De-escalation of Axillary Surgery in the Neoadjuvant Chemotherapy (NACT) Setting for Breast Cancer: Is it Oncologically Safe?

Wazir, Umar; Mokbel, Kefah

doi:10.21873/anticanres.14542

Cited by 8 publications

(12 citation statements)

References 21 publications

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“…This is due to the high FN rate observed (8). The FNR of 48% for PET/CT (sensitivity=52%) compares with 10% for SNB (33). Therefore, we could not rely on a negative PET scan to avoid axillary surgery.…”

Section: Discussionmentioning

confidence: 99%

Sensitivity, Specificity and the Diagnostic Accuracy of PET/CT for Axillary Staging in Patients With Stage I-III Cancer: A Systematic Review of The Literature

Kasem

Wazir

Mokbel

2021

In Vivo

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Section: Discussionmentioning

confidence: 99%

Sensitivity, Specificity and the Diagnostic Accuracy of PET/CT for Axillary Staging in Patients With Stage I-III Cancer: A Systematic Review of The Literature

Kasem

Wazir

Mokbel

2021

In Vivo

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“…Tumor size or the presence of multifocality or multicentricity were not considered among the selection criteria as they are managed independently in breast cancer [7][8][9][10].…”

Section: Study Population and Management Protocolmentioning

confidence: 99%

“…Subsequently, the protocol was adapted by adding a second axillary mapping system, MLNB. Therefore, since March 2019, TAD with SNB and MLNB with axillary wire on the clipped node was performed, ensuring the excision and the histological analysis of the initially affected lymph node, which not always coincide with the sentinel node [7][8][9]. In all cases, a complete axil- lary lymphadenectomy was performed, as it was established by the protocol in force in our center.…”

Section: Lymphatic Mapping Techniquementioning

confidence: 99%

“…Sentinel node biopsy (SNB) is established as the axillary staging method in patients with initial negative node involvement, even in cases treated with NAST. In this context, the detection rate (DR) is greater than 96%, the false negative rates (FNR) are around 5% and the axillary recurrence rate is less than 1.2% [7].…”

Section: Introductionmentioning

confidence: 98%

“…Lymph node preservation requires the establishment of reliable and safe protocols for the selection of patients for surgical de-escalation in order not to worsen the prognosis of their disease. The clinical or radiological examination does not have sufficient sensitivity or specificity to rule out residual disease [5,7].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of axillary response to neoadjuvant systemic therapy with sentinel node biopsy and axillary wire in node-positive breast cancer

Sierra¹,

Cuesta²,

Salguero³

et al. 2021

European Journal of Gynaecological Oncology

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To determine the safety and reliability of directed axillary dissection with sentinel node biopsy (SNB) and marked lymph node biopsy (MLNB) with axillary wire on the clipped node, for the selection of patients who are candidates for conservative axillary treatment after the diagnosis of node-positive breast cancer who show a complete axillary response after neoadjuvant treatment. Materials: A prospective cohort study was carried out at Miguel Servet University Hospital in Zaragoza. 66 patients with a diagnosis of breast cancer and initial histological axillary involvement were finally included, in which the biopsied node was marked with a titanium clip prior to the start of neoadjuvant treatment. All patients underwent axillary sampling using SNB or Targeted axillary dissection (TAD) by SNB and MLNB with axillary wire on the clipped node before performing lymphadenectomy. Results: The detection rate (DR) of the SNB was 100% with a mean of 1.8 sentinel nodes studied. In 14 patients, axillary sampling was performed only with SNB, with a false negative rate (FNR) of 14.29%, which decreased when 2 or more nodes were removed or when clipped node was removed. In 51 cases, double marking with SNB and MLNB with axillary wire was performed, which ensures excision of the clipped node in 96.1% of cases with a FNR of 1.96%. The negative predictive value (NPV) of the sample when the clipped node is studied was 96.8%. Conclusions: Targeted axillary dissection with SNB and MLNB with axillary wire on the clipped node is a safe and effective strategy for the selection of patients who are candidates for conservative axillary treatment after neoadjuvant treatment, avoiding unnecessary lymphadenectomies.

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Safety of Targeted Axillary Dissection After Neoadjuvant Therapy in Patients With Node-Positive Breast Cancer

et al. 2023

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ImportanceThe increasing use of neoadjuvant systemic therapy (NST) has led to substantial pathological complete response rates in patients with initially node-positive, early breast cancer, thereby questioning the need for axillary lymph node dissection (ALND). Targeted axillary dissection (TAD) is feasible for axillary staging; however, data on oncological safety are scarce.ObjectiveTo assess 3-year clinical outcomes in patients with node-positive breast cancer who underwent TAD alone or TAD with ALND.Design, Setting, and ParticipantsThe SenTa study is a prospective registry study and was conducted between January 2017 and October 2018. The registry includes 50 study centers in Germany. Patients with clinically node-positive breast cancer underwent clipping of the most suspicious lymph node (LN) before NST. After NST, the marked LNs and sentinel LNs were excised (TAD) followed by ALND according to the clinician’s choice. Patients who did not undergo TAD were excluded. Data analysis was performed in April 2022 after 43 months of follow-up.ExposureTAD alone vs TAD with ALND.Main Outcomes and MeasuresThree-year clinical outcomes were evaluated.ResultsOf 199 female patients, the median (IQR) age was 52 (45-60) years. A total of 182 patients (91.5%) had 1 to 3 suspicious LNs; 119 received TAD alone and 80 received TAD with ALND. Unadjusted invasive disease-free survival was 82.4% (95% CI, 71.5-89.4) in the TAD with ALND group and 91.2% (95% CI, 84.2-95.1) in the TAD alone group (P = .04); axillary recurrence rates were 1.4% (95% CI, 0-54.8) and 1.8% (95% CI, 0-36.4), respectively (P = .56). Adjusted multivariate Cox regression indicated that TAD alone was not associated with an increased risk of recurrence (hazard ratio [HR], 0.83; 95% CI, 0.34-2.05; P = .69) or death (HR, 1.07; 95% CI, 0.31-3.70; P = .91). Similar results were obtained for 152 patients with clinically node-negative breast cancer after NST (invasive disease-free survival: HR, 1.26; 95% CI, 0.27-5.87; P = .77; overall survival: HR, 0.81; 95% CI, 0.15-3.83; P = .74).Conclusions and RelevanceThese results suggest that TAD alone in patients with mostly good clinical response to NST and at least 3 TAD LNs may confer survival outcomes and recurrence rates similar to TAD with ALND.

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De-escalation of Axillary Surgery in the Neoadjuvant Chemotherapy (NACT) Setting for Breast Cancer: Is it Oncologically Safe?

Cited by 8 publications

References 21 publications

Sensitivity, Specificity and the Diagnostic Accuracy of PET/CT for Axillary Staging in Patients With Stage I-III Cancer: A Systematic Review of The Literature

Sensitivity, Specificity and the Diagnostic Accuracy of PET/CT for Axillary Staging in Patients With Stage I-III Cancer: A Systematic Review of The Literature

Evaluation of axillary response to neoadjuvant systemic therapy with sentinel node biopsy and axillary wire in node-positive breast cancer

Safety of Targeted Axillary Dissection After Neoadjuvant Therapy in Patients With Node-Positive Breast Cancer

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