed. Citar: doi 10.1097/SLA.0000000000000558*
