Management of the clinically positive axilla

Euhus, David M.

doi:10.1111/tbj.13719

Cited by 3 publications

(3 citation statements)

References 18 publications

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“…This surgical technique can further reduce the FNR in initially cNþ patients undergoing NACT to an acceptable level of 1.4% [27] -9.1% [28]. Interestingly, the SN and TLN represent the same lymph node in up to 70% of patients [29]. Based on available data, most guidelines agree that TAD is a reliable technique and equivalent to ALND for axillary lymph node assessment in patients initially presenting with a limited axillary burden (e.g., with a maximum of three suspicious nodes) and converting to ycN0 after NACT.…”

Section: Controversies In the Cnr Settingmentioning

confidence: 99%

Controversies in axillary management of patients with breast cancer – updates for 2024

Tauber,

Bjelic-Radisic,

Thill

et al. 2023

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review For some time now, the question of de-escalation in axillary staging in breast cancer patients has been raised. The aim is to improve the patients’ quality of life and reduce morbidity by optimizing surgical strategies with a high level of oncological safety. This review offers a current overview of published evidence and clinical practice, aiming to guide the surgical community as they reassess and reshape their practices. Recent findings Years after introducing sentinel lymph node biopsy (SLNB) in clinically node negative breast cancer patients several guidelines suggest completely omitting SLNB in older patients with low-risk tumors. It is worth noting that for patients with a metastatic sentinel lymph node in the upfront surgery setting, a de-escalation of axillary surgery may in fact lead to an escalation of radiation therapy. Currently, there is limited evidence on the axillary surgical approach for patients with initially positive node status achieving complete axillary response (ycN0), resulting in heterogenous guideline recommendations. Summary Innovative trials are contributing to a growing evidence on de-escalation of axillary surgery with the aim of reducing arm morbidity and improving long-term health-related quality of life.

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Section: Controversies In the Cnr Settingmentioning

confidence: 99%

Controversies in axillary management of patients with breast cancer – updates for 2024

Tauber,

Bjelic-Radisic,

Thill

et al. 2023

Current Opinion in Obstetrics &Amp; Gynecology

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show abstract

“…Several trials since analyzed the FNR of TAD in initially node-positive patients undergoing NACT demonstrating acceptable FNR between 2 and 9% (Table 2). Interestingly, the TLN and SLN are the same node in approximately 70% of patients [61]. In the remaining 30% of cases, the marking of the initially metastatic lymph node allows its identification and resection after completion of NACT.…”

Section: Axillary Surgery In Cn + Patientsmentioning

confidence: 99%

“…However, it is worth mentioning that ALND had no influence on the rate of distant metastasis or OS [60]. The cN + status was defined as palpable suspicious lymph nodes in this study and patients with negative clinical examination and lymph node metastases detected on ultrasound were not included [61].…”

Section: Introductionmentioning

confidence: 99%

Locoregional Therapy: From Mastectomy to Reconstruction, Targeted Surgery, and Ultra-Hypofractionated Radiotherapy

Banys-Paluchowski,

Hartmann,

Ditsch

et al. 2023

Breast Care

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Background: The past 3 decades have seen an unprecedented shift toward treatment de-escalation in surgical therapy of breast cancer. Summary: Radical mastectomy has been replaced by breast-conserving and oncoplastic approaches in most patients, and full axillary lymph node dissection by less radical staging procedures, such as sentinel lymph node biopsy and targeted axillary dissection. Further, attempts have been made to spare healthy tissue while increasing the probability of removing the tumor with clear margins, thus improving cosmetic results and minimizing the risk of local recurrence. In this context, modern probe-guided localization techniques have been introduced to guide surgical excision. This progress was accompanied by the development of targeted systemic therapies. At the same time, radiotherapy for breast cancer has undergone significant changes. The use of hypofractionation has decreased the typical length of a treatment course from 5–6 weeks to 1–3 weeks. Partial breast irradiation is now a valid option for de-escalation in patients with low-risk features. Axillary radiotherapy achieves similar recurrence rates and decreases the risk of lymphedema in patients with limited sentinel node involvement. Key Messages: Taken together, these advances are important steps toward individualization of locoregional management strategies. This highlights the importance of interdisciplinary approaches for de-escalation of locoregional therapies.

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

Aragón-Sánchez

Ciruelos-Gil²,

López-Marín³

et al. 2022

Surgical Oncology

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Management of the clinically positive axilla

Cited by 3 publications

References 18 publications

Controversies in axillary management of patients with breast cancer – updates for 2024

Controversies in axillary management of patients with breast cancer – updates for 2024

Locoregional Therapy: From Mastectomy to Reconstruction, Targeted Surgery, and Ultra-Hypofractionated Radiotherapy

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

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