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Trends in Axillary Management of Early Breast Cancer: a Questionnaire-Based Pattern of Practice Survey for India

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Abstract

Surgical management of breast cancer (BC) has evolved from radical surgeries to conservative with better cosmetic and comparable oncological outcomes. For axillary staging, it has evolved from axillary lymph node dissection (ALND) to sentinel lymph node biopsy (SLNB). No detailed information exists in terms of the clinical practice pattern of surgical management of axilla for BC patients in India. A questionnaire-based survey was developed. The survey was done at the annual meeting of the Association of Breast Surgeons of India (ABSI) in November 2018. Responses were recorded and analysed by SPSS 23. One hundred twelve out of 400 (28%) responded to the survey. Half of the respondents were surgical oncologist and 36.6% were performing > 150 BC surgeries/year. The primary technique for axillary staging in node-negative BC was SLNB for 68.5% of respondents. Majority of surgeons (47%) reported performing SLNB by methylene blue dye only. Unavailability of radioisotope (46.7%) and lack of frozen section (26.7%) were reported as two major barriers for not performing SLNB. Twenty-three percent did perform SLNB in post-NACT setting. Only 15.8% have omitted completion ALND in Z0011 trial eligible SLN-positive patients. 45.9% skipped completion ALND in SLN positive with micro metastasis only. Many surgeons in India are adopting SLNB as a method of axillary staging into their clinical practice. However, large number of surgeons still believe in conservative approach, most probably due to unavailability of resources and lack of Indian data. Barrier identified in this survey may be useful for future development.

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Abbreviations

ABSI:

Association of Breast Surgeons of India

ALND:

axillary lymph node dissection

EBC:

early breast cancer

DFS:

disease-free survival

ICG:

indocyanine green

LAS:

low axillary sampling

MB:

methylene blue

MDT:

multi-disciplinary team

NACT:

neoadjuvant chemotherapy

OS:

overall survival

SLNB:

sentinel lymph node biopsy

SOUND:

sentinel node versus observation after axillary ultrasound

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Authors and Affiliations

  1. Department Of Breast Oncosurgery, Tata Medical Center, Rajarhat, Newtown, Kolkata, West Bengal, 700156, India

    Sanjit Kumar Agrawal, Noopur Priya, Pooja Agarwal, Abhishek Sharma & Rosina Ahmed

  2. Department of palliative care and psycho oncology, Tata Medical Center, Kolkata, India

    Soumitra Shankar Datta

  3. Department of Surgical Oncology, AIIMS, New Delhi, India

    S. V. S. Deo

Authors
  1. Sanjit Kumar Agrawal
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  2. Noopur Priya
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  6. S. V. S. Deo
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  7. Rosina Ahmed
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Contributions

Conceptualization: Sanjit Kumar Agrawal. Methodology: Sanjit Kumar Agrawal, Soumitra Shankar Datta, Rosina Ahmed, S.V.S Deo. Data collection: Noopur Priya and Pooja Agrawal. Data analysis: Sanjit Kumar Agrawal and Abhishek Sharma. Writing—original draft preparation: Sanjit Kumar Agrawal and Noopur Priya. Writing—review and editing: All authors. Final approval of manuscript: All authors.

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Correspondence to Sanjit Kumar Agrawal.

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Agrawal, S.K., Priya, N., Agarwal, P. et al. Trends in Axillary Management of Early Breast Cancer: a Questionnaire-Based Pattern of Practice Survey for India. Indian J Surg Oncol 12, 401–407 (2021). https://doi.org/10.1007/s13193-021-01334-4

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