Validation of the targeted axillary dissection technique in the axillary staging of breast cancer after neoadjuvant therapy: Preliminary results

Flores-Funes, Diego; Aguilar-Jiménez, José; Martínez‐Gálvez, María; Ibáñez-Ibáñez, María José; Carrasco-González, Luis; Gil-Izquierdo, José Ignacio; Chaves-Benito, María Asunción; Peña, Francisco Ayala de la; Nieto-Olivares, Andrés; Aguayo-Albasini, José Luís

doi:10.1016/j.suronc.2019.05.019

Cited by 32 publications

(21 citation statements)

References 24 publications

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“…The use of SNB following NAC for patients with cN1 breast cancer is controversial because clinical trials have shown that the FNR exceeds the prespecified threshold of 10% [3][4][5] . To decrease FNR, dual-agent mapping, examining more than two sentinel lymph nodes (SLNs) [3][4][5]7 , targeted axillary dissection (TAD) placement including MARI, and tattooing procedure have been suggested [8][9][10][11][12] . When limited to patients with more than two SLNs removed, the FNR was 7.3% and 9.1% in the SENTINA and ACOSOG Z1071 trails, respectively 3,4 .…”

Section: Discussionmentioning

confidence: 99%

Assessment of axillary node status by ultrasound after neoadjuvant chemotherapy in patients with clinically node-positive breast cancer according to breast cancer subtype

Maeshima

Sakai

Ogiya

et al. 2021

Sci Rep

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The use of sentinel node biopsy (SNB) following neoadjuvant chemotherapy (NAC) for patients with cN1 breast cancer is controversial. Improvements of negative predictive value (NPV) by axillary ultrasound (AUS), which corresponds to the accurate prediction rate of node-negative status after NAC, would lead to decreased FNR of SNB following NAC. In this study, we retrospectively investigated the accurate prediction rate of NPV by AUS after NAC in patients with cytologically node-positive breast cancer treated between January 2012 and December 2016. Of 279 eligible patients, the NPV was 49.2% in all patients, but varied significantly by tumor subtype (p < 0.001) and tumor response determined by magnetic resonance imaging (MRI) (p = 0.0003). Of the 23 patients with clinically node negative (ycN0) by AUS and clinical complete response in primary lesion by MRI, the NPV was 100% in patients with HR±/HER2+ or HR−/HER2− breast cancer. In conclusion, regarding FNR reduction post-NAC, it will be of clinical value to take tumor subtype and primary tumor response using MRI into account to identify patients for SNB after NAC.

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Section: Discussionmentioning

confidence: 99%

Assessment of axillary node status by ultrasound after neoadjuvant chemotherapy in patients with clinically node-positive breast cancer according to breast cancer subtype

Maeshima

Sakai

Ogiya

et al. 2021

Sci Rep

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“…Using currently available data 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , the AGO has evaluated the following procedures to reduce false negative rates during the surgical staging of cases who are pN+ CNB before NACT and ycN0 after NACT with AGO + ( Fig. 1 ):…”

Section: Surgical Management Of the Axilla After Neoadjuvant Chemotherapymentioning

confidence: 99%

“…Basierend auf der derzeitigen Datenlage 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 bewertet die AGO folgende Verfahren zur Verringerung der Falsch-negativ-Rate des operativen Stagings bei pN+ CNB vor NACT und ycN0 nach NACT mit AGO + ( Abb. 1 ):…”

Section: Empfehlung Der Ago Kommission Mamma Zur Verringerung Der Falsch-negativ-rate Des Operativen Stagings Bei Stanzbioptisch Gesicherunclassified

AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy: 2021 Update

Friedrich

Kühn

Janni

et al. 2021

Geburtshilfe Frauenheilkd

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For many decades, the standard procedure to treat breast cancer included complete dissection of the axillary lymph nodes. The aim was to determine histological node status, which was then used as the basis for adjuvant therapy, and to ensure locoregional tumour control. In addition to the debate on how to optimise the therapeutic strategies of systemic treatment and radiotherapy, the current discussion focuses on improving surgical procedures to treat breast cancer. As neoadjuvant chemotherapy is becoming increasingly important, the surgical procedures used to treat breast cancer, whether they are breast surgery or axillary dissection, are changing. Based on the currently available data, carrying out SLNE prior to neoadjuvant chemotherapy is not recommended. In contrast, surgical axillary management after neoadjuvant chemotherapy is considered the procedure of choice for axillary staging and can range from SLNE to TAD and ALND. To reduce the rate of false negatives during surgical staging of the axilla in pN+CNB stage before NACT and ycN0 after NACT, targeted axillary dissection (TAD), the removal of > 2 SLNs (SLNE, no untargeted axillary sampling), immunohistochemistry to detect isolated tumour cells and micro-metastases, and marking positive lymph nodes before NACT should be the standard approach. This most recent update on surgical axillary management describes the significance of isolated tumour cells and micro-metastasis after neoadjuvant chemotherapy and the clinical consequences of low volume residual disease diagnosed using SLNE and TAD and provides an overview of this yearʼs AGO recommendations for surgical management of the axilla during primary surgery and in relation to neoadjuvant chemotherapy.

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“…It is worth mentioning that some researchers do not specifically report the FNR according to N status (N1, N2, etc. ), but rather grant an overall FNR of 0% for all N statuses [10, 15, 17, 19]. This indirectly suggests that, for patients with axillary disease >N1, the FNR of TAD is still 0%.…”

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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Validation of the targeted axillary dissection technique in the axillary staging of breast cancer after neoadjuvant therapy: Preliminary results

Cited by 32 publications

References 24 publications

Assessment of axillary node status by ultrasound after neoadjuvant chemotherapy in patients with clinically node-positive breast cancer according to breast cancer subtype

Assessment of axillary node status by ultrasound after neoadjuvant chemotherapy in patients with clinically node-positive breast cancer according to breast cancer subtype

AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy: 2021 Update

False Negativity of Targeted Axillary Dissection in Breast Cancer

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