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Current axillary management of patients with early breast cancer and low-volume nodal disease undergoing primary surgery: results of a United Kingdom national practice survey

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2024年5月10日

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  • K. Fairhurst,
  • S. A. McIntosh,
  • R. I. Cutress,
  • S. Potter,
  • Nick Abbott,
  • Mohammad Abdullah,
  • Avi Agrawal,
  • Laura Arthur,
  • Amina Bouhelal,
  • Rachel Bright-Thomas,
  • Victoria Brown,
  • Sundas Butt,
  • Charlie Chan,
  • Wilson Cheah,
  • Adamantia Chrysafi,
  • Sarah Clark,
  • Ramsey Cutress,
  • Urszula Donigiewicz,
  • Hannah Dunlop,
  • Donna Egbeare,
  • Waleed Fahmy,
  • Douglas Ferguson,
  • Nina Gill,
  • Daniel Glassman,
  • Tomasz Graja,
  • Kelvin Francis Gomez,
  • Amit Goyal,
  • Ahmed Hamad,
  • Anita Hargreaves,
  • Grant Harris,
  • Thomas Hubbard,
  • Alex Humphreys,
  • Javeria Iqbal,
  • Eliana Kalakouti,
  • Charlotte Kallaway,
  • Isabella Karat,
  • Sabeeha Karim,
  • Saira Khawaja,
  • Polly King,
  • Eleftheria Kleidi,
  • Hannah Knight,
  • Jaroslaw Krupa,
  • Alexander Leeper,
  • Valentina Lefemine,
  • Rebecca Lewis,
  • Richard Linforth,
  • Emma MacInnes,
  • Mhairi Mactier,
  • Christina Mamareli,
  • Yazan Masannat,
  • Tahir Masudi,
  • Ross McLean,
  • Rob Milligan,
  • Bijan Ansari Mohabadian,
  • Jenna Morgan,
  • Asma Munir,
  • Claire Murphy,
  • Soudamini Nayak,
  • Keith Ogston,
  • Robert Price,
  • Mujahid Pervaz,
  • Saed Ramzi,
  • Tim Rattay,
  • Azel Regan,
  • Laszlo Romics,
  • Claire Louise Rutherford,
  • Sunita Saha,
  • Ibrahim Sallam,
  • Subodh Seth,
  • Lisa Sheehan,
  • Amanda Thorne,
  • Raghavan Vidya,
  • Kate Williams,
  • Mina Youssef,
  • Shaista Zafar

摘要

Purpose

UK NICE guidelines recommend axillary node clearance (ANC) should be performed in all patients with biopsy-proven node-positive breast cancer having primary surgery. There is, however, increasing evidence such extensive surgery may not always be necessary. Targeted axillary dissection (TAD) may be an effective alternative in patients with low-volume nodal disease who are clinically node negative (cN0) but have abnormal nodes detected radiologically. This survey aimed to explore current management of this group to inform feasibility of a future trial.

Methods

An online survey was developed to explore current UK management of patients with low-volume axillary disease and attitudes to a future trial. The survey was distributed via breast surgery professional associations and social media from September to November 2022. One survey was completed per unit and simple descriptive statistics used to summarise the results.

Results

51 UK breast units completed the survey of whom 78.5% (n = 40) reported performing ANC for all patients with biopsy-proven axillary nodal disease having primary surgery. Only 15.7% of units currently performed TAD either routinely (n = 6, 11.8%) or selectively (n = 2, 3.9%). There was significant uncertainty (83.7%, n = 36/43) about the optimal surgical management of these patients. Two-thirds (n = 27/42) of units felt an RCT comparing TAD and ANC would be feasible.

Conclusions

ANC remains standard of care for patients with low-volume node-positive breast cancer having primary surgery in the UK, but considerable uncertainty exists regarding optimal management of this group. This survey suggests an RCT comparing the outcomes of TAD and ANC may be feasible.