Feasibility of targeted axillary dissection for de-escalation of surgical treatment after neoadjuvant chemotherapy in breast cancer

Aragón-Sánchez, Sofía; Ciruelos-Gil, Eva; López-Marín, Laura; Galindo, Alberto; Tabuenca-Mateos, María José; Jiménez-Arranz, Sara; Colmenero-Hernández, María; Oliver-Pérez, Reyes

doi:10.1016/j.suronc.2022.101823

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…TAD has been shown to be feasible [ 17 ] and more accurate in identifying and removing involved nodes than SNB alone [ 24 , 25 ]. If TAD can safely and effectively replace ANC for patients with low-volume nodal disease having primary surgery, it would reduce patient morbidity, whilst continuing to provide accurate staging information which is important for prognostication and to inform appropriate selection of adjuvant therapies.…”

Section: Discussionmentioning

confidence: 99%

“…Use of TAD addresses concerns about high false-negative rates with SNB alone in patients with nodal involvement [ 16 ], facilitating removal of known disease, and providing accurate staging information to guide adjuvant treatment decision making whilst allowing patients to avoid the morbidity associated with an ANC. The technique has been shown to be feasible [ 17 ] and is now standard of care in node-positive patients who have a complete response to neoadjuvant chemotherapy [ 18 ]. There are also emerging data to support the use of TAD in patients having primary surgery [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Current axillary management of patients with early breast cancer and low-volume nodal disease undergoing primary surgery: results of a United Kingdom national practice survey

Fairhurst,

McIntosh,

Cutress

et al. 2024

Breast Cancer Res Treat

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Purpose UK NICE guidelines recommend axillary node clearance (ANC) should be performed in all patients with biopsy-proven node-positive breast cancer having primary surgery. There is, however, increasing evidence such extensive surgery may not always be necessary. Targeted axillary dissection (TAD) may be an effective alternative in patients with low-volume nodal disease who are clinically node negative (cN0) but have abnormal nodes detected radiologically. This survey aimed to explore current management of this group to inform feasibility of a future trial. Methods An online survey was developed to explore current UK management of patients with low-volume axillary disease and attitudes to a future trial. The survey was distributed via breast surgery professional associations and social media from September to November 2022. One survey was completed per unit and simple descriptive statistics used to summarise the results. Results 51 UK breast units completed the survey of whom 78.5% (n = 40) reported performing ANC for all patients with biopsy-proven axillary nodal disease having primary surgery. Only 15.7% of units currently performed TAD either routinely (n = 6, 11.8%) or selectively (n = 2, 3.9%). There was significant uncertainty (83.7%, n = 36/43) about the optimal surgical management of these patients. Two-thirds (n = 27/42) of units felt an RCT comparing TAD and ANC would be feasible. Conclusions ANC remains standard of care for patients with low-volume node-positive breast cancer having primary surgery in the UK, but considerable uncertainty exists regarding optimal management of this group. This survey suggests an RCT comparing the outcomes of TAD and ANC may be feasible.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Current axillary management of patients with early breast cancer and low-volume nodal disease undergoing primary surgery: results of a United Kingdom national practice survey

Fairhurst,

McIntosh,

Cutress

et al. 2024

Breast Cancer Res Treat

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“…This technique has recently been introduced in the main guidelines and is associated with a further reduction in the false-negative rate, which ranges from 2% to 6.8% [ 24 , 25 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…Targeted axillary dissection (TAD) is an axillary staging technique that combines the removal of the metastatic LNs clipped before NACT and SLNB. This technique has recently been introduced in the main guidelines ( Table 2 ) and is associated with a further reduction in the false-negative rate, which ranges from 2% to 6.8% [ 24 , 25 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ].…”

Section: Introductionmentioning

confidence: 99%

Image-Guided Localization Techniques for Metastatic Axillary Lymph Nodes in Breast Cancer; What Radiologists Should Know

Paola¹,

Mazzotta

Conti

et al. 2023

Cancers

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Targeted axillary dissection (TAD) is an axillary staging technique after NACT that involves the removal of biopsy-proven metastatic lymph nodes in addition to sentinel lymph node biopsy (SLNB). This technique avoids the morbidity of traditional axillary lymph node dissection and has shown a lower false-negative rate than SLNB alone. Therefore, marking positive axillary lymph nodes before NACT is critical in order to locate and remove them in the subsequent surgery. Current localization methods include clip placement with intraoperative ultrasound, carbon-suspension liquids, localization wires, radioactive tracer-based localizers, magnetic seeds, radar reflectors, and radiofrequency identification devices. The aim of this paper is to illustrate the management of axillary lymph nodes based on current guidelines and explain the features of axillary lymph node markers, with relative advantages and disadvantages.

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Obesity-Associated Breast Cancer: Analysis of Risk Factors and Current Clinical Evaluation

Engin

2024

Advances in Experimental Medicine and Biology

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Feasibility of targeted axillary dissection for de-escalation of surgical treatment after neoadjuvant chemotherapy in breast cancer

Cited by 6 publications

References 26 publications

Current axillary management of patients with early breast cancer and low-volume nodal disease undergoing primary surgery: results of a United Kingdom national practice survey

Current axillary management of patients with early breast cancer and low-volume nodal disease undergoing primary surgery: results of a United Kingdom national practice survey

Image-Guided Localization Techniques for Metastatic Axillary Lymph Nodes in Breast Cancer; What Radiologists Should Know

Obesity-Associated Breast Cancer: Analysis of Risk Factors and Current Clinical Evaluation

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