The problem of axillary staging in breast cancer after neoadjuvant chemotherapy. Role of targeted axillary dissection and types of lymph node markers

Flores-Funes, Diego; Aguilar-Jiménez, José; Martínez‐Gálvez, María; Ibáñez-Ibáñez, María José; Carrasco-González, Luis; Gil-Izquierdo, José Ignacio; Aguayo-Albasini, José Luís

doi:10.1016/j.cireng.2020.10.012

Cited by 3 publications

(4 citation statements)

References 21 publications

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“…The evolving role of marked lymph node biopsy (MLNB) and targeted axillary dissection (TAD) enables the option of analyzing the effect of NAC. Hence, a statement whether tumor-infiltrated lymph nodes turned negative during therapy can be made (Flores-Funes et al 2020 ; Swarnkar et al 2021 ). Both mammary and axillary tumor manifestations can develop differently.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of different imaging modalities for axillary lymph node staging in breast cancer patients to provide a personalized and optimized therapy algorithm

Diessner

Anders

Herbert

et al. 2022

J Cancer Res Clin Oncol

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Purpose The reliable detection of tumor-infiltrated axillary lymph nodes for breast cancer [BC] patients plays a decisive role in further therapy. We aimed to find out whether cross-sectional imaging techniques could improve sensitivity for pretherapeutic axillary staging in nodal-positive BC patients compared to conventional imaging such as mammography and sonography. Methods Data for breast cancer patients with tumor-infiltrated axillary lymph nodes having received surgery between 2014 and 2020 were included in this study. All examinations (sonography, mammography, computed tomography [CT] and magnetic resonance imaging [MRI]) were interpreted by board-certified specialists in radiology. The sensitivity of different imaging modalities was calculated, and binary logistic regression analyses were performed to detect variables influencing the detection of positive lymph nodes. Results All included 382 breast cancer patients had received conventional imaging, while 52.61% of the patients had received cross-sectional imaging. The sensitivity of the combination of all imaging modalities was 68.89%. The combination of MRI and CT showed 63.83% and the combination of sonography and mammography showed 36.11% sensitivity. Conclusion We could demonstrate that cross-sectional imaging can improve the sensitivity of the detection of tumor-infiltrated axillary lymph nodes in breast cancer patients. Only the safe detection of these lymph nodes at the time of diagnosis enables the evaluation of the response to neoadjuvant therapy, thereby allowing access to prognosis and improving new post-neoadjuvant therapies.

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Section: Discussionmentioning

confidence: 99%

Evaluation of different imaging modalities for axillary lymph node staging in breast cancer patients to provide a personalized and optimized therapy algorithm

Diessner

Anders

Herbert

et al. 2022

J Cancer Res Clin Oncol

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“…The evolving role of Marked Lymph Node Biopsy (MLNB) and Targeted Axillary Dissection (TAD) enables the option of analyzing the effect of NAC. Hence, a statement whether tumor-in ltrated lymph nodes turned negative during therapy can be made [31,33].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Different Imaging Modalities for Axillary Lymph Node Staging in Breast Cancer Patients to Provide A Personalized and Optimized Therapy Algorithm

Diessner¹,

Anders²,

Herbert³

et al. 2021

Preprint

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Purpose The prognostic importance of lymph node infiltration in breast cancer patients before and after neoadjuvant therapy has increased significantly in recent years. For that reason, the reliable detection of tumor-infiltrated axillary lymph nodes at the time of diagnosis plays a decisive role in further therapy. We therefore focused on the sensitivity of different pretherapeutic imaging modalities (sonography, mammography, computed tomography [CT] and magnetic resonance imaging [MRI]) in nodal positive breast cancer patients and aimed to find out whether cross-sectional imaging techniques (MRI, CT) could improve sensitivity for pretherapeutic axillary staging compared to conventional imaging such as mammography and sonography. Methods Breast cancer patients with tumor-infiltrated axillary lymph nodes between 2014 and 2020 having a surgery for breast cancer were included in the study. Results All included 382 breast cancer patients had received conventional imaging, while 52.61% of the patients had received cross-sectional imaging. The sensitivity of the combination of all imaging modalities was 68.89%. The combination of MRI and CT showed 63.83% and the combination of sonography and mammography showed 36.11% sensitivity.Conclusion We could demonstrate that cross-sectional imaging can improve the sensitivity of the detection of tumor-infiltrated axillary lymph nodes in breast cancer patients. Considering the increasing importance of neoadjuvant and post-neoadjuvant therapeutic algorithms, the reliable detection of tumor-infiltrated lymph nodes gains increasing importance. Only the safe detection of tumor-infiltrated lymph nodes at the time of diagnosis enables the evaluation of the response to neoadjuvant therapy and thereby allows access to prognosis–improving post-neoadjuvant therapies.

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“…However, in addition to the frequent use of TAD, a relatively high rate of marked TLNs that could not be detected was also reported (9.28 %). False-negative rates in the literature are somewhat lower [15]. In their initial studies, Caudle et al and Boughey et al reported false-negative rates of 4.2 % and 6.8 %, respectively [10,16].…”

Section: Proportion Of Respondents [%]mentioning

confidence: 93%

“…Neben der häufigen Anwendung der TAD wurde jedoch auch eine relativ hohe Rate an markierten TLN angegeben, die nicht detektiert werden konnten (9,28 %). Die Falsch-Negativ-Raten in der Literatur liegen etwas niedriger [15]. Caudle dar, nicht nur unter gesundheitsökonomischen Gesichtspunkten [19,20].…”

Section: Zufriedenheit Mit Markierungsverfahrenunclassified

Can We Still Afford Innovative Surgical Procedures?

Lux

Untch

Kolberg

et al. 2023

Senologie - Zeitschrift für Mammadiagnostik und -therapie

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Introduction Hospitals are currently facing major financial challenges. Due to the high incidence of breast cancer and the complex range of associated services, surgical treatment of breast cancer is a particular case in point when it comes to the question of cost coverage for innovative versus established procedures by the service providers. The aim of this study is to shed light from a healthcare economics perspective on the current situation of hospitals in Germany with regard to their different structures and processes for breast-conserving therapy. Materials and methods An online questionnaire with 46 questions was developed and made available to hospitals that are members of the AGO [German Working Group for Gynecological Oncology] Breast Committee and AWOgyn [German Working Group for Cosmetic, Plastic and Reconstructive Surgery in Gynecology], as well as AG-certified breast centers. The questions cover various parameters for health economics analysis, including primary case numbers, structures, and questions about tumor and sentinel marking and surgical procedures. Results 142 hospitals or breast centers took part in the survey. 93% of the hospitals were certified. The average number of primary cases was 264.6 per year. In over 60% of the hospitals, the surgical procedure and surgery planning were influenced by capacity limitations of cooperation partners. “Targeted axillary dissection” was performed in 83.5% of the hospitals, and radioactive markers were most commonly used for sentinel lymph node marking. Over 60% of participating hospitals were highly satisfied with the marking method used. Conclusion This structure and process analysis now makes it possible to reflect on the costs involved for hospitals of different sizes, in different regions, and with different funding models, and to use this as a basis for the economic evaluation of new surgical procedures within an overall context. In general, it is possible to make savings through innovative procedures in the surgical treatment of breast cancer.

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The problem of axillary staging in breast cancer after neoadjuvant chemotherapy. Role of targeted axillary dissection and types of lymph node markers

Cited by 3 publications

References 21 publications

Evaluation of different imaging modalities for axillary lymph node staging in breast cancer patients to provide a personalized and optimized therapy algorithm

Evaluation of different imaging modalities for axillary lymph node staging in breast cancer patients to provide a personalized and optimized therapy algorithm

Evaluation of Different Imaging Modalities for Axillary Lymph Node Staging in Breast Cancer Patients to Provide A Personalized and Optimized Therapy Algorithm

Can We Still Afford Innovative Surgical Procedures?

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