G Vugts1, A J G Maaskant-Braat2, W K de Roos3, A C Voogd4, G A P Nieuwenhuijzen5. 1. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands. Electronic address: guusje.vugts@catharinaziekenhuis.nl. 2. Department of Surgery, Maxima Medical Centre, Veldhoven, The Netherlands. 3. Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands. 4. Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands; Department of Epidemiology, Maastricht University, Maastricht, The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht, The Netherlands. 5. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Abstract
BACKGROUND: Axillary pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) is achieved in a substantial part of clinically node positive breast cancer patients. Treatment of the axilla after NAC varies widely, and new techniques to spare patients from an axillary lymph node dissection (ALND) are being introduced. METHODS: This Dutch nationwide survey regarding treatment of the initially clinically node positive axilla in patients receiving NAC was conducted amongst 148 surgical oncologists during November 2014-June 2015, to survey the diagnostic work-up, axillary mapping and willingness to omit ALND. RESULTS: Axillary ultrasound was considered a standard procedure in the diagnostic work-up by 99% of participants. The majority of 70% of participants stated that ALND could possibly be omitted in node positive patients with a favourable response to NAC. A positive correlation was observed between the total amount of patients treated, versus patients receiving NAC (P < 0.01). A total of 93 respondents performed axillary response evaluation after NAC, using imaging (72%), excision of localized lymph nodes (56%) or sentinel node biopsy (SNB; 45%). Decision-making in omitting ALND was influenced by the presence of N2-3 disease, patient age and type of breast surgery. Multivariable analysis showed that clinicians who administered NAC more often, were more likely to omit ALND (P < 0.01). DISCUSSION: The majority of surgeons are inclined to omit ALND in case of an axillary pCR. A large variety of techniques is being used to identify a pCR. The lack of consensus on this topic indicates the need for guidelines based on the best available evidence.
BACKGROUND: Axillary pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) is achieved in a substantial part of clinically node positive breast cancerpatients. Treatment of the axilla after NAC varies widely, and new techniques to spare patients from an axillary lymph node dissection (ALND) are being introduced. METHODS: This Dutch nationwide survey regarding treatment of the initially clinically node positive axilla in patients receiving NAC was conducted amongst 148 surgical oncologists during November 2014-June 2015, to survey the diagnostic work-up, axillary mapping and willingness to omit ALND. RESULTS: Axillary ultrasound was considered a standard procedure in the diagnostic work-up by 99% of participants. The majority of 70% of participants stated that ALND could possibly be omitted in node positive patients with a favourable response to NAC. A positive correlation was observed between the total amount of patients treated, versus patients receiving NAC (P < 0.01). A total of 93 respondents performed axillary response evaluation after NAC, using imaging (72%), excision of localized lymph nodes (56%) or sentinel node biopsy (SNB; 45%). Decision-making in omitting ALND was influenced by the presence of N2-3 disease, patient age and type of breast surgery. Multivariable analysis showed that clinicians who administered NAC more often, were more likely to omit ALND (P < 0.01). DISCUSSION: The majority of surgeons are inclined to omit ALND in case of an axillary pCR. A large variety of techniques is being used to identify a pCR. The lack of consensus on this topic indicates the need for guidelines based on the best available evidence.
Authors: Erika Barbieri; Damiano Gentile; Alberto Bottini; Andrea Sagona; Wolfgang Gatzemeier; Agnese Losurdo; Bethania Fernandes; Corrado Tinterri Journal: Eur J Breast Health Date: 2021-10-04
Authors: Hyung Suk Kim; Man Sik Shin; Chang Jong Kim; Sun Hyung Yoo; Tae Kyung Yoo; Yong Hwa Eom; Byung Joo Chae; Byung Joo Song Journal: J Breast Cancer Date: 2017-12-19 Impact factor: 3.588
Authors: Janine M Simons; Thiemo J A van Nijnatten; Carmen C van der Pol; Ernest J T Luiten; Linetta B Koppert; Marjolein L Smidt Journal: Ann Surg Date: 2019-03 Impact factor: 12.969