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, Yuxin; Xu, Zheng Feng; Liang, Mingxing; Liu, Zhen; Hou, Jianglong; Chen, Xiu; Xu, Di; Fei, Yin-Jiao; Tang, Jinhai

doi:10.1002/cam4.4769

Cited by 14 publications

(9 citation statements)

References 71 publications

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“…Similarly, more patients undergoing RBS showed lymph node positivity (ypN+) (23 out of 32-71.8%), a greater number of positive lymph nodes (6.1 vs. 2-p = 0.001), and a worse ratio between positive lymph nodes and lymph nodes removed (0.41 vs. 0.15p < 0.0001). Thus, in our case series, radical breast surgery is confirmed in patients unresponsive or poorly responsive to NA in both breast and axillary [39,40].…”

Section: Discussionsupporting

confidence: 59%

Conservative Surgery in cT4 Breast Cancer: Single-Center Experience in the Neoadjuvant Setting

Franco

Leone

Fabi

et al. 2023

Cancers

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Background: The diffusion of screening programs has resulted in a decrease of cT4 breast cancer diagnosis. The standard care for cT4 was neoadjuvant chemotherapy (NA), surgery, and locoregional or adjuvant systemic therapies. NA allows two outcomes: 1. improve survival rates, and 2. de-escalation of surgery. This de-escalation has allowed the introduction of conservative breast surgery (CBS). We evaluate the possibility of submitting cT4 patients to CBS instead of radical breast surgery (RBS) by assessing the risk of locoregional disease-free survival, (LR-DFS) distant disease-free survival (DDFS), and overall survival (OS). Methods: This monocentric, retrospective study evaluated cT4 patients submitted to NA and surgery between January 2014 and July 2021. The study population included patients undergoing CBS or RBS without immediate reconstruction. Survival curves were obtained using the Kaplan-Meyer method and compared using a Log Rank test. Results: At a follow-up of 43.7 months, LR-DFS was 70% and 75.9%, respectively, in CBS and RBS (p = 0.420). DDFS was 67.8% and 29.7%, respectively, (p = 0.122). OS was 69.8% and 59.8%, respectively, (p = 0.311). Conclusions: In patients with major or complete response to NA, CBS can be considered a safe alternative to RBS in the treatment of cT4a-d stage. In patients with poor response to NA, RBS remained the best surgical choice.

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Section: Discussionsupporting

confidence: 59%

Conservative Surgery in cT4 Breast Cancer: Single-Center Experience in the Neoadjuvant Setting

Franco

Leone

Fabi

et al. 2023

Cancers

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“…16 more metastatic LNs were found in CLN than in SLN (66.3% compared to 47%, respectively) ( Table 3 ). In a meta-analysis, the compliance rate of CLNs and SLNs was found to be between 35.7% and 87.5%, and groups with higher compliance rates were found to had superior IR and lower FNR ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

Feasibility and accuracy of targeted axillary dissection in breast cancer patients; single center experience

Kaya,

Burcu,

Çetinoğlu

et al. 2024

Front. Surg.

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IntroductionAxillary complete response (pCR) was observed in approximately half of breast cancer patients who received neoadjuvant chemotherapy (NAC) due to axillary positivity. Preventing axillary morbidity due to unnecessary axillary lymph node dissection (ALND) is extremely important for patients' quality of life. Targeted axillary dissection (TAD) is a technique developed to improve axillary staging and reduce the false negative rate in sentinel lymph node biopsy.MethodsPatients with cN1-N2 (clinically node) breast cancer whose axillary lymph node metastasis was confirmed by biopsy and who received NAC marked with a clip were included in the study. Patients who achieved clinical response after systemic treatment underwent sentinel lymph node biopsy (SLNB) with additional methods such as methylene blue guided dissection, skin marking for clip on lymph node (CLN) localization, and wire guided with imaging excision of the CLN. TAD and ALND pathology results were evaluated and analyzed with patient and tumor characteristics.Results83 patients who met the eligibility criterias for the study were examined retrospectively. 21 of the patients underwent TAD alone, and 62 patients underwent ALND after TAD. CLN rate was 98.8% in patients underwent only TAD and this rate was increased to 100% in patients underwent ALND after TAD. FNR in SLN, CLN, and TAD were 28.6%, 10.7%, and 3.6%, respectively.ConclusionTAD is a feasible and reliable surgical approach to detect axillary residual disease with a high success rate.

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“…A recent meta-analysis compared the DR for different TLN marking techniques, such as iodine seeds (95.6%), metallic clips (91.7%), and carbon particles (97.1%). The identification of metallic clips, the currently most popular procedure, is associated with highly variable results (DR 70–98%) [ 34 ]. In the German SenTa study, a prospective trial using metallic clips for TLN labeling, the DR for the TLN was only 77.8% in a multicenter setting [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…This procedure has shown excellent results for the localization of non-palpable breast lesions [ 35 ]. Since limited data are available on their use in TLNB, they were not included in the above-mentioned meta-analysis regarding different techniques for TLN marking [ 34 ]. The restricted approval of MS to remain in the body for up to 30 days was removed in 2020 [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Applicability of magnetic seeds for target lymph node biopsy after neoadjuvant chemotherapy in initially node-positive breast cancer patients: data from the AXSANA study

Hartmann,

Banys-Paluchowski,

Stickeler

et al. 2023

Breast Cancer Res Treat

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Purpose Currently, various techniques are available to mark and selectively remove initially suspicious axillary lymph nodes (target lymph nodes, TLNs) in breast cancer patients receiving neoadjuvant chemotherapy (NACT). To date, limited data are available on whether the use of magnetic seeds (MS) is suitable for localizing TLNs. This study aimed to investigate the feasibility of MS in patients undergoing target lymph node biopsy (TLNB) or targeted axillary dissection (TAD) after NACT. Methods Prospective data from the ongoing multicentric AXSANA study were extracted from selected patients in whom the TLN had been marked with an MS before NACT and who were enrolled from June 2020 to June 2023. The endpoints of the analysis were the detection rate, the rate of lost markers, and the potential impairment on magnetic resonance imaging (MRI) assessment. Results In 187 patients from 27 study sites in seven countries, MS were placed into the TLN before NACT. In 151 of these, post-NACT surgery had been completed at the time of analysis. In 146 patients (96.0%), a TLN could successfully be detected. In three patients, the seed was removed but no lymphoid tissue was detected on histopathology. The rate of lost markers was 1.2% (2 out of 164 MS). In 15 out of 151 patients (9.9%), MRI assessment was reported to be compromised by MS placement. Conclusion MS show excellent applicability for TLNB/TAD when inserted before NACT with a high DR and a low rate of lost markers. Axillary MS can impair MRI assessment of the breast. Trial registration number NCT04373655 (date of registration May 4, 2020).

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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

Abstract: Yu-xin Song, Zheng Xu and Ming-xing Liang are contributed equally to this work.

Cited by 14 publications

References 71 publications

Conservative Surgery in cT4 Breast Cancer: Single-Center Experience in the Neoadjuvant Setting

Conservative Surgery in cT4 Breast Cancer: Single-Center Experience in the Neoadjuvant Setting

Feasibility and accuracy of targeted axillary dissection in breast cancer patients; single center experience

Applicability of magnetic seeds for target lymph node biopsy after neoadjuvant chemotherapy in initially node-positive breast cancer patients: data from the AXSANA study

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