Prospective, multicenter registry trial to evaluate the clinical feasibility of targeted axillary dissection (TAD) in patients (pts) with breast cancer (BC) and core biopsy proven axillary involvement (cN+)

Reinisch, Mattea; Heil, Joerg; Rüland, Anna; Seiberling, Christine; Harrach, Hakima; Schindowski, D; Lubitz, Juliane; Ankel, C; Graßhoff, Sven-Thomas; Deuschle, Petra; Hanf, Volker; Holtschmidt, Johannes; Traut, Eugene F.; Kuehn, Thorsten; Küemmel, Sherko

doi:10.1093/annonc/mdz240.003

Cited by 4 publications

(5 citation statements)

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“…The results of the prospective German multicenter SENTA register study were presented at the ESMO conference in 2019 and are now available as a full publication [ 28 , 29 ]. In this study, the TLN was clipped before NACT in 473 patients.…”

Section: Targeted Axillary Dissection: More Questions Open Than Anmentioning

confidence: 99%

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Surgical Management of the Axilla in Clinically Node-Positive Breast Cancer Patients Converting to Clinical Node Negativity through Neoadjuvant Chemotherapy: Current Status, Knowledge Gaps, and Rationale for the EUBREAST-03 AXSANA Study

Banys‐Paluchowski

Gasparri

Boniface

et al. 2021

Cancers

106

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In the last two decades, surgical methods for axillary staging in breast cancer patients have become less extensive, and full axillary lymph node dissection (ALND) is confined to selected patients. In initially node-positive patients undergoing neoadjuvant chemotherapy, however, the optimal management remains unclear. Current guidelines vary widely, endorsing different strategies. We performed a literature review on axillary staging strategies and their place in international recommendations. This overview defines knowledge gaps associated with specific procedures, summarizes currently ongoing clinical trials that address these unsolved issues, and provides the rationale for further research. While some guidelines have already implemented surgical de-escalation, replacing ALND with, e.g., sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD) in cN+ patients converting to clinical node negativity, others recommend ALND. Numerous techniques are in use for tagging lymph node metastasis, but many questions regarding the marking technique, i.e., the optimal time for marker placement and the number of marked nodes, remain unanswered. The optimal number of SLNs to be excised also remains a matter of debate. Data on oncological safety and quality of life following different staging procedures are lacking. These results provide the rationale for the multinational prospective cohort study AXSANA initiated by EUBREAST, which started enrollment in June 2020 and aims at recruiting 3000 patients in 20 countries (NCT04373655; Funded by AGO-B, Claudia von Schilling Foundation for Breast Cancer Research, AWOgyn, EndoMag, Mammotome, and MeritMedical).

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Section: Targeted Axillary Dissection: More Questions Open Than Anmentioning

confidence: 99%

“…Relatively low detection rate (rate of successful target lymph node (TLN) removal 70% in the largest available dataset [ 28 ])…”

Section: Figurementioning

confidence: 99%

Surgical Management of the Axilla in Clinically Node-Positive Breast Cancer Patients Converting to Clinical Node Negativity through Neoadjuvant Chemotherapy: Current Status, Knowledge Gaps, and Rationale for the EUBREAST-03 AXSANA Study

Banys‐Paluchowski

Gasparri

Boniface

et al. 2021

Cancers

106

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“…Surgical methods, indications for TAD, the degree of axillary involvement at presentation, and the final success rate varied considerably. There was only 1 prospective, multicenter study [5].…”

Section: Resultsmentioning

confidence: 99%

False Negativity of Targeted Axillary Dissection in Breast Cancer

2021

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Introduction: Targeted axillary dissection (TAD) has been proposed as an alternative method for the staging of patients with node-positive breast cancer who undergo neoadjuvant chemotherapy. However, not much is known yet about the false-negative rate (FNR) of the method and the subsequent risk of underestimation of residual axillary disease. Methods: This study reviews published articles with calculations of false negativity of TAD and potential factors that may influence it. Results: The FNR of TAD is usually reported as being <10%, but this calculation is usually based on small study populations. Lower FNR is a common finding along with lower N status, while not enough data are available yet for greater axillary involvement. When a marked node is revealed to be a sentinel lymph node (SLN) at surgery after neoadjuvant chemotherapy (NAC), this seems to be another factor that contributes to reliable TAD. With regard to the methods used to mark the positive node before chemotherapy and retrieval at surgery, there is no clear advantage of one over the other. The availability of relevant resources, the costs, and local legislation must all be taken into account for the selection of the optimal strategy. Conclusion: Although still in its early days, the FNR of TAD can be low, at least in patients with relatively little axillary involvement and when the marked node is the SLN. All reported methods of lymph node marking seem reliable.

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“…However, the applicability of the very promising initial results by Caudle and colleagues in broad clinical practice has so far not been verified in a large scale, prospective manner. The so far largest prospective multicenter registry trial has lately reported a non-detection of the TLN in 22% of 473 patients/attempted resections (29). These colleagues used almost exclusively ultrasound detectable clips.…”

Section: Discussionmentioning

confidence: 99%

“…The contrast between the device and the initially hypo-echogenic, tumor infiltrated LN cortex is thereby diminished. This explains the difficulties of clip detection in ultrasound-navigated guidewire localization of clipmarked TLNs (29). Stereotactic guidewire placement can overcome this obstacle but requires the aid of a different department.…”

Section: Discussionmentioning

confidence: 99%

First Reported Use of Radiofrequency Identification (RFID) Technique for Targeted Excision of Suspicious Axillary Lymph Nodes in Early Stage Breast Cancer – Evaluation of Feasibility and Review of Current Recommendations

Malter

Eichler

Hanstein

et al. 2020

In Vivo

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Background/Aim: The purpose of this study was to evaluate, whether radio frequency identification (RFID) labeling of axillary lymph nodes (LNs) for the use of targeted resection is feasible in primary breast cancer patients with suspicious LNs. Patients and Methods: We analyzed 10 consecutive patients where RFID technique was used for intraoperative detection of suspicious LNs without preceding neoadjuvant chemotherapy (NACT). We compared the specifics of these procedures to 10 consecutive sentinel lymph node biopsies (SLNB) in the cN0 situation. Results: Intraoperative detection rate (DR) for the RFID-labeled target lymph node (TLN) was 100%. Perioperative complications were infrequent and comparable to SLNB. Average time for location of the RFID labeled TLN was quicker than for the SLN. In 71.4% the chip bearing TLN equaled a SLN. Conclusion: The use of the RFID technique for intraoperative localization of axillary LNs for targeted excision seems feasible. RFID technique for targeted axillary dissection (TAD) following NACT should be investigated in a prospective manner.

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Prospective, multicenter registry trial to evaluate the clinical feasibility of targeted axillary dissection (TAD) in patients (pts) with breast cancer (BC) and core biopsy proven axillary involvement (cN+)

Cited by 4 publications

References 0 publications

Surgical Management of the Axilla in Clinically Node-Positive Breast Cancer Patients Converting to Clinical Node Negativity through Neoadjuvant Chemotherapy: Current Status, Knowledge Gaps, and Rationale for the EUBREAST-03 AXSANA Study

Surgical Management of the Axilla in Clinically Node-Positive Breast Cancer Patients Converting to Clinical Node Negativity through Neoadjuvant Chemotherapy: Current Status, Knowledge Gaps, and Rationale for the EUBREAST-03 AXSANA Study

False Negativity of Targeted Axillary Dissection in Breast Cancer

First Reported Use of Radiofrequency Identification (RFID) Technique for Targeted Excision of Suspicious Axillary Lymph Nodes in Early Stage Breast Cancer – Evaluation of Feasibility and Review of Current Recommendations

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