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Targeted axillary dissection: worldwide variations in clinical practice

  • 期刊论文

  • 发表日期：

    2024年1月4日

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  • Michalis Kontos,
  • Prodromos Kanavidis,
  • Thorsten Kühn,
  • Yazan Masannat,
  • Bahadir Gulluoglu,
  • Eduardo Gonzalez,
  • Melanie Walker,
  • A. J. Collins,
  • M. T. Nano,
  • Kim Heron,
  • Beth Penington,
  • Mike He,
  • Norman Janu,
  • Katrina Read,
  • Jose Cid Fernandez,
  • Belinda Brown,
  • Aashit Shah,
  • Kylie Snook,
  • Sarah Forsyth,
  • Janne Bingham,
  • Jocelyn Lippey,
  • Joel Symonds,
  • Alec Winder,
  • Nita Bartlett,
  • Petar Vujovic,
  • Jenny Gough,
  • Sarah Birks,
  • Farid Meybodi,
  • Saud Hamza,
  • Elisabeth Elder,
  • Heidi Stranzl,
  • Tahmina Kosayeva,
  • Glenn Vergauwen,
  • Jaime Letzkus,
  • Gilberto Benitez,
  • Eduardo Cabrera,
  • Evros Kitiris,
  • Michalis Kailides,
  • Patricio Corral,
  • Khaled Mohamed Abdelwahab Ali,
  • Laura Niinikoski,
  • Kerstin Weinand,
  • Stephan Hasmüller,
  • Conny Kurz,
  • Hans-Christian Kolberg,
  • Ingo Thalmann,
  • Maggie Banys-Paluchowski,
  • Aikaterini Manika,
  • Vasileios Venizelos,
  • Georgios Metaxas,
  • Lazaros Papadopoulos,
  • Ioannis Natsiopoulos,
  • Eleftheria Ignatiadou,
  • Rodoniki Iosifidou,
  • Ioannis Askoksilakis,
  • Nikolaos Michalopoulos,
  • Grigorios Xepapadakis,
  • Serena Yu Yan Wong,
  • Karishma Kirti,
  • Roghieh Nooripour,
  • Alessandra Invento,
  • Lea Regolo,
  • Corrado Chiappa,
  • Maria-Grazia Lazzaretti,
  • Andrea Sibilio,
  • Viviana-Enrica Galimberti,
  • Denise Mattar,
  • Silvia Michieletto,
  • Rosa Di Micco,
  • Teresa Di Palma,
  • Oreste D. Gentilini,
  • Nicola Rocco,
  • Mauro Porpiglia,
  • Mervat Alsaleh,
  • Ibtisam Albader,
  • Sergio Aguilar-Villanueva,
  • Emiel Rutges,
  • Eva Juhasz,
  • Nicola Davis,
  • Stan Govender,
  • Khaled Sharaf,
  • Lia Pamela Rebaza Vasquez,
  • Aldine Basa,
  • Dawid Murawa,
  • David Pinto,
  • Bonci Eduard-Alexandru,
  • Florin Bobirca,
  • Elena Adelina Toma,
  • Bogdan Diaconescu,
  • Radu Mihail Mirica,
  • Adrian Udrea,
  • Silvia Brotea-Mosoiu,
  • Gabriel Dimofte,
  • Lunca Sorinel,
  • Octav Ginghina,
  • Gata Vlad Alexandru,
  • Mihai-Stefan Muresan,
  • Ana-Maria Musina,
  • Lolwah Alriyees,
  • Chi Wei Mok,
  • Andraz Perhavec,
  • Laura Comin,
  • José Ignacio Sánchez-Méndez,
  • Gloria Ortega-Perez,
  • Jana De Boniface,
  • Ira Oikonomou,
  • Andreas Karakatsanis,
  • Christoph Tausch,
  • Walter Weber,
  • Maria-Luisa Gasparri,
  • Ahmet Necati Sanli,
  • Seymur Abdullayev,
  • Melek Gokova,
  • Abut Kebudi,
  • Gultekin Ozan Kucuk,
  • Baha Zengel,
  • Tolga Kalayci,
  • Lutfi Dogan,
  • Betul Bozkurt,
  • Semra Gunay,
  • Elina Shaari,
  • Ashutosh Kothari,
  • Manas Dube,
  • Chloe Constantinou,
  • Teresa Fernandez Cuadrafo,
  • Jane Macaskill,
  • Hazem Khout,
  • Anupama Nagarajakumar,
  • Rob Milligan,
  • Laura Arthur,
  • Ricardo Pardo,
  • Peter Barry,
  • Emanuele Garreffa,
  • Jill Dietz,
  • Shawna Willey,
  • Judy Boughey,
  • Susan Boolbol,
  • Anne Peled

摘要

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.