Breast conservation and axillary management after primary systemic therapy in patients with early-stage breast cancer: the Lucerne toolbox

Dubsky, Peter; Pinker, Katja; Cardoso, Fátima; Montagna, Giacomo; Ritter, Mathilde; Denkert, Carsten; Rubio, Isabel T.; Azambuja, Evandro de; Curigliano, Giuseppe; Gentilini, Oreste Davide; Gnant, Michael; Günthert, Andreas R.; Hauser, Nik; Heil, Joerg; Knauer, Michael; Knotek-Roggenbauerc, Mona; Knox, Susan; Kovács, Tibor; Kuerer, Henry Mark; Loibl, Sibylle; Mannhart, Meinrad; Meattini, Icro; Penault‐Llorca, Frédérique; Radosevic‐Robin, Nina; Sager, Patrizia; Španić, Tanja; Steyerová, Petra; Tausch, Christoph; Peeters, M; Weber, Walter; Cardoso, Maria João; Poortmans, Philip

doi:10.1016/s1470-2045(20)30580-5

Cited by 56 publications

(50 citation statements)

References 68 publications

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“…At the same time, it may answer whether, in cN positive patients, the metastatic node is a sentinel or if, at presentation, there are non-sentinel metastases, which is suggestive of a higher axillary nodal burden. In this manner, it becomes safer to identify more appropriate potential candidates for axillary conservation post-NAT as recently suggested in the Lucerne toolbox [ 12 ]. Moreover, MRI-LG before and after NAT allows for an estimate of the number of SLNs in the axilla.…”

Section: Discussionmentioning

confidence: 99%

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Magnetic-Guided Axillary UltraSound (MagUS) Sentinel Lymph Node Biopsy and Mapping in Patients with Early Breast Cancer. A Phase 2, Single-Arm Prospective Clinical Trial

Jazrawi

Pantiora

Abdsaleh

et al. 2021

Cancers

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Lymph Node Dissection (SLND) is standard of care for diagnosing sentinel lymph node (SLN) status in patients with early breast cancer. Study aim was to determine whether the combination of Superparamagnetic iron oxide nanoparticles (SPIO) MRI-lymphography (MRI-LG) and a Magnetic-guided Axillary UltraSound (MagUS) with biopsy can allow for minimally invasive, axillary evaluation to de-escalate surgery. Patients were injected with 2 mL of SPIO and underwent MRI-LG for SN mapping. Thereafter MagUS and core needle biopsy (CNB) were performed. Patients planned for neoadjuvant treatment, the SLN was clipped and SLND was performed after neoadjuvant with the addition of isotope. During surgery, SLNs were controlled for signs of previous biopsy or clip. The primary endpoint was MagUS SLN detection rate, defined as successful SLN detection of at least one SLN of those retrieved in SLND. In 79 patients, 48 underwent upfront surgery, 12 received neoadjuvant and 19 had recurrent cancer. MagUS traced the SLN in all upfront and neoadjuvant cases, detecting all patients with macrometastases (n = 10). MagUS missed only one micrometastasis, outperforming baseline axillary ultrasound AUS (AUC: 0.950 vs. 0.508, p < 0.001) and showing no discordance to SLND (p = 1.000). MagUS provides the niche for minimally invasive axillary mapping that can reduce diagnostic surgery.

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Section: Discussionmentioning

confidence: 99%

“…In patients scheduled for NAT, identifying those with a true negative axilla, but also those with low-volume disease, as de-escalation of axillary surgery after conversion from cN1 to cN0, could be safely attempted. [ 7 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Magnetic-Guided Axillary UltraSound (MagUS) Sentinel Lymph Node Biopsy and Mapping in Patients with Early Breast Cancer. A Phase 2, Single-Arm Prospective Clinical Trial

Jazrawi

Pantiora

Abdsaleh

et al. 2021

Cancers

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“…While the use of NAT for locally advanced stages is the standard of care, it is increasingly being considered for early BC [ 83 ], with its impact on long-term outcomes being controversial. The main aims of NAT are to reduce the extent of surgery in the breast and/or axilla, to attain the good prognostic impact of pCR and to guide the adjuvant therapy according to response.…”

Section: Discussionmentioning

confidence: 99%

“…The main aims of NAT are to reduce the extent of surgery in the breast and/or axilla, to attain the good prognostic impact of pCR and to guide the adjuvant therapy according to response. Besides allowing for more breast tissue conservative surgery, NAT may offer to omit the formal axillary dissection in patients with limited axillary tumour burden (cN1) who showed a clinical complete response from applying strict technical standards [ 83 ]. Additionally, data showed that achieving a pCR is associated with better DFS and OS in TNBC [ 84 , 85 , 86 ].…”

Section: Discussionmentioning

confidence: 99%

“…In real-life clinical practice, it may be argued that there should not be a limit to the number of cycles but rather to be guided by the maximum response of the tumour. Imaging is advised midway through the NAT to assess response and to exclude progressive disease [ 83 ]. Seventy-six percent of the panellists voted for 6–8 cycles, which is still aligned with most of the reported study designs, whereas 24% of the voters preferred to choose a more ’dynamic’ approach where the number of cycles would be guided by the toxicity and maximum tumour response achieved before referral to surgery.…”

Section: Discussionmentioning

confidence: 99%

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Breast-Gynaecological & Immuno-Oncology International Cancer Conference (BGICC) Consensus and Recommendations for the Management of Triple-Negative Breast Cancer

Elghazaly

Rugo

Azim

et al. 2021

Cancers

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Background: The management of patients with triple-negative breast cancer (TNBC) is challenging with several controversies and unmet needs. During the 12th Breast-Gynaecological & Immuno-oncology International Cancer Conference (BGICC) Egypt, 2020, a panel of 35 breast cancer experts from 13 countries voted on consensus guidelines for the clinical management of TNBC. The consensus was subsequently updated based on the most recent data evolved lately. Methods: A consensus conference approach adapted from the American Society of Clinical Oncology (ASCO) was utilized. The panellists voted anonymously on each question, and a consensus was achieved when ≥75% of voters selected an answer. The final consensus was later circulated to the panellists for critical revision of important intellectual content. Results and conclusion: These recommendations represent the available clinical evidence and expert opinion when evidence is scarce. The percentage of the consensus votes, levels of evidence and grades of recommendation are presented for each statement. The consensus covered all the aspects of TNBC management starting from defining TNBC to the management of metastatic disease and highlighted the rapidly evolving landscape in this field. Consensus was reached in 70% of the statements (35/50). In addition, areas of warranted research were identified to guide future prospective clinical trials.

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Diagnostic accuracy of de‐escalated surgical procedure in axilla for node‐positive breast cancer patients treated with neoadjuvant systemic therapy: A systematic review and meta‐analysis

Song

Liang

et al. 2022

Cancer Medicine

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Breast conservation and axillary management after primary systemic therapy in patients with early-stage breast cancer: the Lucerne toolbox

Cited by 56 publications

References 68 publications

Magnetic-Guided Axillary UltraSound (MagUS) Sentinel Lymph Node Biopsy and Mapping in Patients with Early Breast Cancer. A Phase 2, Single-Arm Prospective Clinical Trial

Magnetic-Guided Axillary UltraSound (MagUS) Sentinel Lymph Node Biopsy and Mapping in Patients with Early Breast Cancer. A Phase 2, Single-Arm Prospective Clinical Trial

Breast-Gynaecological & Immuno-Oncology International Cancer Conference (BGICC) Consensus and Recommendations for the Management of Triple-Negative Breast Cancer

Diagnostic accuracy of de‐escalated surgical procedure in axilla for node‐positive breast cancer patients treated with neoadjuvant systemic therapy: A systematic review and meta‐analysis

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