J M Simons1, A J G Maaskant-Braat2, E J T Luiten3, M H K Leidenius4, T J A van Nijnatten5, P G Boelens6, L B Koppert7, C C van der Pol8, C J H van de Velde6, R A Audisio9, M L Smidt10. 1. Erasmus Medical Center Rotterdam, Department of Surgical Oncology, Rotterdam, the Netherlands; University Medical Center Utrecht, Department of Surgical Oncology, Utrecht, the Netherlands; Maastricht University Medical Center+, GROW - School for Oncology and Developmental Biology, Maastricht, the Netherlands. Electronic address: j.m.simons@umcutrecht.nl. 2. Maxima Medisch Centrum, Department of Surgical Oncology, Eindhoven, the Netherlands. 3. Amphia Hospital, Department of Surgical Oncology, Breda, the Netherlands. 4. Helsinki University Hospital, Department of Breast Surgery, Helsinki, Finland. 5. Maastricht University Medical Center+, Department of Radiology and Nuclear Medicine, Maastricht, the Netherlands. 6. Leiden University Medical Center, Department of Surgery, Leiden, the Netherlands. 7. Erasmus Medical Center Rotterdam, Department of Surgical Oncology, Rotterdam, the Netherlands. 8. Alrijne Hospital, Department of Surgical Oncology, Leiderdorp, the Netherlands. 9. Institute of Clinical Sciences, Sahlgrenska University Hospital, Department of Surgery, Göteborg, Sweden. 10. Maastricht University Medical Center+, Department of Surgical Oncology, Maastricht, the Netherlands; Maastricht University Medical Center+, GROW - School for Oncology and Developmental Biology, Maastricht, the Netherlands.
Abstract
INTRODUCTION: Various options for axillary staging after neoadjuvant systemic therapy (NST) are available for breast cancer patients with a clinically positive axillary node (cN+). This survey assessed current practices amongst breast cancer specialists. MATERIALS AND METHODS: A survey was performed amongst members of the European Society of Surgical Oncology and two UK-based Associations: the Association of Breast Surgery and the British Association of Surgical Oncology. The survey included 3 parts: 1. general information, 2. diagnostic work-up and 3. axillary staging after NST. RESULTS: A total of 310 responses were collected: parts 1, 2 and 3 were fully completed by 282 (91%), 270 (87.1%) and 225 (72.6%) respondents respectively. After NST, 153/267 (57.3%) respondents currently perform ALND routinely and 114 (42.7%) respondents perform less invasive restaging of the axilla with possible omission of ALND. In the latter group, 85% does and 15% does not use nodal response seen on imaging to guide the axillary restaging procedure. Regarding respondents that do use imaging: 95% would perform a less invasive staging procedure in case of complete nodal response on imaging (63% sentinel lymph node biopsy (SLNB), excision of a previously marked positive node with SLNB (21%) and without SLNB (11%)). In case of no nodal response on imaging 77% would perform ALND. CONCLUSION: Current axillary staging and management practices in cN + patients after NST vary widely. To determine optimal axillary staging and management in terms of quality of life and oncologic safety, breast specialists are encouraged to include patients in clinical trials/prospective registries.
INTRODUCTION: Various options for axillary staging after neoadjuvant systemic therapy (NST) are available for breast cancerpatients with a clinically positive axillary node (cN+). This survey assessed current practices amongst breast cancer specialists. MATERIALS AND METHODS: A survey was performed amongst members of the European Society of Surgical Oncology and two UK-based Associations: the Association of Breast Surgery and the British Association of Surgical Oncology. The survey included 3 parts: 1. general information, 2. diagnostic work-up and 3. axillary staging after NST. RESULTS: A total of 310 responses were collected: parts 1, 2 and 3 were fully completed by 282 (91%), 270 (87.1%) and 225 (72.6%) respondents respectively. After NST, 153/267 (57.3%) respondents currently perform ALND routinely and 114 (42.7%) respondents perform less invasive restaging of the axilla with possible omission of ALND. In the latter group, 85% does and 15% does not use nodal response seen on imaging to guide the axillary restaging procedure. Regarding respondents that do use imaging: 95% would perform a less invasive staging procedure in case of complete nodal response on imaging (63% sentinel lymph node biopsy (SLNB), excision of a previously marked positive node with SLNB (21%) and without SLNB (11%)). In case of no nodal response on imaging 77% would perform ALND. CONCLUSION: Current axillary staging and management practices in cN + patients after NST vary widely. To determine optimal axillary staging and management in terms of quality of life and oncologic safety, breast specialists are encouraged to include patients in clinical trials/prospective registries.
Authors: Giacomo Montagna; Minna K Lee; Varadan Sevilimedu; Andrea V Barrio; Monica Morrow Journal: Ann Surg Oncol Date: 2022-07-28 Impact factor: 4.339
Authors: Liselore M Janssen; Britt B M Suelmann; Sjoerd G Elias; Markus H A Janse; Paul J van Diest; Elsken van der Wall; Kenneth G A Gilhuijs Journal: BMJ Open Date: 2022-09-20 Impact factor: 3.006