Maggie Banys-Paluchowski1, Michael Untch2, Natalia Krawczyk3, Maria Thurmann2, Thorsten Kühn4, Jalid Sehouli5,6, Maria Luisa Gasparri7,8, Jana de Boniface9,10, Oreste Davide Gentilini11, Elmar Stickeler12, Nina Ditsch13, Achim Rody14, Peter Paluchowski15, Jens-Uwe Blohmer16. 1. Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany. Maggie.Banys-Paluchowski@uksh.de. 2. Department of Gynecology and Obstetrics, Helios Klinikum Berlin-Buch, Berlin, Germany. 3. Department of Gynecology and Obstetrics, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. 4. Department of Gynecology and Obstetrics, Klinikum Esslingen, Esslingen, Germany. 5. Department of Gynecology With Center for Oncological Surgery, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, Berlin, Germany. 6. Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Freie Universität Berlin, Berlin, Germany. 7. Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale, Ospedale Regionale Di Lugano, Lugano, Switzerland. 8. Faculty of Biomedicine, University of the Italian Switzerland (USI), Lugano, Switzerland. 9. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. 10. Department of Surgery, Capio St. Göran's Hospital, Stockholm, Sweden. 11. Breast Surgery Unit, San Raffaele Hospital Milan, Milan, Italy. 12. Department of Gynecology and Obstetrics, University Hospital Aachen, Aachen, Germany. 13. Department of Gynecology and Obstetrics, University of Augsburg, Augsburg, Germany. 14. Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany. 15. Department of Gynecology and Obstetrics and Breast Cancer Center, Regio Klinikum Pinneberg, Pinneberg, Germany. 16. Department of Gynecology and Breast Cancer Center, Charité Universitätsmedizin Berlin, Berlin, Germany.
Abstract
PURPOSE: In the last 2 decades, the optimal management of the axilla in breast cancer patients receiving neoadjuvant chemotherapy (NACT) has been one of the most frequently discussed topics. Little is known about the attitudes of surgeons/radiologists towards new developments such as targeted axillary dissection. Therefore, the NOGGO conducted a survey to evaluate the current approach to axillary management. METHODS: A standardized digital questionnaire was sent out to > 200 departments in Germany between 7/2021 and 5/2022. The survey was supported by EUBREAST. RESULTS: In total, 116 physicians completed the survey. In cN0 patients scheduled to receive NACT, 89% of respondents recommended sentinel lymph node biopsy (SLNB) after NACT. In case of ypN1mi(sn), 44% advised no further therapy, while 31% proposed ALND and 25% axillary irradiation. 64% of respondents recommended a minimally invasive axillary biopsy to cN + patients. TAD was used at the departments of 82% of respondents and was offered to all cN + patients converting to ycN0 by 57% and only to selected patients, usually based on the number of suspicious nodes at time of presentation, by 43%. The most common marking technique was a clip/coil. 67% estimated that the detection rate of their marker was very good or good. CONCLUSION: This survey shows a heterogenous approach towards axillary management in the neoadjuvant setting in Germany. Most respondents follow current guidelines. Since only two-thirds of respondents experienced the detection rate of the marker used at their department as (very) good, future studies should focus on the comparative evaluation of different marking techniques.
PURPOSE: In the last 2 decades, the optimal management of the axilla in breast cancer patients receiving neoadjuvant chemotherapy (NACT) has been one of the most frequently discussed topics. Little is known about the attitudes of surgeons/radiologists towards new developments such as targeted axillary dissection. Therefore, the NOGGO conducted a survey to evaluate the current approach to axillary management. METHODS: A standardized digital questionnaire was sent out to > 200 departments in Germany between 7/2021 and 5/2022. The survey was supported by EUBREAST. RESULTS: In total, 116 physicians completed the survey. In cN0 patients scheduled to receive NACT, 89% of respondents recommended sentinel lymph node biopsy (SLNB) after NACT. In case of ypN1mi(sn), 44% advised no further therapy, while 31% proposed ALND and 25% axillary irradiation. 64% of respondents recommended a minimally invasive axillary biopsy to cN + patients. TAD was used at the departments of 82% of respondents and was offered to all cN + patients converting to ycN0 by 57% and only to selected patients, usually based on the number of suspicious nodes at time of presentation, by 43%. The most common marking technique was a clip/coil. 67% estimated that the detection rate of their marker was very good or good. CONCLUSION: This survey shows a heterogenous approach towards axillary management in the neoadjuvant setting in Germany. Most respondents follow current guidelines. Since only two-thirds of respondents experienced the detection rate of the marker used at their department as (very) good, future studies should focus on the comparative evaluation of different marking techniques.
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