Tumark® Vision Atlas

Case 3

A 45 year-old patient with right-axillary lymph node suggestive of metastasis detected in ultrasound

Dr. S. Metz, Institute for Diagnostic and Interventional Radiology at the Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany

Case description

A right-axillary lymph node, suggestive of metastasis, was detected in an ultrasound. Initially, an ultrasound-guided punch biopsy of the lymph node detected cancerous cells. PET-CT and breast MRI for staging followed. Second ultrasound and sonobiopsy of the inside-right of the breast: NST, G3, HR negative; HER2-immunohistochemistry: 3+.

Course of treatment

The primary tumor and right-axillary lymph node clip marked with Tumark Vision. Primary systemic therapy initiated, consisting of 4 x EC followed by 12 x trastuzumab + pertuzumab weekly. Following primary systemic therapy (PST), complete remission (CR) shown in the imaging.


A treatment option analogous to the course of action suggested in the SenTa study would be a suitable option for the case presented. The hospitals “Kliniken Essen-Mitte” (Kümmel S. et al.) have initiated this study, which is a prospective, multi-centric registry on the usage frequency and feasibility of targeted axillary dissection in patients with primary breast cancer and PST, in whom a punch biopsy is initially performed and the clinically suspicious lymph node is marked with a clip. The primary study goal defined is the identification of the surgical detection rate of the target lymph node (TLNB) marked with a clip. In this context, distinguishing of the clip via ultrasound for pre-operative marking is of crucial importance.