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Man V, Duan J, Luk WP, Fung LH, Kwong A. Different strategies in de-escalation of axillary surgery in node-positive breast cancer following neoadjuvant treatment: a systematic review and meta-analysis of long-term outcomes. Breast Cancer 2025:10.1007/s12282-025-01692-9. [PMID: 40186790 DOI: 10.1007/s12282-025-01692-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Accepted: 03/13/2025] [Indexed: 04/07/2025]
Abstract
PURPOSE Different surgical options existed in the management of axilla among breast cancer patients who were initially node-positive and were converted node-negative after neoadjuvant systemic treatment (NST). De-escalation of axillary surgery was feasible, but previous studies focused on the false-negative rate (FNR) of respective procedures. The aim of this study is to evaluate the oncological outcomes of sentinel lymph-node biopsy (SLNB), MARI procedure, and targeted axillary dissection (TAD). PATIENTS AND METHODS PubMed, Embase, and the Cochrane library literature databases were searched systematically. Studies were eligible if they addressed the axillary recurrence rate of patients with nodal pathological complete response (pCR) and omission of axillary lymph-node dissection (ALND) after NST. Pooled analysis was performed using inverse variance methods for logit transformed proportions. RESULTS Eleven retrospective studies and three prospective studies involving 4268 patients with node-positive breast cancers were included. A total of 1650 patients achieved nodal pCR and avoided ALND, 1382 patients with SLNB only and 268 patients with MARI/TAD. The pooled estimate of axillary recurrence was 2.1% (95%CI 1.4-3.2%) for patients with negative SLNB and 1.5% (95% CI 0.5-4.1%) for patients with negative MARI/TAD. There was no significant benefit of ALND over SLNB in patients with nodal pCR after NST. Pooled estimates of 5-year DFS, DDFS, and OS of SLNB alone were 0.87 (95% CI 0.83-0.90], 0.90 (95% CI 0.88-0.92), and 0.92 (95% CI 0.88-0.94), respectively. CONCLUSION Breast cancer patients who are converted node-negative after NST have extremely low nodal recurrence rate, irrespective of the choice of axillary surgery. Omission of ALND is oncologically safe in patients who have nodal pCR after NST.
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Affiliation(s)
- Vivian Man
- Division of Breast Surgery, Department of Surgery, The University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong SAR
| | - Jiaxu Duan
- The University of Hong Kong Li Ka Shing Faculty of Medicine, The University of Hong Kong Li Ka Shing, Hong Kong, Hong Kong SAR
| | - Wing-Pan Luk
- Medical Physics and Research Department, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong SAR
| | - Ling-Hiu Fung
- Medical Physics and Research Department, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong SAR
| | - Ava Kwong
- Daniel CK Yu Professor in Breast Cancer Research, Chief of Breast Surgery Division, Department of Surgery, The University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong SAR.
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Kouzmina E, Castelo M, Look Hong NJ, Hallet J, Coburn N, Wright FC, Nguyen L, Gandhi S, Jerzak KJ, Eisen A, Roberts A. Axillary Surgery After Neoadjuvant Chemotherapy for Breast Cancer: Population-Based Trends Over Time. Ann Surg Oncol 2025:10.1245/s10434-025-17236-6. [PMID: 40183891 DOI: 10.1245/s10434-025-17236-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Accepted: 03/09/2025] [Indexed: 04/05/2025]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) is recommended for patients initially presenting with cN1 disease and evidence of clinical/imaging response after NAC. We aimed to describe real-world population changes in management. METHODS We completed a population-based cohort study including adult women undergoing NAC followed by surgery for cT1-3N1 breast cancer between 1 April 2012 and 31 January 2020 in Ontario, Canada. Axillary surgeries (SLNB, axillary lymph node dissection [ALND], or SLNB followed by ALND) were studied over time using the Cochran-Armitage test, while multivariable logistic regression evaluated factors associated with surgery type. RESULTS Overall, 2563 patients were analyzed (37.9% were HER2-positive [HER2+ve], 42.3% were hormone receptor-positive and HER2-ve [HR+/HER2-ve], and 19.8% were triple-negative [TN]). 593 (23.1%) patients underwent SLNB and 1860 (72.6%) underwent ALND, while 110 (4.3%) patients underwent SLNB + ALND. From 2012 to 2020, SLNB increased from 5.7 to 29.9% (p < 0.01) and SLNB + ALND increased from 1.7 to 4.7% (p < 0.01), while ALND decreased from 92.6 to 65.4% (p < 0.01). Similar trends were identified across all receptor groups. After adjustment, patients who underwent SLNB had fewer comorbidities (odds ratio [OR] 1.82, 95% confidence interval [CI] 1.03-3.19), smaller tumors (T2 vs. T3: OR 1.52, 95% CI 1.21-1.92; T1 vs. T3: OR 1.56, 95% CI 1.14-2.13), and had surgery later in the study period (OR 1.32, 95% CI 1.25-1.38). CONCLUSION In alignment with current practice guidelines, de-escalation of axillary surgery to SLNB has increased over time for patients after breast cancer NAC.
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Affiliation(s)
| | - Matthew Castelo
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Nicole J Look Hong
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Julie Hallet
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Natalie Coburn
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Frances C Wright
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Sonal Gandhi
- Department of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Katarzyna J Jerzak
- Department of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Andrea Eisen
- Department of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Amanda Roberts
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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Bogacz P, Pelc Z, Mlak R, Sędłak K, Kobiałka S, Mielniczek K, Leśniewska M, Chawrylak K, Polkowski W, Rawicz-Pruszyński K, Kurylcio A. Sentinel lymph node biopsy in breast cancer: the role of ICG fluorescence after neoadjuvant chemotherapy. Breast Cancer Res Treat 2025; 210:699-707. [PMID: 39809982 PMCID: PMC11953180 DOI: 10.1007/s10549-025-07608-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Accepted: 01/02/2025] [Indexed: 01/16/2025]
Abstract
PURPOSE The purpose of this study was to evaluate the feasibility and safety of indocyanine green (ICG) fluorescence as an alternative to traditional sentinel lymph node biopsy (SLNB) techniques in breast cancer (BC) patients undergoing neoadjuvant chemotherapy (NAC). Specifically, the study aimed to assess sentinel node identification rates and the effectiveness of ICG in axillary staging without the use of radioactive tracers. METHODS This retrospective study included 71 BC patients treated with NAC, who underwent SLNB using ICG fluorescence between 2020 and 2024. ICG was injected intradermally around the nipple-areolar complex, and the lymphatic pathways were visualized with a fluorescence camera. SN identification rate (IR) and retrieval of three or more SNs were the primary and secondary endpoints, respectively. Statistical analyses were performed using the Mann-Whitney U test for continuous variables and Fisher's exact test for categorical variables. RESULTS ICG-guided SNs were identified in 91.5% of patients, with a median retrieval time of 25 min (range: 10-50). Three or more SNs were successfully collected among 66.2% of cases and 38% of patients achieved a complete pathological response to NAC, while 53.5% had partial responses. Metastatic SNs were found in 21.1% of patients, and no serious intraoperative or postoperative complications were observed. CONCLUSION ICG fluorescence-guided SLNB proved to be a feasible and promising method for SNs identification among BC patients after NAC. While ICG shows potential as an alternative to traditional techniques, further studies are required to confirm these findings and to establish ICG role in post-NAC axillary staging.
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Affiliation(s)
- Paweł Bogacz
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland.
| | - Radosław Mlak
- Department of Laboratory Diagnostics, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Sebastian Kobiałka
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Katarzyna Mielniczek
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Magdalena Leśniewska
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Katarzyna Chawrylak
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Wojciech Polkowski
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Karol Rawicz-Pruszyński
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Andrzej Kurylcio
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
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van Hemert AKE, van Loevezijn AA, Baas MSPD, Stokkel MPM, Groen EJ, van der Noort V, Loo CE, Sonke GS, Russell N, van Duijnhoven FH, Vrancken Peeters MJTFD. Omitting axillary lymph node dissection in breast cancer patients with extensive nodal disease and excellent response to primary systemic therapy using the MARI protocol. Breast 2025; 80:104411. [PMID: 39954569 PMCID: PMC11872389 DOI: 10.1016/j.breast.2025.104411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Revised: 01/30/2025] [Accepted: 02/01/2025] [Indexed: 02/17/2025] Open
Abstract
PURPOSE Axillary lymph node staging techniques after primary systemic therapy (PST) show low false negative rates, stimulating the omission of axillary lymph node dissection (ALND). Breast cancer patients with extensive nodal disease are underreported in studies on response-guided axillary treatment. In this study, we present the oncologic outcome of breast cancer patients with ≥4 involved axillary lymph nodes treated according to the MARI-protocol. METHODS This prospective single arm registration study included breast cancer patients with extensive nodal disease defined as ≥4 involved axillary lymph nodes on FDG-PET/CT pre-PST between July 2014 and December 2021. After PST, the marked (MARI) lymph node was excised. Patients with a pathologic complete response (pCR) of the MARI node (ypN0) received locoregional radiation treatment (RT). In patients with residual disease of the MARI node (ypN+), ALND was performed followed by RT. Primary endpoint was axillary recurrence rate. Secondary endpoints were invasive disease-free survival (DFS) and overall survival (OS). RESULTS In total, 218 patients were registered of which 39 % of patients also had extra-axillary nodal disease. Median (IQR) age was 50 (42-57) years. After PST 47 % of patients (103/218) had ypN0, whereas 53 % of patients (115/218) had ypN+. After a median follow up of 44 (26-62) months, axillary recurrence rate was 2.9 % (n = 3) in the ypN0 group and 3.5 % (n = 4) in the ypN + group. Five-year invasive DFS and OS were respectively 89 % (95 % CI 83 %-96 %) and 95 % (95 % CI 91 %-99 %) in ypN0 patients. CONCLUSION Omission of ALND after PST in breast cancer patients with extensive nodal involvement who achieve pCR of the MARI node is associated with excellent five-year oncologic outcome.
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Affiliation(s)
- Annemiek K E van Hemert
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Ariane A van Loevezijn
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Marie-Sophie P D Baas
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Marcel P M Stokkel
- Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Emma J Groen
- Department of Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Vincent van der Noort
- Department of Biometrics, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Claudette E Loo
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Gabe S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Nicola Russell
- Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Frederieke H van Duijnhoven
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Marie-Jeanne T F D Vrancken Peeters
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC-University of Amsterdam, Amsterdam, the Netherlands.
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5
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Ma L, Chen R, Wang M, Li X, Zheng R, Wang L, Ding J, Yao H, Gong Y, Wang Y, Sheng X, Wang J, Zha X. Omission of axillary lymph node dissection in patients with breast cancer with axillary pathological complete response confirmed by stained region lymph node biopsy after neoadjuvant systemic therapy (SrLNB study): study protocol for a single-arm, single-centre, phase-II trial. BMJ Open 2025; 15:e092563. [PMID: 40164484 PMCID: PMC11962808 DOI: 10.1136/bmjopen-2024-092563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Accepted: 03/14/2025] [Indexed: 04/02/2025] Open
Abstract
INTRODUCTION Given that axillary lymph node dissection (ALND) may not contribute to local control or survival and could lead to increased arm morbidity, axillary de-escalation procedures have replaced ALND in patients achieving axillary pathologic complete response (apCR) after neoadjuvant systemic therapy (NST). However, the application of targeted lymph node biopsy, one of the de-escalation procedures, remains limited due to a lack of long-term follow-up studies. METHODS AND ANALYSIS This prospective, single-arm, open-label, non-inferiority, single-centre phase II trial targets breast cancer patients initially diagnosed with axillary metastasis who achieved apCR after NST. The study aims to validate the oncological safety of stained region lymph node biopsy (SrLNB) procedure. SrLNB is a novel de-escalation axillary surgery, which was developed and tested in our preliminary study. The primary endpoint of this trial is the 3-year invasive disease-free survival (iDFS). Secondary endpoints include local-regional recurrence, incidence of breast cancer-related lymphoedema and patient-reported outcomes. The 3-year iDFS in patients undergoing ALND is expected to be approximately 90%, with a non-inferiority margin of 10%, a significance level of 0.05, power of 0.8 and a loss-to-follow-up rate of 10%. The planned enrolment is 92 patients. The trial was initiated on 11 September 2023, with the first patient enrolled on 25 September 2023, and is scheduled to end in 2026. ETHICS AND DISSEMINATION The trial protocol received approval from the Human Research Ethics Committee of The First Affiliated Hospital with Nanjing Medical University in May 2023 (No. 2023-SR-169). All participants will provide informed consent. The study results will be disseminated through international peer-reviewed scientific journals, presentations at international scientific conferences and public lectures. TRIAL REGISTRATION NUMBER NCT05939830.
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Affiliation(s)
- Lingjun Ma
- Department of Breast Disease, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Rui Chen
- Department of Breast Disease, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Mingyu Wang
- Department of Breast Disease, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xuan Li
- Department of Breast Disease, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ran Zheng
- Department of Breast Disease, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lexin Wang
- Department of Breast Disease, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jingjing Ding
- Department of Breast Disease, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hao Yao
- Department of Breast Disease, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yichun Gong
- Department of Breast Disease, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuanyuan Wang
- Department of Breast Disease, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xingye Sheng
- Department of Breast Disease, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jue Wang
- Department of Breast Disease, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaoming Zha
- Department of Breast Disease, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
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Liu X, Eriksson Bergman L, Boman C, Foukakis T, Matikas A. Long-term outcome for neoadjuvant versus adjuvant chemotherapy in early breast cancer and the prognostic impact of nodal therapy response: A population-based study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109587. [PMID: 39794172 DOI: 10.1016/j.ejso.2025.109587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2024] [Accepted: 01/06/2025] [Indexed: 01/13/2025]
Abstract
INTRODUCTION Although neoadjuvant systemic treatment for non-metastatic breast cancer has gained ground during the past decade, there is no compelling evidence that it improves overall survival compared to primary tumor resection and adjuvant treatment. At the same time, the approach to responders to neoadjuvant treatment in the axilla is evolving. MATERIALS AND METHODS This is a retrospective analysis of a prospectively collected population-based registry. Patients that received neoadjuvant (n = 2126) or adjuvant chemotherapy (n = 4754) for non-metastatic breast cancer during 2007-2020 in the Stockholm-Gotland region, which comprises 25 % of the entire Swedish population, were included. Overall survival of patients treated preoperatively and postoperatively was compared using inverse probability treatment weighting and landmark analysis. The prognostic impact of change between prechemotherapy clinical to postchemotherapy pathologic nodal stage (cN/pN) in women receiving neoadjuvant treatment was investigated. RESULTS Median follow-up was 4.93 years. There was no difference in adjusted overall survival between adjuvant (reference) and neoadjuvant treatment in the entire population (HR = 1.38, 95 % CI 0.98-1.93, p = 0.062) or in breast cancer subtypes. Patients converting from positive clinical to negative pathologic nodal stage (cN+/pN0) had improved outcomes compared to cN0/pN0 or patients with pN0 following primary surgery. These patients had a particular disease trajectory, with early peak in risk of death followed by quick and sustained decrease. CONCLUSION There was no difference in survival of patients treated with neoadjuvant versus adjuvant systemic therapy for non-metastatic breast cancer. Patients with cN+/pN0 have excellent prognosis and represent potential candidates for de-escalation of local and systemic treatment.
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Affiliation(s)
- Xingrong Liu
- Karolinska Institutet, Oncology/Pathology Department, Stockholm, Sweden
| | - Louise Eriksson Bergman
- Karolinska Institutet, Oncology/Pathology Department, Stockholm, Sweden; Department of Surgery and Oncology, Capio Sankt Göran Hospital, Stockholm, Sweden
| | - Caroline Boman
- Karolinska Institutet, Oncology/Pathology Department, Stockholm, Sweden; Breast Center, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - Theodoros Foukakis
- Karolinska Institutet, Oncology/Pathology Department, Stockholm, Sweden; Breast Center, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - Alexios Matikas
- Karolinska Institutet, Oncology/Pathology Department, Stockholm, Sweden; Breast Center, Karolinska Comprehensive Cancer Center, Stockholm, Sweden.
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7
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Liu P, Liu D, Zhao C, Wei Y, Liu X, Cui H, Zhao X, Chang L, Lin S, Wu H, Ma X, Kang H, Wang M. Identifying subgroups of ypN1 breast cancer patients who may exempt from axillary lymph node dissection after neoadjuvant chemotherapy: insights from a large cohort study. Breast Cancer 2025; 32:369-384. [PMID: 39729291 DOI: 10.1007/s12282-024-01663-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Accepted: 12/20/2024] [Indexed: 12/28/2024]
Abstract
BACKGROUND In patients with breast cancer staged ypN1 after neoadjuvant chemotherapy (NAC), there is limited evidence-based guidance regarding exemption from axillary lymph node dissection (ALND). METHODS This study analyzed ypN1 breast cancer patients post-NAC from the Surveillance, Epidemiology, and End Results databases. Patients were categorized into the breast-conserving surgery (BCS) group and the total mastectomy (TM) group, and further divided by the number of positive lymph nodes (LNs). The effects of three axillary management strategies, ALND, sentinel lymph node biopsy combined with radiotherapy (SLNB + RT), and ALND + RT were compared. The overall survival (OS) and breast cancer-specific survival (BCSS) of all subgroups and their independent risk factors were analyzed. Independent prognostic factors selected from multivariate Cox analysis were utilized to create nomograms for predicting OS and BCSS. RESULTS A total of 3641 patients were involved, with 1331 in the BCS group and 2310 in the TM group. In the TM group, patients with 3 residual positive LNs exhibited significant improvements in OS and BCSS when treated with ALND + RT. For patients with 1 or 2 residual positive LNs in the TM group and all BCS patients, no significant survival differences in survival outcomes were observed among the three axillary management methods. The accuracy of the nomograms was validated via calibration curves, receiver operating characteristic curves, and decision curve analysis curves. CONCLUSION For TM group patients with 3 residual positive LNs after NAC, ALND + RT is recommended. For other subgroups of ypN1 patients, SLNB + RT can be considered an alternative to ALND. The nomogram developed to predict OS and BCSS in ypN1 breast cancer patients demonstrated excellent predictive ability.
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Affiliation(s)
- Peinan Liu
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Dandan Liu
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Changying Zhao
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yumeng Wei
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Xingyu Liu
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Hanxiao Cui
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Xuyan Zhao
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Lidan Chang
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Shuai Lin
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Hao Wu
- School of Basic Medical Sciences, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Xiaobin Ma
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Huafeng Kang
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.
| | - Meng Wang
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.
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8
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Agostinetto E, Caballero C, Ignatiadis M, Pop CF. Axillary Surgery for Patients With Residual Isolated Tumor Cells (ypN0i+) After Neoadjuvant Systemic Therapy for Early Breast Cancer. J Clin Oncol 2025; 43:771-775. [PMID: 39531609 DOI: 10.1200/jco-24-01711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 09/01/2024] [Accepted: 09/18/2024] [Indexed: 11/16/2024] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.
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Affiliation(s)
- Elisa Agostinetto
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Medical Oncology Department, Brussels, Belgium
| | | | - Michail Ignatiadis
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Medical Oncology Department, Brussels, Belgium
| | - C Florin Pop
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Surgery Department, Brussels, Belgium
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9
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Tayebi A, TizMaghz A, Gorjizad M, Tavasol A, Tajaddini A, Rashnoo F, Vakili K, Behmanesh M, Olamaeian F, Ashoori M. Evaluating the effect of neoadjuvant chemotherapy on surgical outcomes in breast cancer patients: a systematic review study. J Chemother 2025:1-14. [PMID: 40019128 DOI: 10.1080/1120009x.2025.2468044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 01/18/2025] [Accepted: 01/22/2025] [Indexed: 03/01/2025]
Abstract
As a systematic review, this study addresses a gap in the literature by evaluating both the short-term and long-term outcomes of breast cancer patients undergoing neoadjuvant chemotherapy (NAC). The purpose of the current study was to evaluate NAC's impact on breast cancer patients' surgical outcomes. We performed a comprehensive search of international databases, including PubMed, Scopus, Embase, and Science Direct, covering studies from 2000 to 2023, using carefully selected keywords. Our search strategy aimed to capture a wide variety of relevant studies. To ensure a structured and unbiased selection, we followed PRISMA guidelines throughout the process. We concentrated on identifying studies that reported on short-term outcomes, like surgical complications (e.g., operation time, blood loss), as well as long-term outcomes, including overall survival, tumor size reduction, metastasis rates, breast conservation surgery, and recurrence rates. The findings highlighted the benefits of NAC in terms of lower recurrence and metastasis rates. The results also emphasized the significance of considering tumor characteristics and nodal involvement for prognostication in this patient population. The findings of this study will contribute to a better understanding of the impact of NAC on surgical outcomes in breast cancer patients, providing valuable insights for treatment planning and optimizing patient care.
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Affiliation(s)
- Ali Tayebi
- Firoozabadi Clinical Research Development Unit (FACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Adnan TizMaghz
- Firoozabadi Clinical Research Development Unit (FACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mahmood Gorjizad
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arian Tavasol
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Tajaddini
- Department of Surgery, Shiraz University of Medical Sciences, Tehran, Iran
| | - Fariborz Rashnoo
- Department of General and Minimally Invasive Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kimia Vakili
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Behmanesh
- Firoozabadi Clinical Research Development Unit (FACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Faranak Olamaeian
- Firoozabadi Clinical Research Development Unit (FACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
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10
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Zeng Q, Deng Y, Nan J, Zou Z, Yu T, Liu L. Delta dual‑region DCE-MRI radiomics from breast masses predicts axillary lymph node response after neoadjuvant therapy for breast cancer. BMC Cancer 2025; 25:264. [PMID: 39953506 PMCID: PMC11827315 DOI: 10.1186/s12885-025-13678-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Accepted: 02/06/2025] [Indexed: 02/17/2025] Open
Abstract
OBJECTIVES This study was designed to develop and validate models based on delta intratumoral and peritumoral radiomics features from breast masses on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the prediction of axillary lymph node (ALN) pathological complete response (pCR) after neoadjuvant therapy (NAT) in patients with breast cancer (BC). METHODS We retrospectively collected data from 187 BC patients with ALN metastases. Radiomics features were extracted from the intratumoral and 3 mm-peritumoral regions on DCE-MRI at baseline and after the 2nd course of NAT to calculate delta intratumoral and peritumoral radiomics features, respectively. After feature selection, the delta intratumoral radiomics (DIR) model and delta peritumoral radiomics (DPR) model were built using the retained features. An ultrasound model was constructed on the basis of preoperative axillary ultrasound results. All variables were screened by univariate and multivariate logistic regression to construct the combined model. The above models were evaluated and compared. RESULTS In the validation set, the ultrasound model had the lowest AUC, which was lower than those of the DIR, DPR and combined models (0.627 vs 0.825, 0.687, 0.846, respectively). The combined model constructed by delta dual-region radiomics and ultrasound dianogsis was significantly better than the ultrasound model in terms of the Delong test and integrated discrimination improvement (all p < 0.05). CONCLUSIONS Delta intratumoral and peritumoral radiomics based on DCE-MRI have the potential to predict ALN status after NAT. The combined model based on delta dual-region radiomics of breast mass can accurately diagnose ALN-pCR and provide assistance in the selection of axillary surgical approaches for patients.
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Affiliation(s)
- Qiao Zeng
- Department of Radiology, Jiangxi Cancer Hospital & Institute, Jiangxi Clinical Research Center for Cancer, The Second Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Yiwen Deng
- Department of Ultrasound, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Jiayu Nan
- Department of Radiology, Jiangxi Cancer Hospital & Institute, Jiangxi Clinical Research Center for Cancer, The Second Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Zhennan Zou
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Tenghua Yu
- Department of Breast Surgery, Jiangxi Cancer Hospital & Institute, Jiangxi Clinical Research Center for Cancer, The Second Affiliated Hospital of Nanchang Medical College, Nanchang, China.
| | - Lan Liu
- Department of Radiology, Jiangxi Cancer Hospital & Institute, Jiangxi Clinical Research Center for Cancer, The Second Affiliated Hospital of Nanchang Medical College, Nanchang, China.
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11
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Xiang X, Lu X, He M, Gou Z. Trends in Surgical Axillary Staging and Clinical Outcomes Among Breast Cancer Patients With Neoadjuvant Therapy: A Population-Based Cohort Study. Clin Breast Cancer 2025:S1526-8209(25)00030-8. [PMID: 40021431 DOI: 10.1016/j.clbc.2025.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2024] [Revised: 01/30/2025] [Accepted: 02/03/2025] [Indexed: 03/03/2025]
Abstract
OBJECTIVES Surgical management of the axilla with neoadjuvant treatment has been a significant research focus over the past decade, resulting in numerous publications. The trends in surgical choices based on lymph node status and survival outcomes in large populations were previously unclear. METHODS Breast cancer patients who underwent neoadjuvant therapy were identified from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2021 and categorized into 2 cohorts: LN- (no lymph node metastasis) and LNm (1-2 sentinel node metastases). We analyzed the trends in surgical axillary staging and compared the 10-year overall survival between sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND). RESULTS Among 26,320 patients, 18,548 were in the LN- cohort (16,607 with SLNB and 1,941 with ALND) and 7,772 were in the LNm cohort (3,601 with SLNB and 4,171 with ALND). The proportion of patients undergoing SLNB increased from 76.4% in 2010 to 93.8% in 2021 in the LN- cohort and doubled from 25.2% in 2010 to 55.0% in 2021 in the LNm cohort. ALND was identified as a favorable factor over SLNB in the LNm cohort (hazard ratio [HR] 0.84; 95% CI, 0.73-0.96; P = .014). CONCLUSION Omission of ALND for patients with 1 to 2 node metastases after neoadjuvant therapy has doubled since 2010. SLNB is an efficient and safe approach of surgical axillary staging for the LN- cohort but not for patients with residual axillary cancer, even with low-volume disease.
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Affiliation(s)
- Xihan Xiang
- Breast Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xunxi Lu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Institute of Clinical Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mengting He
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zongchao Gou
- Breast Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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12
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Cabioglu N, Karanlik H, Igci A, Muslumanoglu M, Gulcelik MA, Uras C, Kocer HB, Trabulus DC, Ozkurt E, Cakmak GK, Tukenmez M, Bademler S, Yildirim N, Akgul GG, Sen E, Senol K, Emiroglu S, Citgez B, Ersoy YE, Dag A, Zengel B, Basaran G, Kara H, Dilege E, Ugurlu MU, Celik A, Ilgun S, Bolukbasi Y, Karaman N, Sakman G, Ozbas S, Kilic HG, Polat AK, Ozemir IA, Kilic B, Altınok A, Varol E, Dogan L, Akcan A, Ozcinar B, Zer L, Soyder A, Velidedeoglu M, Erozgen F, Goktepe B, Dogan M, Kebudi A, Yigit B, Celik B, Yormaz S, Arici C, Agcaoglu O, Sevinc AI, Atahan MK, Valiyeva V, Baran E, Aljorani I, Utkan Z, Yeniay L, Kivilcim T, Soran A, Aydiner A, Ibis K, Ozmen V. Breast Cancer Recurrence in Initially Clinically Node-Positive Patients Undergoing Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in the NEOSENTITURK-Trials MF18-02/18-03. Ann Surg Oncol 2025; 32:952-966. [PMID: 39623189 DOI: 10.1245/s10434-024-16472-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Accepted: 10/23/2024] [Indexed: 01/16/2025]
Abstract
BACKGROUND This study aims to identify factors predicting recurrence and unfavorable prognosis in cN+ patients who have undergone sentinel lymph node biopsy (SLNB) following neoadjuvant chemotherapy (NAC). METHODS The retrospective multi-centre "MF18-02" and the prospective multi-centre cohort registry trial "MF18-03" (NCT04250129) included patients with cT1-4N1-3M0 with SLNB+/- axillary lymph node dissection (ALND) post-NAC. RESULTS A total of 2407 cN+ patients, who later achieved cN0 status after NAC and subsequently underwent SLNB, were studied. The majority had cT1-2 (79.1%) and N1 (80.7%). After a median follow-up time of 41 months, the rates of locoregional recurrence and axillary recurrence (AR) were 1.83% and 0.37%, respectively. No significant difference in locoregional recurrence or AR rates was observed between the SLNB/targeted axillary dissection-only (n = 1470) and ALND (n = 937) groups. Factors significantly linked with AR included age younger than 45 years, nonpathological complete response (non-pCR) in the breast, and nonluminal pathology. Locoregional recurrences were associated with nonluminal or HER2(+) pathology, non-pCR in the breast, and ALND. Poor prognostic factors for disease-free survival (DFS) included having cT3-T4, no breast pCR (non-pCR), ypN(+), and nonluminal pathology. No significant difference was found in DFS or disease-specific survival (DSS) rates among ypN0, ypN-isolated tumour cells, ypNmic, and ypN1. However, significant decreases in DFS and DSS rates were observed when comparing ypN2 or ypN3 disease with ypN0. CONCLUSIONS The present large registry data indicate that younger patients (<45), those with nonluminal pathology, and those who only partially respond in the breast are more susceptible to axillary and locoregional recurrences.
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Affiliation(s)
- Neslihan Cabioglu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye.
| | - Hasan Karanlik
- Department of Surgical Oncology, Istanbul University Institute of Oncology, Istanbul, Türkiye
| | - Abdullah Igci
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
- Department of Surgery, American Hospital, Istanbul, Türkiye
| | - Mahmut Muslumanoglu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Mehmet Ali Gulcelik
- Department of Surgical Oncology, Gulhane Faculty of Medicine, Health Sciences University, Ankara, Türkiye
| | - Cihan Uras
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
| | - Havva Belma Kocer
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Türkiye
| | - Didem Can Trabulus
- Department of General Surgery, Istanbul Samatya Training and Research Hospital, Health Sciences University, Istanbul, Türkiye
- Department of General Surgery, Istanbul Bahcesehir University, Istanbul, Türkiye
| | - Enver Ozkurt
- Department of General Surgery, Istanbul Demiroğlu Bilim University School of Medicine, Istanbul, Türkiye
| | - Guldeniz Karadeniz Cakmak
- Department of General Surgery, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Türkiye
| | - Mustafa Tukenmez
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Suleyman Bademler
- Department of Surgical Oncology, Istanbul University Institute of Oncology, Istanbul, Türkiye
| | | | - Gökhan Giray Akgul
- Department of Surgical Oncology, Gulhane Faculty of Medicine, Health Sciences University, Ankara, Türkiye
| | - Ebru Sen
- Department of General Surgery, Basaksehir Cam and Sakura City Hospital, Health Sciences University, Istanbul, Türkiye
| | - Kazim Senol
- Department of General Surgery, Uludag University Faculty of Medicine, Bursa, Türkiye
| | - Selman Emiroglu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Bulent Citgez
- Department of General Surgery, Seyrantepe Hamidiye Etfal Training and Research Hospital, Health Sciences University, Istanbul, Türkiye
- Department of General Surgery, Memorial Atasehir Hospital, Üsküdar University, Istanbul, Türkiye
| | - Yeliz Emine Ersoy
- Department of General Surgery, Bezmialem Vakif University Faculty of Medicine, Istanbul, Türkiye
| | - Ahmet Dag
- Department of General Surgery, Faculty of Medicine, Mersin University, Mersin, Türkiye
| | - Baha Zengel
- Department of General Surgery, Izmir Bozyaka Training and Research Hospital, Izmir, Türkiye
- Department of General Surgery, School of Medicine, Medical Point Hospital, Izmir University of Economics, Izmir, Türkiye
| | - Gul Basaran
- Department of Medical Oncology, Altunizade Acibadem Hospital, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
| | - Halil Kara
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
| | - Ece Dilege
- Department of General Surgery, Koç University School of Medicine, Istanbul, Türkiye
| | - M Umit Ugurlu
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Türkiye
| | - Atilla Celik
- Department of General Surgery, Bagcilar Training and Research Hospital, Health Sciences University, Istanbul, Türkiye
| | - Serkan Ilgun
- Department of General Surgery, Istanbul Demiroğlu Bilim University School of Medicine, Istanbul, Türkiye
- Department of General Surgery, Mater Dei Hospital, Msida, Malta
| | - Yasemin Bolukbasi
- Department of Radiation Oncology, Koç University School of Medicine, Istanbul, Türkiye
| | - Niyazi Karaman
- Department of Surgical Oncology, Ankara Oncology Training and Research Hospital Hospital, Health Sciences University, Ankara, Türkiye
| | - Gürhan Sakman
- Department of Surgery, School of Medicine, Çukurova University, Adana, Türkiye
| | - Serdar Ozbas
- Breast and Endocrine Surgeon, Private Practice, Ankara, Türkiye
| | - Halime Gul Kilic
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Ayfer Kamali Polat
- Department of General Surgery, School of Medicine, Ondokuz Mayıs University, Samsun, Türkiye
| | - Ibrahim Ali Ozemir
- Department of General Surgery, School of Medicine, Göztepe State Hospital, Istanbul Medeniyet University, Istanbul, Türkiye
| | - Berkay Kilic
- Department of Surgical Oncology, Istanbul University Institute of Oncology, Istanbul, Türkiye
| | - Ayse Altınok
- Department of Radiation Oncology, Bahçelievler Medical Park Hospital, Altınbas University, Istanbul, Türkiye
| | - Ecenur Varol
- Department of General Surgery, Faculty of Medicine, Kocaeli University, Kocaeli, Türkiye
| | - Lutfi Dogan
- Department of Surgical Oncology, Ankara Oncology Training and Research Hospital Hospital, Health Sciences University, Ankara, Türkiye
| | - Alper Akcan
- Department of General Surgery, Erciyes University School of Medicine, Kayseri, Türkiye
| | - Beyza Ozcinar
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Leyla Zer
- Department of General Surgery, Ataşehir Florence Nightingale, Istanbul, Türkiye
| | - Aykut Soyder
- Department of General Surgery, Altunizade Acibadem Hospital, School of Medicine, Acıbadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
| | - Mehmet Velidedeoglu
- Department of General Surgery, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Fazilet Erozgen
- Department of General Surgery, Haseki Training and Research Hospital, Health Sciences University, Istanbul, Türkiye
| | - Berk Goktepe
- Department of General Surgery, School of Medicine, Ege University, Izmir, Türkiye
| | - Mutlu Dogan
- Department of Medical Oncology, Ankara Oncology Training and Research Hospital, Health Sciences University, Ankara, Türkiye
| | - Abut Kebudi
- Department of General Surgery, Faculty of Medicine, Istanbul Okan University, Istanbul, Türkiye
| | - Banu Yigit
- Department of General Surgery, Seyrantepe Hamidiye Etfal Training and Research Hospital, Health Sciences University, Istanbul, Türkiye
- Department of General Surgery, Bagcilar Training and Research Hospital, Health Sciences University, Istanbul, Türkiye
| | - Burak Celik
- Department of General Surgery, Koç University School of Medicine, Istanbul, Türkiye
| | - Serdar Yormaz
- Department of General Surgery, Faculty of Medicine, Selçuk University, Konya, Türkiye
| | - Cumhur Arici
- Department of General Surgery, Faculty of Medicine, Akdeniz University, Antalya, Türkiye
| | - Orhan Agcaoglu
- Department of General Surgery, Koç University School of Medicine, Istanbul, Türkiye
| | - Ali Ibrahim Sevinc
- Department of General Surgery, School of Medicine, Dokuz Eylül University, Izmir, Türkiye
| | - M Kemal Atahan
- Department of General Surgery, School of Medicine, Izmir Katip Çelebi University, Izmir, Türkiye
| | - Vafa Valiyeva
- Department of Breast Surgery, Azerbaijan Medical University, Oncology Clinic, Baku, Azerbaijan
| | - Elif Baran
- Department of General Surgery, Seyrantepe Hamidiye Etfal Training and Research Hospital, Health Sciences University, Istanbul, Türkiye
| | - Israa Aljorani
- Department of General Surgery, Uludag University Faculty of Medicine, Bursa, Türkiye
| | - Zafer Utkan
- Department of General Surgery, Faculty of Medicine, Kocaeli University, Kocaeli, Türkiye
| | - Levent Yeniay
- Department of General Surgery, School of Medicine, Ege University, Izmir, Türkiye
| | - Taner Kivilcim
- Department of General Surgery, Faculty of Medicine, Istanbul Okan University, Istanbul, Türkiye
| | - Atilla Soran
- Department of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Adnan Aydiner
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Türkiye
| | - Kamuran Ibis
- Department of Radiation Oncology, Istanbul University Institute of Oncology, Istanbul, Türkiye
| | - Vahit Ozmen
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
- Breast Center, Istanbul Florence Nightingale Hospital, Istanbul, Türkiye
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13
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Huang JX, Lu Y, Tan YT, Liu FT, Li YL, Wang XY, Huang JH, Lin SY, Huang GL, Zhang YT, Pei XQ. Elastography-based AI model can predict axillary status after neoadjuvant chemotherapy in breast cancer with nodal involvement: a prospective, multicenter, diagnostic study. Int J Surg 2025; 111:221-229. [PMID: 39724577 PMCID: PMC11745675 DOI: 10.1097/js9.0000000000002105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 09/18/2024] [Indexed: 12/28/2024]
Abstract
OBJECTIVE To develop a model for accurate prediction of axillary lymph node (LN) status after neoadjuvant chemotherapy (NAC) in breast cancer patients with nodal involvement. METHODS Between October 2018 and February 2024, 671 breast cancer patients with biopsy-proven LN metastasis who received NAC followed by axillary LN dissection were enrolled in this prospective, multicenter study. Preoperative ultrasound (US) images, including B-mode ultrasound (BUS) and shear wave elastography (SWE), were obtained. The included patients were randomly divided at a ratio of 8:2 into a training set and an independent test set, with five-fold cross-validation applied to the training set. The authors first identified clinicopathological characteristics and conventional US features significantly associated with the axillary LN response and developed corresponding prediction models. The authors then constructed deep learning radiomics (DLR) models based on BUS and SWE data. Models performances were compared, and a combination model was developed using significant clinicopathological data and interpreted US features with the SWE-based DLR model. Discrimination, calibration and clinical utility of this model were analyzed using the receiver operating characteristic curve, calibration curve, and decision curve, respectively. RESULTS Axillary pathologic complete response (pCR) was achieved in 52.41% of patients. In the test cohort, the clinicopathologic model had an accuracy of 71.30%, while radiologists' diagnoses ranged from 64.26 to 71.11%, indicating limited to moderate predictive ability for the axillary response to NAC. The SWE-based DLR model, with an accuracy of 80.81%, significantly outperformed the BUS-based DLR model, which scored 59.57%. The combination DLR model boasted an accuracy of 88.70% and a false-negative rate of 8.82%. It demonstrated strong discriminatory ability (AUC, 0.95), precise calibration ( P -value obtained by Hosmer-Lemeshow goodness-of-fit test, 0.68), and practical clinical utility (probability threshold, 2.5-97.5%). CONCLUSIONS The combination SWE-based DLR model can predict the axillary status after NAC in patients with node-positive breast cancer, and thus, may inform clinical decision-making to help avoid unnecessary axillary LN dissection.
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Affiliation(s)
- Jia-Xin Huang
- Department of Liver Surgery, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China
- Department of Medical Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Yao Lu
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yu-Ting Tan
- Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Feng-Tao Liu
- Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yi-Liang Li
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Xue-Yan Wang
- Department of Medical Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Jia-Hui Huang
- Institute of Artificial Intelligence and Blockchain, Guangzhou University, Guangzhou, People’s Republic of China
| | - Shi-Yang Lin
- Department of Medical Ultrasound, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Gui-Ling Huang
- Department of Medical Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Yu-Ting Zhang
- Department of Medical Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Xiao-Qing Pei
- Department of Medical Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China
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14
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Gao M, Chen X, Xu L. Axillary lymph node management strategies in cN + breast cancer patients after neoadjuvant chemotherapy. Clin Transl Oncol 2024:10.1007/s12094-024-03817-6. [PMID: 39688773 DOI: 10.1007/s12094-024-03817-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 11/23/2024] [Indexed: 12/18/2024]
Abstract
With the widespread use of neoadjuvant chemotherapy (NAC), the optimal management strategy for axillary lymph nodes following chemotherapy has become a hot topic of discussion. For patients with clinically positive axillary lymph nodes (cN +) (defined as axillary lymph nodes confirmed positive by pathology before NAC), axillary lymph node dissection (ALND) remains the current standard treatment. However, there is still no consensus on whether sentinel lymph node biopsy (SLNB) and other local axillary treatments following NAC can safely replace ALND to reduce injury and complications. This article provides a narrative review of strategies for managing axillary lymph nodes in this patient population.
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Affiliation(s)
- Min Gao
- Breast Disease Center, Peking University First Hospital, Beijing, 100034, China
| | - Xiaoxi Chen
- Breast Disease Center, Peking University First Hospital, Beijing, 100034, China
| | - Ling Xu
- Breast Disease Center, Peking University First Hospital, Beijing, 100034, China.
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15
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Gasparri ML, Kaidar-Person O, Gentilini OD, de Boniface J, Kuehn T, Poortmans P. Radiation therapy volumes after primary systemic therapy in breast cancer patients: an international EUBREAST survey. Radiat Oncol J 2024; 42:308-318. [PMID: 39748531 DOI: 10.3857/roj.2024.00248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/28/2024] [Indexed: 01/04/2025] Open
Abstract
PURPOSE After primary systemic therapy (PST), agreement on the extent of locoregional therapy is lacking in breast cancer patients who convert from a node-positive to a node-negative status. The aim of this survey was to investigate radiation therapy approaches after PST according to different axillary surgical strategies and disease responses. MATERIALS AND METHODS The European Breast Cancer Research Association of Surgical Trialists developed a web-based survey containing 39 questions on locoregional management based on clinical scenarios in initially node positive breast cancer patients undergoing PST. Twelve international breast cancer societies distributed the link to breast surgeons and radiation oncologists. RESULTS Responses from 349 breast specialists were recorded, 72 of whom (20.6%) were radiation oncologists from 17 countries. Nodal status at diagnosis informed the decision for postoperative regional nodal irradiation (RNI) for 44/72 (61.1%) responders. RNI in node positive patients having undergone axillary lymph node dissection (ALND) is delivered in selected cases by 30/72 (41.7%) responders and systemically recommended by 26/72 (36.1%) responders. In case of macrometastases found on ALND, 43/72 (59.7%) responders always deliver RNI. In case of micrometastases in the sentinel lymph node(s) or targeted lymph node(s), 45/72 (62.5%) responders prefer RNI to completion ALND. A majority of responders (59.7%) determine the target volume for RNI according to European Society for Radiotherapy and Oncology guidelines. Significant heterogeneity was observed regarding nodal basins and volumes of interest for dose coverage by RNI. CONCLUSIONS There is significant heterogeneity in radiation-therapy delivered to the axilla after PST. A more standardized approach engaging both radiation oncologists and breast surgeons will help to optimize the harm-benefit equilibrium of axillary surgery and RNI.
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Affiliation(s)
- Maria Luisa Gasparri
- Centro di Senologia della Svizzera Italiana, Ospedale Regionale di Lugano, Lugano, Switzerland
- Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale, Centro di Senologia della Svizzera Italiana, Lugano, Switzerland
- Faculty of Biomedicine, University of the Italian Switzerland, Lugano, Switzerland
| | - Orit Kaidar-Person
- Tel Aviv University, Tel Aviv, Israel
- Breast Cancer Radiation Therapy Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Oreste Davide Gentilini
- IRCCS Ospedale San Raffaele, Milano, Italy
- Università Vita-Salute San Raffaele, Milano, Italy
| | - Jana de Boniface
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Surgery, Breast Centre, Capio St. Göran's Hospital, Stockholm, Sweden
| | | | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk, Antwerp, Belgium
- University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk, Antwerp, Belgium
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16
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Schmidt RFM, Harder Y, Rossi L, Canino P, Schiaffino S, Calcinotto A, Perriard U, Graffeo R, Decio R, Canonica C, Cuzzocrea M, Farooqi AA, Colombo GE, Diller M, Peradze N, Papadia A, Pagnamenta A, Gasparri ML. Albumin-To-Alkaline Phosphatase Ratio as a New Early Predictive Marker of Axillary Response in Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy: A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1767. [PMID: 39596952 PMCID: PMC11596826 DOI: 10.3390/medicina60111767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Accepted: 10/17/2024] [Indexed: 11/29/2024]
Abstract
Background and Objectives: The Albumin-to-Alkaline Phosphatase ratio (AAPR) is an easily applicable and cost-effective marker investigated as an outcome predictor in solid cancers. Preliminary evidence in breast cancer suggests that a low AAPR correlates with a poor response to neoadjuvant chemotherapy (NAC) in primary tumors. However, data regarding the axillary response are lacking. This study aims to evaluate whether the AAPR can predict the axillary response in initially nodal-positive (cN+) breast cancer patients undergoing NAC. Materials and Methods: Clinical and biochemical variables of cN+ breast cancer patients undergoing NAC were collected. Pre-NAC albumin and alkaline phosphatase serum values were utilized in the AAPR calculation. Fisher's exact test was performed to identify differences between the two groups of patients (high and low AAPR according to the cut-off reported in the literature). The primary outcome was the nodal pathologic complete response (pCR) rate in the two groups of patients. Results: Nodal pCR was achieved in 20/45 (44.4%) patients. A total of 36/45 (80%) patients had an AAPR > 0.583. Among patient and tumor characteristics, the only statistically significant difference between the two groups was the axillary pCR between the low and high AAPR groups (p-value = 0.03, OR = 0.129, 95% CI = 0.00-0.835). Conclusions: This pilot study suggests that the pre-treatment AAPR might be an early predictor of axillary response in cN+ breast cancer patients undergoing NAC. This result justifies further investigation in larger prospective trials to validate this finding.
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Affiliation(s)
- Rahel Felicia Mirjam Schmidt
- Faculty of Biomedical Science, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland; (R.F.M.S.); (S.S.); (A.C.); (A.P.); (A.P.)
| | - Yves Harder
- Department of Plastic, Reconstructive and Aesthetic Surgery and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), 1005 Lausanne, Switzerland;
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - Lorenzo Rossi
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (L.R.); (P.C.); (U.P.); (R.G.); (R.D.); (C.C.); (M.C.); (N.P.)
- Istituto Oncologico della Svizzera Italiana (IOSI), Centro di Senologia della Svizzera Italiana, 6962 Lugano, Switzerland
| | - Paola Canino
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (L.R.); (P.C.); (U.P.); (R.G.); (R.D.); (C.C.); (M.C.); (N.P.)
- Servizio di Radio-Oncologia, Istituto Oncologico della Svizzera Italiana, Ente Ospedaliere Cantonale (EOC), Centro di Senologia della Svizzera Italiana, 6962 Lugano, Switzerland
| | - Simone Schiaffino
- Faculty of Biomedical Science, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland; (R.F.M.S.); (S.S.); (A.C.); (A.P.); (A.P.)
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (L.R.); (P.C.); (U.P.); (R.G.); (R.D.); (C.C.); (M.C.); (N.P.)
- Servizio di Radiologia, Istituto Imaging della Svizzera Italiana, Ente Ospedaliere Cantonale (EOC), Centro di Senologia della Svizzera Italiana, 6962 Lugano, Switzerland
| | - Arianna Calcinotto
- Faculty of Biomedical Science, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland; (R.F.M.S.); (S.S.); (A.C.); (A.P.); (A.P.)
- Cancer Immunotherapy Lab, Institute of Oncology Research (IOR), 6500 Bellinzona, Switzerland
| | - Ulrike Perriard
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (L.R.); (P.C.); (U.P.); (R.G.); (R.D.); (C.C.); (M.C.); (N.P.)
- Servizio di Istopatologia, Istituto Cantonale di Patologia, Ente Ospedaliere Cantonale (EOC), 6600 Locarno, Switzerland
| | - Rossella Graffeo
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (L.R.); (P.C.); (U.P.); (R.G.); (R.D.); (C.C.); (M.C.); (N.P.)
- Istituto Oncologico della Svizzera Italiana (IOSI), Centro di Senologia della Svizzera Italiana, 6962 Lugano, Switzerland
| | - Roberta Decio
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (L.R.); (P.C.); (U.P.); (R.G.); (R.D.); (C.C.); (M.C.); (N.P.)
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliere Cantonale (EOC), Centro di Senologia della Svizzera Italiana, 6962 Lugano, Switzerland; (G.E.C.); (M.D.)
| | - Claudia Canonica
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (L.R.); (P.C.); (U.P.); (R.G.); (R.D.); (C.C.); (M.C.); (N.P.)
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliere Cantonale (EOC), Centro di Senologia della Svizzera Italiana, 6962 Lugano, Switzerland; (G.E.C.); (M.D.)
| | - Marco Cuzzocrea
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (L.R.); (P.C.); (U.P.); (R.G.); (R.D.); (C.C.); (M.C.); (N.P.)
- Clinica di Medicina Nucleare, Ente Ospedaliere Cantonale (EOC), dell’Istituto Imaging della Svizzera Italiana, Ospedale Regionale di Bellinzona sede San Giovanni e Ospedale Regionale di Lugano sede Civico, 6900 Lugano, Switzerland
| | - Ammad Ahmad Farooqi
- Institute of Biomedical and Genetic Engineering (IBGE), Rashid Latif Medical College, Lahore 54000, Pakistan;
| | - Giorgia Elisabeth Colombo
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliere Cantonale (EOC), Centro di Senologia della Svizzera Italiana, 6962 Lugano, Switzerland; (G.E.C.); (M.D.)
| | - Mirjam Diller
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliere Cantonale (EOC), Centro di Senologia della Svizzera Italiana, 6962 Lugano, Switzerland; (G.E.C.); (M.D.)
| | - Nickolas Peradze
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (L.R.); (P.C.); (U.P.); (R.G.); (R.D.); (C.C.); (M.C.); (N.P.)
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliere Cantonale (EOC), Centro di Senologia della Svizzera Italiana, 6962 Lugano, Switzerland; (G.E.C.); (M.D.)
| | - Andrea Papadia
- Faculty of Biomedical Science, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland; (R.F.M.S.); (S.S.); (A.C.); (A.P.); (A.P.)
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliere Cantonale (EOC), Centro di Senologia della Svizzera Italiana, 6962 Lugano, Switzerland; (G.E.C.); (M.D.)
| | - Alberto Pagnamenta
- Faculty of Biomedical Science, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland; (R.F.M.S.); (S.S.); (A.C.); (A.P.); (A.P.)
- Clinical Trial Unit, Ente Ospedaliere Cantonale (EOC), 6900 Lugano, Switzerland
| | - Maria Luisa Gasparri
- Faculty of Biomedical Science, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland; (R.F.M.S.); (S.S.); (A.C.); (A.P.); (A.P.)
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (L.R.); (P.C.); (U.P.); (R.G.); (R.D.); (C.C.); (M.C.); (N.P.)
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliere Cantonale (EOC), Centro di Senologia della Svizzera Italiana, 6962 Lugano, Switzerland; (G.E.C.); (M.D.)
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Sun Z, Liu K, Guo Y, Jiang N, Ye M. Surgery paradigm for locally advanced breast cancer following neoadjuvant systemic therapy. Front Surg 2024; 11:1410127. [PMID: 39308852 PMCID: PMC11412956 DOI: 10.3389/fsurg.2024.1410127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 08/27/2024] [Indexed: 09/25/2024] Open
Abstract
Locally advanced breast cancer (LABC) remains a significant clinical challenge, particularly in developing countries. While neoadjuvant systemic therapy (NST) has improved the pathological complete response (pCR) rates, particularly in HER2-positive and triple-negative breast cancer patients, surgical management post-NST continues to evolve. The feasibility of omitting surgery and the increasing consideration of breast-conserving surgery, immediate reconstruction in LABC patients are important areas of exploration. Accurate assessment of tumor response to NST through advanced imaging and minimally invasive biopsies remains pivotal, though challenges persist in reliably predicting pCR. Additionally, axillary lymph node management continues to evolve, with emerging strategies aiming to minimize the extent of surgery in patients who achieve nodal downstaging post-NST. Minimizing axillary lymph node dissection in favor of less invasive approaches is gaining attention, though further evidence is needed to establish its oncological safety. The potential for personalized treatment approaches, reducing surgical morbidity, and improving quality of life are key goals in managing LABC, while maintaining the priority of achieving favorable long-term outcomes.
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Affiliation(s)
| | | | | | | | - Meina Ye
- Department of Breast Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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18
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van Amstel FJG, de Mooij CM, Simons JM, Mitea C, van Diest PJ, Nelemans PJ, van der Pol CC, Luiten EJT, Koppert LB, Smidt ML, van Nijnatten TJA. Disease extent according to baseline [18F]fluorodeoxyglucose PET/CT and molecular subtype: prediction of axillary treatment response after neoadjuvant systemic therapy for breast cancer. Br J Surg 2024; 111:znae203. [PMID: 39302345 PMCID: PMC11414043 DOI: 10.1093/bjs/znae203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/19/2024] [Accepted: 07/23/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Axillary disease extent according to baseline [18F]fluorodeoxyglucose PET/CT combined with pathological axillary treatment response has been proposed to guide de-escalation of axillary treatment for clinically node-positive breast cancer patients treated with neoadjuvant systemic therapy. The aim of this study was to assess whether axillary disease extent according to baseline [18F]fluorodeoxyglucose PET/CT and breast cancer molecular subtype are predictors of axillary pCR. METHODS This study included clinically node-positive patients treated with neoadjuvant systemic therapy in the prospective Radioactive Iodine Seed placement in the Axilla with Sentinel lymph node biopsy ('RISAS') trial (NCT02800317) with baseline [18F]fluorodeoxyglucose PET/CT imaging available. The predictive value of axillary disease extent according to baseline [18F]fluorodeoxyglucose PET/CT and breast cancer molecular subtype to estimate axillary pCR was evaluated using logistic regression analysis. Discriminative ability is expressed using ORs with 95% confidence intervals. RESULTS Overall, 185 patients were included, with an axillary pCR rate of 29.7%. The axillary pCR rate for patients with limited versus advanced baseline axillary disease according to [18F]fluorodeoxyglucose PET/CT was 31.9% versus 26.1% respectively. Axillary disease extent was not a significant predictor of axillary pCR (OR 0.75 (95% c.i. 0.38 to 1.46) (P = 0.404)). There were significant differences in axillary pCR rates between breast cancer molecular subtypes. The lowest probability (7%) was found for hormone receptor+/human epidermal growth factor receptor 2- tumours. Using this category as a reference group, significantly increased ORs of 14.82 for hormone receptor+/human epidermal growth factor receptor 2+ tumours, 40 for hormone receptor-/human epidermal growth factor receptor 2+ tumours, and 6.91 for triple-negative tumours were found (P < 0.001). CONCLUSION Molecular subtype is a significant predictor of axillary pCR after neoadjuvant systemic therapy, whereas axillary disease extent according to baseline [18F]fluorodeoxyglucose PET/CT is not.
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Affiliation(s)
- Florien J G van Amstel
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
- GROW – Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Cornelis M de Mooij
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
- GROW – Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Janine M Simons
- GROW – Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Radiotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Cristina Mitea
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- GROW – Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Patty J Nelemans
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | | | - Ernest J T Luiten
- Department of Surgery, Amphia Hospital Breda, Breda, The Netherlands
- Tawam Breast Care Center, Tawam Hospital, Al Ain, United Arab Emirates
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Linetta B Koppert
- Department of Surgical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marjolein L Smidt
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
- GROW – Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Thiemo J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- GROW – Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
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19
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Huang JX, Chen YJ, Wang XY, Huang JH, Gan KH, Tang LN, Pei XQ. Nomogram Based on US and Clinicopathologic Characteristics: Axillary Nodal Evaluation Following Neoadjuvant Chemotherapy in Patients With Node-Positive Breast Cancer. Clin Breast Cancer 2024; 24:e452-e463.e4. [PMID: 38580573 DOI: 10.1016/j.clbc.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND To develop a convenient modality to predict axillary response to neoadjuvant chemotherapy (NAC) in breast cancer patients. MATERIALS AND METHODS In this multi-center study, a total of 1019 breast cancer patients with biopsy-proven positive lymph node (LN) receiving NAC were randomly assigned to the training and validation groups at a ratio of 7:3. Clinicopathologic and ultrasound (US) characteristics of both primary tumors and LNs were used to develop corresponding prediction models, and a nomogram integrating clinicopathologic and US predictors was generated to predict the axillary response to NAC. RESULTS Axillary pathological complete response (pCR) was achieved in 47.79% of the patients. The expression of estrogen receptor, human epidermal growth factor receptor -2, Ki-67 score, and clinical nodal stage were independent predictors for nodal response to NAC. Location and radiological response of primary tumors, cortical thickness and shape of LNs on US were also significantly associated with nodal pCR. In the validation cohort, the discrimination of US model (area under the curve [AUC], 0.76) was superior to clinicopathologic model (AUC, 0.68); the combined model (AUC, 0.85) demonstrates strong discriminatory power in predicting nodal pCR. Calibration curves of the nomogram based on the combined model demonstrated that substantial agreement can be observed between the predictions and observations. This nomogram showed a false-negative rates of 16.67% in all patients and 10.53% in patients with triple negative breast cancer. CONCLUSION Nomogram incorporating routine clinicopathologic and US characteristics can predict nodal pCR and represents a tool to aid in treatment decisions for the axilla after NAC in breast cancer patients.
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Affiliation(s)
- Jia-Xin Huang
- Department of Medical Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Yi-Jie Chen
- Department of Medical Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, PR China
| | - Xue-Yan Wang
- Department of Medical Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Jia-Hui Huang
- Institute of Artificial Intelligence and Blockchain, Guangzhou University, Guangzhou, PR China
| | - Ke-Hong Gan
- Department of Medical Ultrasound, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, PR China
| | - Li-Na Tang
- Department of Medical Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, PR China
| | - Xiao-Qing Pei
- Department of Medical Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, PR China.
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20
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Boland MR. Modern management of the axilla. J Surg Oncol 2024; 130:23-28. [PMID: 38643485 DOI: 10.1002/jso.27649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/11/2024] [Indexed: 04/23/2024]
Abstract
Surgical management of the axilla has evolved considerably in recent years, with a strong focus on de-escalation to minimise morbidity whilst maintaining oncological outcomes. Current trials will focus on the omission of Sentinel node biopsy in select groups of patients, while axillary lymph node dissection will be reserved for those with more aggressive disease.
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Affiliation(s)
- Michael R Boland
- Department of Breast Surgery, St Vincent's University Hospital, Dublin, Ireland
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21
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Bhargavan RV, Prasannan N, Krishna KJ, Augustine P, Cherian K. The Role of Level III Dissection in Locally Advanced Breast Cancer following Neoadjuvant Chemotherapy-A Prospective Study. South Asian J Cancer 2024; 13:170-176. [PMID: 39410990 PMCID: PMC11473130 DOI: 10.1055/s-0043-1777727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2024] Open
Abstract
Nisha Prasannan Breast cancer is the most common female cancer in India, with a significant number presenting as locally advanced breast cancer (LABC). Level III clearance is routinely performed in our institute in LABC following neoadjuvant chemotherapy (NACT). In our previous retrospective study, level III positivity rate was 15.5%. We aim to prospectively assess level III positivity rate in LABC patients post-NACT. This is a prospective study of female patients with LABC (defined as cT3N1-3M0 or cT4N0-3M0 or cT any N2,3M0) who received NACT and underwent surgery including level III dissection from November 2019 to October 2021. Data collected included age, menopausal status, TNM stage at presentation, grade, hormone receptor and HER2 status, treatment response, ycT and ycN stage, and final histopathology. Univariate and multivariate analysis was undertaken. p -Value less than or equal to 0.05 was considered significant. Study recruited 598 patients. Level III node positivity rate was 8.4%. The clinical complete response rate (cCR) was 36% (215/598). On univariate analysis, significant association was present between level III node and cCR ( p < 0.01), ycT0 stage ( p = 0.001), ycN0 stage ( p = 0.028), level II node positivity ( p = 0.001), ypT stage ( p = 0.001), and ypN stage ( p = 0.001). On multivariate analysis, significant association was present between level III node and ycT stage ( p < 0.001), ypT stage ( p = 0.001), and ypN stage ( p = 0.001). Level III positivity rate in LABC post-NACT is high. In patients with advanced ycT stage, it would be advisable to offer complete axillary dissection including level III. Level III dissection may be avoided in patients with ycT0 or ycN0 or with cCR.
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Affiliation(s)
- Rexeena V. Bhargavan
- Department of Surgical Services, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Nisha Prasannan
- Department of Surgical Oncology, KIMS Hospital, Thiruvananthapuram, Kerala, India
| | - K.M. Jagathnath Krishna
- Department of Epidemiology and Biostatistics, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Paul Augustine
- Department of Surgical Services, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Kurian Cherian
- Department of Surgical Services, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
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22
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Schiavone A, Ventimiglia F, Zarba Meli E, Taffurelli M, Caruso F, Gentilini OD, Del Mastro L, Livi L, Castellano I, Bernardi D, Minelli M, Fortunato L. Third national surgical consensus conference of the Italian Association of Breast Surgeons (ANISC) on management after neoadjuvant chemotherapy: The difficulty in reaching a consensus. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108351. [PMID: 38701582 DOI: 10.1016/j.ejso.2024.108351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/15/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION Neoadjuvant chemotherapy (NAC) has a profound impact on surgical management of breast cancer. For this reason, the Italian Association of Breast Surgeons (ANISC) promoted the third national Consensus Conference on this subject, open to multidisciplinary specialists. MATERIALS AND METHODS The Consensus Conference was held on-line in November 2022, and after an introductory session with five core-team experts, participants were asked to vote on eleven controversial issues, while results were collected in real-time with a polling system. RESULTS A total of 164 dedicated specialists from 74 Breast Centers participated. Consensus was reached for only three of the eleven issues, including: 1) the indication to assess the response with Magnetic Resonance Imaging (79 %); 2) the need to re-assess the biological factors of the residual tumor if present (96 %); 3) the possibility of omitting a formal axillary node dissection for cN1 patients if a pathologic Complete Response (pCR) was confirmed with analysis of one or more sentinel lymph nodes (82 %). The majority voted in favor of mapping both the breast and nodal lesions pre-NAC (59 %), and against the omission of sentinel lymph node biopsy in cN0 patients in the case of pathologic or clinical Complete Response (69 %). In cases of cT3/cN1+ tumors with pCR, only 8 % of participants considered appropriate the omission of Post-Mastectomy Radiation Therapy. CONCLUSION There is still a wide variability in surgical approaches after NAC in the "real world". As NAC is increasingly used, multidisciplinary teams should be attuned to conforming their procedures to the rapid advances in this field.
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Affiliation(s)
- Alfonso Schiavone
- Breast Center, San Giovanni-Addolorata Hospital, Via Dell'Amba Aradam 8, 00184, Rome, Italy; Department of Surgical Science, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy.
| | - Fabrizio Ventimiglia
- Breast Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Emanuele Zarba Meli
- Breast Center, San Giovanni-Addolorata Hospital, Via Dell'Amba Aradam 8, 00184, Rome, Italy
| | - Mario Taffurelli
- Breast Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Francesco Caruso
- Breast Unit, Humanitas Istituto Clinico Catanese, Contrada Cubba 11, SP54, 95045, Misterbianco, CT, Italy
| | | | - Lucia Del Mastro
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Department of Internal Medicine and Medical Specialties (DIMI), Largo Rosanna Benzi 10, 16132, Genova, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, P.zza San Marco 4, 50121, Florence, Italy
| | - Isabella Castellano
- Pathology Unit, Department of Medical Sciences, University of Turin, Via Giuseppe Verdi 8, 10124, Turin, Italy
| | - Daniela Bernardi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Mauro Minelli
- Breast Center, San Giovanni-Addolorata Hospital, Via Dell'Amba Aradam 8, 00184, Rome, Italy
| | - Lucio Fortunato
- Breast Center, San Giovanni-Addolorata Hospital, Via Dell'Amba Aradam 8, 00184, Rome, Italy
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23
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Costarelli L, Arienzo F, Broglia L, La Pinta M, Scavina P, Meli EZ, Colavito MH, Ascarelli A, Campagna D, Mastropietro T, Manna E, Amato M, Andrulli AD, Schiavone A, Minelli M, Fortunato L. Clipping a Positive Lymph Node Improves Accuracy of Nodal Staging After Neoadjuvant Chemotherapy for Breast Cancer Patients, but Does It Drive Management Changes? Ann Surg Oncol 2024; 31:3186-3193. [PMID: 38427160 DOI: 10.1245/s10434-024-15052-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy for cN+ breast cancer patients after neoadjuvant chemotherapy (NAC) is controversial because the false-negative rate (FNR) is high. Identification of three or more SLNs with a dual tracer improves these results, and inclusion of a clipped lymph node (CLN) (targeted axillary dissection [TAD]) may be even more effective. METHODS A retrospective, single-institution analysis of consecutive cN+ patients undergoing NAC from 2019 to 2021 was performed. Patients routinely underwent placement of a clip in the positive lymph node before NAC, and TAD was performed after completion of therapy. RESULTS The study analyzed 73 patients, and the identification rate for CLN was 98.6% (72/73). A complete response in the lymph nodes was achieved for 43 (59%) of the 73 patients. Overall, the CLN was not a SLN in 18 (25%) of 73 cases, and for women who had one or two and those who had three or more SLNs identified, this occurred in 11 (32%) and 7 (21%) of 34 cases, respectively. Failure of SLN or TAD to identify a positive residual lymph node status after NAC occurred in 10 (15%) of 69 and 2 (3%) of 73 cases, respectively (p = 0.01). In four cases, a SLN was not retrieved (5.5%), and two of these cases had a positive CLN. In three cases, the CLN was the only positive node and did not match with a SLN, directing lymphadenectomy and oncologic management change in two cases. Therefore, 7 (10%) of 73 cases had a change in surgical or oncologic management with TAD. CONCLUSIONS For a conservative axillary treatment in this setting, TAD is an effective method. It is more accurate than SLN alone and allows management changes. Further studies are warranted.
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Affiliation(s)
- Leopoldo Costarelli
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy.
- Pathology Unit, San Giovanni-Addolorata Hospital, Rome, Italy.
| | - Francesca Arienzo
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Pathology Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Laura Broglia
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Breast Radiology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Massimo La Pinta
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Breast Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Paola Scavina
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Medical Oncology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Emanuele Zarba Meli
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Breast Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Maria Helena Colavito
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Breast Radiology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Alessandra Ascarelli
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Breast Radiology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Domenico Campagna
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Pathology Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Tiziana Mastropietro
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Breast Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Elena Manna
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Breast Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Michela Amato
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Pathology Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Angela Damiana Andrulli
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Radiotherapy Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Alfonso Schiavone
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Breast Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Mauro Minelli
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Medical Oncology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Lucio Fortunato
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Breast Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
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Kontos M, Kanavidis P, Kühn T, Masannat Y, Gulluoglu B. Targeted axillary dissection: worldwide variations in clinical practice. Breast Cancer Res Treat 2024; 204:389-396. [PMID: 38175449 DOI: 10.1007/s10549-023-07204-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/26/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Targeted axillary dissection (TAD) for the axillary staging of clinically node-positive (cN +) breast cancer patients converting to clinically node negative post neoadjuvant chemotherapy (NAC), has gained popularity due to its minimal false negative rate and low arm morbidity. The aim of this study is to shed more light on the variation in the clinical practice globally in terms of indications and perceived limitations of TAD. METHODS A panel of expert breast surgeons constructed a structured questionnaire comprising of 18 questions and asked surgeons worldwide for their opinions and routine practice on TAD. The questionnaire was electronically distributed and answers were collected between May 1st and August 1st 2022. RESULTS Responses included 137 entries from 36 countries. Of them, 73.7% consider TAD for cN + patients planned to receive NAC. Among them, the greatest number of respondents (45%) perform the procedure for tumours up to T3, whereas 27% regardless of T-stage. The majority (42%) perform TAD on patients with 1-3 positive nodes and only 30% consider TAD when matted nodes are present. HER2 positive and Triple Negative subtypes are more likely to undergo TAD than Luminal A and B (86%, 79.1%, 39.5%, and 62.8%, respectively). Maximum acceptable lymph node burden is median 3 nodes for any subtype with a tendency to accept more positive nodes for Triple Negative. CONCLUSION This study demonstrates the differences in current practice regarding TAD as well as the fact that the biology of the tumour heavily affects the method of axillary staging.
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Affiliation(s)
- Michalis Kontos
- National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Yazan Masannat
- Broomfield Hospital, Mid and South Essex NHS Trust, Chelmsford, UK, Broomfield, UK
- University of Aberdeen, School of Medicine, Medical Science and Nutrition, Aberdeen, UK
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25
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Ofri A, Spillane AJ, Baker C, Mann GB, Walker M, Warrier S. Current bi-national attitudes towards targeted axillary dissection. ANZ J Surg 2024; 94:11-13. [PMID: 38149761 DOI: 10.1111/ans.18841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/27/2023] [Accepted: 12/10/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Adam Ofri
- Breast and Endocrine Department, Mater Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital Institute of Academic Surgery, Sydney, New South Wales, Australia
| | - Andrew J Spillane
- Breast and Endocrine Department, Mater Hospital, Sydney, New South Wales, Australia
- Breast and Surgical Oncology at the Poche Centre, Sydney, New South Wales, Australia
- Breast Surgery Department, North Shore Private Hospital, Sydney, New South Wales, Australia
- Breast and Melanoma Surgery Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Caroline Baker
- Breast Surgery Unit, St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - G Bruce Mann
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- The Breast Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Melanie Walker
- Breast, Endocrine and General Surgical Unit, Alfred Health, Melbourne, Victoria, Australia
- Breast Unit, Monash Health, Melbourne, Victoria, Australia
| | - Sanjay Warrier
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital Institute of Academic Surgery, Sydney, New South Wales, Australia
- Department of Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
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26
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Gentilini OD, Cardoso MJ, Senkus E, Poortmans P. De-escalation of loco-regional treatments: Time to find a balance. Breast 2024; 73:103673. [PMID: 38295751 PMCID: PMC10844673 DOI: 10.1016/j.breast.2024.103673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024] Open
Affiliation(s)
- Oreste D Gentilini
- Università Vita-Salute San Raffaele, Milano, Italy; IRCCS Ospedale San Raffaele, Milano, Italy.
| | - Maria-Joao Cardoso
- Champalimaud Foundation Breast Unit, Lisbon, Portugal; University of Lisbon, Faculty of Medicine, Lisbon, Portugal
| | - Elżbieta Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Poland
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium
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Banys-Paluchowski M, Hartmann S, Ditsch N, Krawczyk N, Kühn T, de Boniface J, Banys-Kotomska J, Rody A, Krug D. Locoregional Therapy: From Mastectomy to Reconstruction, Targeted Surgery, and Ultra-Hypofractionated Radiotherapy. Breast Care (Basel) 2023; 18:428-439. [PMID: 38130814 PMCID: PMC10731028 DOI: 10.1159/000533748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/21/2023] [Indexed: 12/23/2023] Open
Abstract
Background The past 3 decades have seen an unprecedented shift toward treatment de-escalation in surgical therapy of breast cancer. Summary Radical mastectomy has been replaced by breast-conserving and oncoplastic approaches in most patients, and full axillary lymph node dissection by less radical staging procedures, such as sentinel lymph node biopsy and targeted axillary dissection. Further, attempts have been made to spare healthy tissue while increasing the probability of removing the tumor with clear margins, thus improving cosmetic results and minimizing the risk of local recurrence. In this context, modern probe-guided localization techniques have been introduced to guide surgical excision. This progress was accompanied by the development of targeted systemic therapies. At the same time, radiotherapy for breast cancer has undergone significant changes. The use of hypofractionation has decreased the typical length of a treatment course from 5-6 weeks to 1-3 weeks. Partial breast irradiation is now a valid option for de-escalation in patients with low-risk features. Axillary radiotherapy achieves similar recurrence rates and decreases the risk of lymphedema in patients with limited sentinel node involvement. Key Messages Taken together, these advances are important steps toward individualization of locoregional management strategies. This highlights the importance of interdisciplinary approaches for de-escalation of locoregional therapies.
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Affiliation(s)
- Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lubeck, Lubeck, Germany
| | - Steffi Hartmann
- Department of Gynecology and Obstetrics, University Hospital Rostock, Rostock, Germany
| | - Nina Ditsch
- Breast Cancer Center, Department of Gynaecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany
| | - Natalia Krawczyk
- Department of Gynecology and Obstetrics, Heinrich-Heine-University Düsseldorf, Dusseldorf, Germany
| | - Thorsten Kühn
- Department of Gynecology and Obstetrics, Die Filderklinik, Filderstadt, Germany
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Capio St. Göran’s Hospital, Stockholm, Sweden
| | - Joanna Banys-Kotomska
- I Department and Clinic of Gynaecology and Obstetrics, Wroclaw Medical University, Wroclaw, Poland
| | - Achim Rody
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lubeck, Lubeck, Germany
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Hartmann S, Banys-Paluchowski M, Stickeler E, de Boniface J, Gentilini OD, Kontos M, Seitz S, Kaltenecker G, Wärnberg F, Zetterlund LH, Kolberg HC, Fröhlich S, Kühn T. Applicability of magnetic seeds for target lymph node biopsy after neoadjuvant chemotherapy in initially node-positive breast cancer patients: data from the AXSANA study. Breast Cancer Res Treat 2023; 202:497-504. [PMID: 37684426 PMCID: PMC10564814 DOI: 10.1007/s10549-023-07100-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023]
Abstract
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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Affiliation(s)
- Steffi Hartmann
- Department of Obstetrics and Gynecology, University Hospital Rostock, Rostock, Germany.
| | - Maggie Banys-Paluchowski
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Elmar Stickeler
- Department of Obstetrics and Gynecology, University Hospital Aachen, Aachen, Germany
| | - Jana de Boniface
- Department of Surgery, Capio St. Göran's Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Stephan Seitz
- Department of Obstetrics and Gynecology, University Medical Center Regensburg, Regensburg, Germany
| | - Gabriele Kaltenecker
- Department of Obstetrics and Gynecology, City Hospital Karlsruhe, Karlsruhe, Germany
| | - Fredrik Wärnberg
- Department of Surgery, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Linda Holmstrand Zetterlund
- Department of Surgery, Capio St. Göran's Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Sarah Fröhlich
- Department of Obstetrics and Gynecology, University Hospital Rostock, Rostock, Germany
| | - Thorsten Kühn
- Department of Obstetrics and Gynecology, Die Filderklinik, Filderstadt, Germany
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
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Yan Y, Jiang T, Sui L, Ou D, Qu Y, Chen C, Lai M, Ni C, Liu Y, Wang Y, Xu D. Combined conventional ultrasonography with clinicopathological features to predict axillary status after neoadjuvant therapy for breast cancer: A case-control study. Br J Radiol 2023; 96:20230370. [PMID: 37750854 PMCID: PMC10646660 DOI: 10.1259/bjr.20230370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/15/2023] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the value of a model combining conventional ultrasonography and clinicopathologic features for predicting axillary status after neoadjuvant therapy in breast cancer. METHODS This retrospective study included 329 patients with lymph node-positive who underwent neoadjuvant systemic treatment (NST) from June 2019 to March 2022. Ultrasound and clinicopathological characteristics of breast lesions and axillary lymph nodes were analyzed before and after NST. The diagnostic efficacy of ultrasound, clinicopathological characteristics, and combined model were evaluated using multivariate logistic regression and receiver operator characteristic curve (ROC) analyses. RESULTS The area under ROC (AUC) for the ability of the combined model to predict the axillary pathological complete response (pCR) after NST was 0.882, that diagnostic effectiveness was significantly better than that of the clinicopathological model (AUC of 0.807) and the ultrasound feature model (AUC of 0.795). In addition, eight features were screened as independent predictors of axillary pCR, including clinical N stage, ERBB2 status, Ki-67, and after NST the maximum diameter reduction rate and margins of breast lesions, the short diameter, cortical thickness, and fatty hilum of lymph nodes. CONCLUSIONS The combined model constructed from ultrasound and clinicopathological features for predicting axillary pCR has favorable diagnostic results, which allowed more accurate identification of BC patients who had received axillary pCR after NST. ADVANCES IN KNOWLEDGE A combined model incorporated ultrasound and clinicopathological characteristics of breast lesions and axillary lymph nodes demonstrated favorable performance in evaluating axillary pCR preoperatively and non-invasively.
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Affiliation(s)
| | | | | | | | - Yiyuan Qu
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
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30
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Munck F, Kroman N, Tvedskov T. ASO Author Reflections: Comparison of Two-Step Methods for Targeted Axillary Dissection in Denmark. Ann Surg Oncol 2023; 30:6370-6371. [PMID: 37351735 DOI: 10.1245/s10434-023-13804-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Frederikke Munck
- Department of Breast Surgery, Herlev-Gentofte Hospital, Gentofte, Denmark.
| | - Niels Kroman
- Department of Breast Surgery, Herlev-Gentofte Hospital, Gentofte, Denmark
| | - Tove Tvedskov
- Department of Breast Surgery, Herlev-Gentofte Hospital, Gentofte, Denmark
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31
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Munck F, Jepsen P, Zeuthen P, Carstensen L, Hauerslev K, Paaskesen CK, Andersen IS, Høyer U, Lanng C, Gerlach MK, Vejborg I, Kroman NT, Tvedskov THF. Comparing Methods for Targeted Axillary Dissection in Breast Cancer Patients: A Nationwide, Retrospective Study. Ann Surg Oncol 2023; 30:6361-6369. [PMID: 37400618 PMCID: PMC10506928 DOI: 10.1245/s10434-023-13792-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/10/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Several techniques exist for performing targeted axillary dissection (TAD) after neoadjuvant chemotherapy with the removal of the sentinel node and a marked metastatic lymph node (LN). Two-step methods include coil-marking of the metastatic LN at diagnosis and re-marking with an intraoperatively identifiable marker before surgery. Because nondetection of the marked lymph node (MLN) warrants axillary clearance and many patients achieve axillary pathological complete response (ax-pCR), the success of TAD is crucial. We compare various two-step TAD methods in a Danish national cohort. METHODS We included patients who received two-step TAD between January 1, 2016 and August 31, 2021. Patients were identified from the Danish Breast Cancer Group database and cross-checked with locally accessible lists. Data were extracted from the patient's medical files. RESULTS We included 543 patients. In 79.4%, preoperative, ultrasound-guided re-marking was possible. Nonidentification of the coil-marked LN was more likely in patients with ax-pCR. The second markers used were hook-wire, iodine seeds, or ink marking on the axillary skin. Of patients with successful secondary marking, the MLN identification rate (IR) was 91%, and the sentinel node (SN) IR was 95%. Marking with iodine seeds was significantly more successful than ink marking with an odds ratio of 5.34 (95% confidence interval 1.62-17.60). The success rate of the complete TAD with the removal of MLN and SN was 82.3%. CONCLUSIONS With two-step TAD, nonidentification of the coiled LN before surgery is frequent, especially in patients with ax-pCR. Despite successful remarking, the IR of the MLN at surgery is inferior to one-step TAD.
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Affiliation(s)
- Frederikke Munck
- Department of Breast Surgery, Herlev-Gentofte Hospital, Hellerup, Denmark.
| | - Pernille Jepsen
- Department of Breast Surgery, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Pernille Zeuthen
- Department of Surgery and Plastic Surgery, Lillebaelt Hospital, Vejle, Denmark
| | - Lena Carstensen
- Department of Surgery Esbjerg, Hospital of South West Jutland, Esbjerg, Denmark
| | - Katrine Hauerslev
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Inge S Andersen
- Department of Breast Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - Ute Høyer
- Department of Plastic and Breast Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Charlotte Lanng
- Department of Breast Surgery, Herlev-Gentofte Hospital, Hellerup, Denmark
| | - Maria K Gerlach
- Department of Pathology, Herlev-Gentofte Hospital, Hellerup, Denmark
| | - Ilse Vejborg
- Department of Breast Examinations and Capital Mammography Screening, Herlev-Gentofte Hospital, Hellerup, Denmark
| | - Niels T Kroman
- Department of Breast Surgery, Herlev-Gentofte Hospital, Hellerup, Denmark
| | - Tove H F Tvedskov
- Department of Breast Surgery, Herlev-Gentofte Hospital, Hellerup, Denmark
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Beltran-Bless AA, Kacerovsky-Strobl S, Gnant M. Explaining risks and benefits of loco-regional treatments to patients. Breast 2023; 71:132-137. [PMID: 37634470 PMCID: PMC10472006 DOI: 10.1016/j.breast.2023.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/15/2023] [Accepted: 08/20/2023] [Indexed: 08/29/2023] Open
Abstract
Treatment for early-stage breast cancer is complex, requiring multidisciplinary care with a multitude of treatment options available for each patient. Coupled with the rising importance of shared decision-making, patient-physician conversations are progressively more complicated. These conversations require frank disclosure of risks and benefits of the different treatment modalities in a way that is individualized for each patient and simple to understand. In most patients, breast conserving therapy with radiation should be presented as the gold-standard local treatment given similar long-term and improved quality of life outcomes. De-escalation is currently at the forefront of research in loco-regional treatments, and further investigations are required to best determine the optimal patient populations for reduced sentinel lymph node sampling, omission of sentinel lymph node biopsy altogether and omission of radiation treatment. For future trials, better endpoints need to be established considering patient-centered outcomes as well as recurrence.
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Affiliation(s)
- Ana-Alicia Beltran-Bless
- Division of Medical Oncology and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Stephanie Kacerovsky-Strobl
- Breast Health Center, St. Francis Hospital, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria.
| | - Michael Gnant
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria.
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van Hemert AKE, van Duijnhoven FH, Vrancken Peeters MJTFD. This house believes that: MARI/TAD is better than sentinel node biopsy after PST for cN+ patients. Breast 2023; 71:89-95. [PMID: 37562108 PMCID: PMC10432821 DOI: 10.1016/j.breast.2023.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/03/2023] [Accepted: 06/28/2023] [Indexed: 08/12/2023] Open
Abstract
The increasing use and effectiveness of primary systemic treatment (PST) enables tailored locoregional treatment. About one third of clinically node positive (cN+) breast cancer patients achieve pathologic complete response (pCR) of the axilla, with higher rates observed in Human Epidermal growth factor Receptor (HER)2-positive or triple negative (TN) breast cancer subtypes. Tailoring axillary treatment for patients with axillary pCR is necessary, as they are unlikely to benefit from axillary lymph node dissection (ALND), but may suffer complications and long-term morbidity such as lymphedema and impaired shoulder motion. By combining pre-PST and post-PST axillary staging techniques, ALND can be omitted in most cN + patients with pCR. Different post-PST staging techniques (MARI/TAD/SN) show low or ultra-low false negative rates for detection of residual disease. More importantly, trials using the MARI (Marking Axillary lymph nodes with Radioactive Iodine seeds) procedure or sentinel lymph node biopsy (SLNB) as axillary staging technique post-PST have already shown the safety of tailoring axillary treatment in patients with an excellent response. Tailored axillary treatment using the MARI procedure in stage I-III breast cancer resulted in 80% reduction of ALND and excellent five-year axillary recurrence free interval (aRFI) of 97%. Similar oncologic outcomes were seen for post-SLNB in stage I-II patients. The MARI technique requires only one invasive procedure pre-NST and a median of one node is removed post-PST, whereas for the SLNB and TAD techniques two to four nodes are removed. A disadvantage of the MARI technique is its use of radioactive iodine, which is subject to extensive regulations.
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Affiliation(s)
- Annemiek K E van Hemert
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands
| | - Frederieke H van Duijnhoven
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands
| | - Marie-Jeanne T F D Vrancken Peeters
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands; Department of Surgery, Amsterdam University Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
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Gasparri ML, Albasini S, Truffi M, Favilla K, Tagliaferri B, Piccotti F, Bossi D, Armatura G, Calcinotto A, Chiappa C, Combi F, Curcio A, Della Valle A, Ferrari G, Folli S, Ghilli M, Listorti C, Mancini S, Marinello P, Mele S, Pertusati A, Roncella M, Rossi L, Rovera F, Segattini S, Sgarella A, Tognali D, Corsi F. Low neutrophil-to-lymphocyte ratio and pan-immune-inflammation-value predict nodal pathologic complete response in 1274 breast cancer patients treated with neoadjuvant chemotherapy: a multicenter analysis. Ther Adv Med Oncol 2023; 15:17588359231193732. [PMID: 37720495 PMCID: PMC10504832 DOI: 10.1177/17588359231193732] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/24/2023] [Indexed: 09/19/2023] Open
Abstract
Background Systemic inflammatory markers draw great interest as potential blood-based prognostic factors in several oncological settings. Objectives The aim of this study is to evaluate whether neutrophil-to-lymphocyte ratio (NLR) and pan-immune-inflammation value (PIV) predict nodal pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in node-positive (cN+) breast cancer (BC) patients. Design Clinically, cN+ BC patients undergoing NAC followed by breast and axillary surgery were enrolled in a multicentric study from 11 Breast Units. Methods Pretreatment blood counts were collected for the analysis and used to calculate NLR and PIV. Logistic regression analyses were performed to evaluate independent predictors of nodal pCR. Results A total of 1274 cN+ BC patients were included. Nodal pCR was achieved in 586 (46%) patients. At multivariate analysis, low NLR [odds ratio (OR) = 0.71; 95% CI, 0.51-0.98; p = 0.04] and low PIV (OR = 0.63; 95% CI, 0.44-0.90; p = 0.01) were independently predictive of increased likelihood of nodal pCR. A sub-analysis on cN1 patients (n = 1075) confirmed the statistical significance of these variables. PIV was significantly associated with axillary pCR in estrogen receptor (ER)-/human epidermal growth factor receptor 2 (HER2)+ (OR = 0.31; 95% CI, 0.12-0.83; p = 0.02) and ER-/HER2- (OR = 0.41; 95% CI, 0.17-0.97; p = 0.04) BC patients. Conclusion This study found that low NLR and PIV levels predict axillary pCR in patients with BC undergoing NAC. Registration Eudract number NCT05798806.
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Affiliation(s)
- Maria Luisa Gasparri
- Department of Gynecology and Obstetrics, Ospedale Regionale di Lugano EOC, Lugano, Switzerland
- Centro di Senologia della Svizzera Italiana, Ospedale Regionale di Lugano EOC, Lugano, Switzerland
| | - Sara Albasini
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Marta Truffi
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Karin Favilla
- Scuola di specializzazione in Chirurgia Generale, Università di Milano, Milano, Italy
| | | | | | - Daniela Bossi
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Giulia Armatura
- Chirurgia Generale, Ospedale Centrale di Bolzano, Azienda Sanitaria dell’Alto Adige, Bolzano, Italy
| | - Arianna Calcinotto
- Institute of Oncology Research (IOR), Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Università della Svizzera italiana, Faculty of Biomedical Sciences, Lugano, Switzerland
| | | | - Francesca Combi
- International PhD School in Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Modena, Italy
- Division of Breast Surgical Oncology, Department of Medical and Surgical, Maternal-Infantile and Adult Sciences, University Hospital of Modena, Modena, Italy
| | - Annalisa Curcio
- Chirurgia Senologica, Ospedale Morgagni Pierantoni, Ausl Romagna, Forlì, Italy
| | - Angelica Della Valle
- General Surgery 3- Breast Surgery, Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Secondo Folli
- Breast Unit, Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Matteo Ghilli
- Breast Cancer Centre, University Hospital of Pisa, Pisa, Italy
| | - Chiara Listorti
- Breast Unit, Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Mancini
- Breast Surgery, Department of Surgery, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Peter Marinello
- Chirurgia Generale, Ospedale Centrale di Bolzano, Azienda Sanitaria dell’Alto Adige, Bolzano, Italy
| | - Simone Mele
- Breast Surgery Unit, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Anna Pertusati
- Breast Surgery, Department of Surgery, ASST Fatebenefratelli Sacco, Milano, Italy
| | | | - Lorenzo Rossi
- Centro di Senologia della Svizzera Italiana, Ospedale Regionale di Lugano EOC, Lugano, Switzerland
- Institute of Oncology of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | | | - Silvia Segattini
- Division of Breast Surgical Oncology, Department of Medical and Surgical, Maternal-Infantile and Adult Sciences, University Hospital of Modena, Modena, Italy
| | - Adele Sgarella
- General Surgery 3 – Breast Surgery, Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Università degli studi di Pavia, Pavia, Italy
| | - Daniela Tognali
- Chirurgia Senologica, Ospedale Morgagni Pierantoni, Ausl Romagna, Forlì, Italy
| | - Fabio Corsi
- Istituti Clinici Scientifici Maugeri IRCCS, Via Maugeri 4, Pavia, Lombardia, Italy
- Dipartimento di Scienze Biomediche e Cliniche, Università di Milano, Milano, Italy
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Munck F, Kroman N, Tvedskov THF. ASO Author Reflections: Feasibility of 125I Seed Targeted Axillary Dissection. Ann Surg Oncol 2023; 30:4143-4144. [PMID: 37029862 DOI: 10.1245/s10434-023-13446-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/09/2023]
Affiliation(s)
- F Munck
- Department of Breast Surgery, Gentofte Hospital, Gentofte, Denmark.
| | - N Kroman
- Department of Breast Surgery, Gentofte Hospital, Gentofte, Denmark
| | - T H F Tvedskov
- Department of Breast Surgery, Gentofte Hospital, Gentofte, Denmark
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Zaborowski AM, Wong SM. Neoadjuvant systemic therapy for breast cancer. Br J Surg 2023; 110:765-772. [PMID: 37104057 PMCID: PMC10683941 DOI: 10.1093/bjs/znad103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/02/2023] [Indexed: 04/28/2023]
Affiliation(s)
| | - Stephanie M Wong
- Department of Surgery and Oncology, McGill University Medical School, Montreal, Quebec, Canada
- Segal Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
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