PurposeTargeted axillary dissection (TAD) for the axillary staging of clinically node-positive (cN +) breast cancer patients converting to clinically node negative post neoadjuvant chemotherapy (NAC), has gained popularity due to its minimal false negative rate and low arm morbidity. The aim of this study is to shed more light on the variation in the clinical practice globally in terms of indications and perceived limitations of TAD.MethodsA panel of expert breast surgeons constructed a structured questionnaire comprising of 18 questions and asked surgeons worldwide for their opinions and routine practice on TAD. The questionnaire was electronically distributed and answers were collected between May 1st and August 1st 2022.ResultsResponses included 137 entries from 36 countries. Of them, 73.7% consider TAD for cN + patients planned to receive NAC. Among them, the greatest number of respondents (45%) perform the procedure for tumours up to T3, whereas 27% regardless of T-stage. The majority (42%) perform TAD on patients with 1-3 positive nodes and only 30% consider TAD when matted nodes are present. HER2 positive and Triple Negative subtypes are more likely to undergo TAD than Luminal A and B (86%, 79.1%, 39.5%, and 62.8%, respectively). Maximum acceptable lymph node burden is median 3 nodes for any subtype with a tendency to accept more positive nodes for Triple Negative.ConclusionThis study demonstrates the differences in current practice regarding TAD as well as the fact that the biology of the tumour heavily affects the method of axillary staging.
Targeted axillary dissection: worldwide variations in clinical practice / Kontos, Michalis; Kanavidis, Prodromos; Kühn, Thorsten; Masannat, Yazan; Gulluoglu, Bahadir; Gonzalez, Eduardo; Walker, Melanie; Collins, A. J.; Nano, M. T.; Heron, Kim; Penington, Beth; He, Mike; Janu, Norman; Read, Katrina; Fernandez, Jose Cid; Brown, Belinda; Shah, Aashit; Snook, Kylie; Forsyth, Sarah; Bingham, Janne; Lippey, Jocelyn; Symonds, Joel; Winder, Alec; Bartlett, Nita; Vujovic, Petar; Gough, Jenny; Birks, Sarah; Meybodi, Farid; Hamza, Saud; Elder, Elisabeth; Stranzl, Heidi; Kosayeva, Tahmina; Vergauwen, Glenn; Letzkus, Jaime; Benitez, Gilberto; Cabrera, Eduardo; Kitiris, Evros; Kailides, Michalis; Corral, Patricio; Ali, Khaled Mohamed Abdelwahab; Niinikoski, Laura; Weinand, Kerstin; Hasmüller, Stephan; Kurz, Conny; Kolberg, Hans-Christian; Thalmann, Ingo; Banys-Paluchowski, Maggie; Manika, Aikaterini; Venizelos, Vasileios; Metaxas, Georgios; Papadopoulos, Lazaros; Natsiopoulos, Ioannis; Ignatiadou, Eleftheria; Iosifidou, Rodoniki; Askoksilakis, Ioannis; Michalopoulos, Nikolaos; Xepapadakis, Grigorios; Wong, Serena Yu Yan; Kirti, Karishma; Nooripour, Roghieh; Invento, Alessandra; Regolo, Lea; Chiappa, Corrado; Lazzaretti, Maria-Grazia; Sibilio, Andrea; Galimberti, Viviana-Enrica; Mattar, Denise; Michieletto, Silvia; Di Micco, Rosa; Di Palma, Teresa; Gentilini, Oreste D.; Rocco, Nicola; Porpiglia, Mauro; Alsaleh, Mervat; Albader, Ibtisam; Aguilar-Villanueva, Sergio; Rutges, Emiel; Juhasz, Eva; Davis, Nicola; Govender, Stan; Sharaf, Khaled; Vasquez, Lia Pamela Rebaza; Basa, Aldine; Murawa, Dawid; Pinto, David; Eduard-Alexandru, Bonci; Bobirca, Florin; Toma, Elena Adelina; Diaconescu, Bogdan; Mirica, Radu Mihail; Udrea, Adrian; Brotea-Mosoiu, Silvia; Dimofte, Gabriel; Sorinel, Lunca; Ginghina, Octav; Alexandru, Gata Vlad; Muresan, Mihai-Stefan; Musina, Ana-Maria; Alriyees, Lolwah; Mok, Chi Wei; Perhavec, Andraz; Comin, Laura; Sánchez-Méndez, José Ignacio; Ortega-Perez, Gloria; De Boniface, Jana; Oikonomou, Ira; Karakatsanis, Andreas; Tausch, Christoph; Weber, Walter; Gasparri, Maria-Luisa; Sanli, Ahmet Necati; Abdullayev, Seymur; Gokova, Melek; Kebudi, Abut; Kucuk, Gultekin Ozan; Zengel, Baha; Kalayci, Tolga; Dogan, Lutfi; Bozkurt, Betul; Gunay, Semra; Shaari, Elina; Kothari, Ashutosh; Dube, Manas; Constantinou, Chloe; Cuadrafo, Teresa Fernandez; Macaskill, Jane; Khout, Hazem; Nagarajakumar, Anupama; Milligan, Rob; Arthur, Laura; Pardo, Ricardo; Barry, Peter; Garreffa, Emanuele; Dietz, Jill; Willey, Shawna; Boughey, Judy; Boolbol, Susan; Peled, Anne; Null, Null. - In: BREAST CANCER RESEARCH AND TREATMENT. - ISSN 0167-6806. - 204:2(2024), pp. 389-396. [10.1007/s10549-023-07204-7]
Targeted axillary dissection: worldwide variations in clinical practice
Gentilini, Oreste D.;
2024-01-01
Abstract
PurposeTargeted axillary dissection (TAD) for the axillary staging of clinically node-positive (cN +) breast cancer patients converting to clinically node negative post neoadjuvant chemotherapy (NAC), has gained popularity due to its minimal false negative rate and low arm morbidity. The aim of this study is to shed more light on the variation in the clinical practice globally in terms of indications and perceived limitations of TAD.MethodsA panel of expert breast surgeons constructed a structured questionnaire comprising of 18 questions and asked surgeons worldwide for their opinions and routine practice on TAD. The questionnaire was electronically distributed and answers were collected between May 1st and August 1st 2022.ResultsResponses included 137 entries from 36 countries. Of them, 73.7% consider TAD for cN + patients planned to receive NAC. Among them, the greatest number of respondents (45%) perform the procedure for tumours up to T3, whereas 27% regardless of T-stage. The majority (42%) perform TAD on patients with 1-3 positive nodes and only 30% consider TAD when matted nodes are present. HER2 positive and Triple Negative subtypes are more likely to undergo TAD than Luminal A and B (86%, 79.1%, 39.5%, and 62.8%, respectively). Maximum acceptable lymph node burden is median 3 nodes for any subtype with a tendency to accept more positive nodes for Triple Negative.ConclusionThis study demonstrates the differences in current practice regarding TAD as well as the fact that the biology of the tumour heavily affects the method of axillary staging.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
