Trends in axillary lymph node dissection for early-stage breast cancer in Europe: Impact of evidence on practice

Garcia–Etienne, Carlos A.; Mansel, Robert Edward; Tomatis, Mariano; Heil, Joerg; Biganzoli, Laura; Ferrari, Alberta; Marotti, Lorenza; Sgarella, Adele; Ponti, Antonio; Danaei, Mahmoud; Stickeler, Elmar; Sarlos, Dimitri; Prové, A.; Pagani, Olivia; Berclaz, Gilles; Taffurelli, Mario; Cretella, Elisabetta; Verhoeven, Didier; Denk, Andreas; Carly, Birgit; Ballardini, B.; Riet, Yvonne van; Reinisch, Mattea; Angiolini, Catia; Möbus, V.; Emons, Günter; Friedrichs, Kay; Schneeweiß, Andreas; Tinterri, Corrado; Egle, Daniel; Staelens, Gracienne; Kiechle, Marion; Harbeck, Nadia; Corsi, Fabio; Menghini, L; Lombardi, A.; Fortunato, Lucio; Bortul, Marina; Huober, Jens; Badbanchi, F; Tausch, Christoph

doi:10.1016/j.breast.2019.03.002

Cited by 31 publications

(21 citation statements)

References 26 publications

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“…One advantage of neoadjuvant therapy in the treatment of breast cancer is the potential to downstage the axilla and reduce the extent of morbid axillary surgery [1][2][3][4][5][6] . The nodal response to neoadjuvant therapy can impact both surgical planning and the appropriate duration and type of neoadjuvant therapy.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of breast MRI in evaluating nodal status after neoadjuvant therapy in invasive lobular carcinoma

et al. 2021

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Neoadjuvant therapy in breast cancer can downstage axillary lymph nodes and reduce extent of axillary surgery. As such, accurate determination of nodal status after neoadjuvant therapy and before surgery impacts surgical management. There are scarce data on the diagnostic accuracy of breast magnetic resonance imaging (MRI) for nodal evaluation after neoadjuvant therapy in patients with invasive lobular carcinoma (ILC), a diffusely growing tumor type. We retrospectively analyzed patients with stage 1–3 ILC who underwent pre-operative breast MRI after either neoadjuvant chemotherapy or endocrine therapy at our institution between 2006 and 2019. Two breast radiologists reviewed MRIs and evaluated axillary nodes for suspicious features. All patients underwent either sentinel node biopsy or axillary dissection. We evaluated sensitivity, specificity, negative and positive predictive values, and overall accuracy of the post-treatment breast MRI in predicting pathologic nodal status. Of 79 patients, 58.2% received neoadjuvant chemotherapy and 41.8% neoadjuvant endocrine therapy. The sensitivity and negative predictive value of MRI were significantly higher in the neoadjuvant endocrine therapy cohort than in the neoadjuvant chemotherapy cohort (66.7 vs. 37.9%, p = 0.012 and 70.6 vs. 40%, p = 0.007, respectively), while overall accuracy was similar. Upstaging from clinically node negative to pathologically node positive occurred in 28.0 and 41.7%, respectively. In clinically node positive patients, those with an abnormal post-treatment MRI had a significantly higher proportion of patients with ≥4 positive nodes on pathology compared to those with a normal MRI (61.1 versus 16.7%, p = 0.034). Overall, accuracy of breast MRI for predicting nodal status after neoadjuvant therapy in ILC was low in both chemotherapy and endocrine therapy cohorts. However, post-treatment breast MRI may help identify patients with a high burden of nodal disease (≥4 positive nodes), which could impact pre-operative systemic therapy decisions. Further studies are needed to assess other imaging modalities to evaluate for nodal disease following neoadjuvant therapy and to improve clinical staging in patients with ILC.

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Section: Introductionmentioning

confidence: 99%

Accuracy of breast MRI in evaluating nodal status after neoadjuvant therapy in invasive lobular carcinoma

et al. 2021

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“…Clinical adoption of clinical trial findings that are counter to previously held standards has been demonstrated to be a slow process 7–9 . Given the publication of these practice‐changing clinical trials, we sought to assess surgeons’ awareness of the MSLT‐II findings, in particular, and its impact on CLND recommendations in their practices.…”

Section: Introductionmentioning

confidence: 99%

“…Clinical adoption of clinical trial findings that are counter to previously held standards has been demonstrated to be a slow process. [7][8][9] Given the publication of these practice-changing clinical trials, we sought to assess surgeons' awareness of the MSLT-II findings, in particular, and its impact on CLND recommendations in their practices. Seven patient scenarios were presented (see Table S1), and surgeons were asked about their likelihood of recommending a CLND (axillary and superficial inguinal).…”

Section: Introductionmentioning

confidence: 99%

Surgeon decision‐making for management of positive sentinel lymph nodes in the post‐Multicenter Selective Lymphadenectomy Trial II era: A survey study

Hui

Burke

Broman

et al. 2020

Journal of Surgical Oncology

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Background and ObjectivesCompletion lymph node dissection (CLND) did not improve melanoma‐specific survival for patients with sentinel lymph node (SLN)‐positive melanoma in the second Multicenter Selective Lymphadenectomy Trial (MSLT‐II). We assessed surgeons’ awareness of MSLT‐II and its impact on CLND recommendations.MethodsAn anonymous online cross‐sectional survey of the Society of Surgical Oncology membership evaluated surgeon thresholds in offering CLND using patient scenarios and clinicopathologic characteristics ranking.ResultsOf the 2881 e‐mails delivered, 146 surgeons (5.1%) completed all seven scenarios. Most (129 of 131, 98%) were aware of MSLT‐II and 125 (95%) found it practice‐changing. Specifically, 52% (65 of 125) always, 40% usually, 6% rarely, and 3% never offered CLND before MSLT‐II. Meanwhile, 4% always, 9% usually, 78% rarely, and 8% never offer CLND now, after MSLT‐II (p < .0001). The most important clinicopathologic factors in determining CLND recommendations were extracapsular extension, number of positive SLN, and SLN tumor deposit size, while primary tumor mitotic index and nodal basin location were the least important. Surgical oncology fellowship training, melanoma patient volume, and academic center practice also influenced CLND recommendations.ConclusionsMost surgeon respondents are aware of MSLT‐II, but its application in practice varies according to several clinicopathologic and surgeon factors.

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“…), a statistically significant decrease in rates of ALND that started after publication of the trial from 2010 (89%) to 2011 (73%), reaching 46% in 2016 (p < 0.001). After multivariable analysis, factors associated with higher probability of ALND were earlier year of surgery, younger age, increasing tumor size and grade, and being operated in Italy (p < 0.001) [27].…”

Section: Change In Practicementioning

confidence: 99%

Management of the axilla in patients with breast cancer and positive sentinel lymph node biopsy: An evidence-based update in a European breast center

Garcia–Etienne

Ferrari

Valle

et al. 2020

European Journal of Surgical Oncology

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Trends in axillary lymph node dissection for early-stage breast cancer in Europe: Impact of evidence on practice

Cited by 31 publications

References 26 publications

Accuracy of breast MRI in evaluating nodal status after neoadjuvant therapy in invasive lobular carcinoma

Accuracy of breast MRI in evaluating nodal status after neoadjuvant therapy in invasive lobular carcinoma

Surgeon decision‐making for management of positive sentinel lymph nodes in the post‐Multicenter Selective Lymphadenectomy Trial II era: A survey study

Management of the axilla in patients with breast cancer and positive sentinel lymph node biopsy: An evidence-based update in a European breast center

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