Background
Over the last decade, neoadjuvant systemic therapy (NAST) has gained considerable popularity and its use has been extended to include breast cancer patients with operable node‐positive disease. It may no longer be necessary to commit patients who are node‐positive at presentation to axillary dissection if they become clinically node‐negative after completing NAST. Targeted axillary dissection (TAD) is a technique where the marked pre‐NAST positive node is excised along with the sentinel nodes and its response to chemotherapy is assessed and thus helps guide further treatment to the axilla.
Methods
The aim of this study was to determine the feasibility of marking positive axillary nodes with a clip and removing the clipped node after neoadjuvant treatment. We also assessed the concordance of the sentinel node with the clipped node.
Results
We prospectively evaluated 37 clinically and/or radiologically node‐positive patients who underwent NAST. The overall identification rate of the clipped node was 78%. The identification rate was 100% if the clipped node was localized preoperatively and was much lower at 68% in patients who did not have the clipped node localized. The clipped node was not retrieved as the sentinel node in 14% of patients.
Conclusion
We present the first Australian series on the feasibility of TAD. TAD is a feasible option in patients having NAST and with every new technique there is a learning curve. With the increasing experience globally and the refinement in marking and localization techniques, the accuracy of performing TAD will likely continue to improve.
Background
Australia has a large population of immigrant women from Arabic‐speaking countries. The aim of this study was to examine breast cancer tumour and surgical treatment features for women born in Arabic‐speaking countries and compare them to women born in Australia and other countries. Another aim was to consider how this information can inform clinical care for this multicultural population.
Methods
This is a retrospective audit of an institutional breast cancer database. Demographic, tumour and surgical treatment data were extracted for the Arab women and compared to Australian‐born women (comparison 1) and to women born in all other countries (comparison 2); chi‐squared analysis was performed to test for differences between groups.
Results
A total of 2086 cases with country of birth information were identified, of whom 139 women (6.7%) were born in Arabic‐speaking countries, 894 (42.8%) were born in Australia and 1053 (50.4%) were born in other countries (71 nations). Arab women tended to be younger (P = 0.013), more disadvantaged (P < 0.001), were more likely to have symptomatic rather than screen‐detected breast cancer (P < 0.001), had a higher rate of high grade (P = 0.021), HER2‐positive (P = 0.025) breast cancer compared to Australian‐born women or others. There was no difference in tumour (pT) stage, rate of breast conservation versus mastectomy, re‐excision and contralateral prophylactic mastectomy between groups. Australian‐born women were more likely to undergo breast reconstruction after mastectomy (P < 0.001); reconstruction rate was >29% in all groups.
Conclusion
Women born in Arabic‐speaking countries were younger, more disadvantaged and showed more aggressive tumour features. This has implications for supportive care during treatment and survivorship.
There was a higher rate of HDP in urban indigenous women compared to the national indigenous prevalence. The family history, or individual history of hypertension was the most significant risk factors and BMI was not identified as a risk factor for HDP in this population.
pCR in either the breast or axilla was most likely to be achieved in patients with HER2-positive or triple-negative breast cancers. In patients with luminal cancers, the goal of NAST is best considered to facilitate surgical options rather than obtaining a pCR.
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