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Twenty-two MRIs were performed before neoadjuvant therapy, and 33 MRIs were after its initiation. There were 34\/55 HydroMARK\u00ae, 10\/55 Tumark\u00ae, and 11\/55 other marker types. Time interval between marker placement and MRI examination was 103 \u00b1 81 days (mean \u00b1 standard deviation). Three readers with 1\u201330\u2009years of experience independently assessed four axial sequences: unenhanced fat-suppressed three-dimensional T1-weighted spoiled gradient-recalled (SPGR), first contrast-enhanced fat-suppressed SPGR, T2-weighted water-only fast spin-echo (T2-WO), and T2-weighted fat-only fast-spin-echo (T2-FO).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Markers were 5.2\u00d7 more likely to be visualized on T2-WO than on unenhanced images (<jats:italic>p<\/jats:italic> = &lt; 0.001), and 3.3\u00d7 more likely to be visualized on contrast-enhanced than on unenhanced sequences (<jats:italic>p<\/jats:italic> = 0.009). HydroMARK markers demonstrated a 3\u00d7 more likelihood of being visualized than Tumark (<jats:italic>p<\/jats:italic> = 0.003). Markers were 8.4\u00d7 more likely to be visualized within morphologically abnormal LNs (<jats:italic>p<\/jats:italic> &lt; 0.001). After 250\u2009days post-placement, confidence in marker brightness of HydroMARK markers on T2-WO images was less than 50% (<jats:italic>p<\/jats:italic> &lt; 0.001). Inter-rater agreement was excellent for T2-WO and contrast-enhanced SPGR, good for unenhanced SPGR, and poor for T2-FO images.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>T2-WO and contrast-enhanced images should be used for marker identification. HydroMARK was the best visualized marker. Markers were easier to identify when placed in abnormal LNs. The visibility of HydroMARK markers was reduced with time.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s41747-020-00161-6","type":"journal-article","created":{"date-parts":[[2020,6,12]],"date-time":"2020-06-12T01:02:23Z","timestamp":1591923743000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Best MRI sequences for identifying axillary lymph node markers in patients with metastatic breast cancer: an inter-reader observational study"],"prefix":"10.1186","volume":"4","author":[{"given":"Naziya","family":"Samreen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asha A.","family":"Bhatt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalie","family":"Adler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Zingula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrina N.","family":"Glazebrook","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,6,12]]},"reference":[{"key":"161_CR1","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/s13058-018-1091-y","volume":"21","author":"SP Gampenrieder","year":"2019","unstructured":"Gampenrieder SP, Peer A, Weismann C et al (2019) Radiologic complete response (rCR) in contrast-enhanced magnetic resonance imaging (CE-MRI) after neoadjuvant chemotherapy for early breast cancer predicts recurrence-free survival but not pathologic complete response (pCR). 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Reviewer approved waiver of the requirement to obtain informed consent in accordance with 45 CFR 46.116.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"See the \u201cEthics approval and consent to participate\u201d section.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"34"}}