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Axillary staging and management of cN + breast cancer patients treated with neoadjuvant chemotherapy: results of a survey among breast cancer surgeons in Spain

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Abstract

Introduction

Given the high rate of complete nodal response, the role of axillary lymph node dissection on staging the axilla has been questioned. This survey, addressed to breast cancer surgeons in Spain, has the objective of assessing current clinical trends on axillary staging of cN + patients treated with NAC.

Methods

An online survey was conducted among breast surgeons from the Spanish Society of Surgery (AEC), Spanish Surgical Oncology Society (SEOQ), Spanish Breast Cancer Surgeons Society (AECIMA) and Spanish Gynecology and Obstetrics Society (SEGO). It was structured in 5 sections: general information and clinical practice, knowledge of clinical trials, diagnosis work-up and nodal marking, axillary staging, and axillary treatment.

Results

150 breast cancer surgeons completed the full survey (96.7%). 81.8% of respondents performed SLNB or targeted axillary dissection in cN1 patients treated with NAC. Radiological axillary response was the preferred parameter guiding the surgical strategy. The excision of the clipped node (92.0%), use of dual tracer (73.2%), and axillary US (65.9%) after treatment were the most important variables considered by respondents, to increase the accuracy of SLNB in cN + patients.

Conclusion

This survey confirms a trend toward a less invasive approach for axillary staging in cN + patients treated with NAC among breast cancer surgeons in Spain. While there is widespread agreement in less invasive approaches to axillary staging, there is, however, a lack of consensus around treatment strategy. Further, it shows a wide heterogeneity in their clinical practice. This study highlights the need for clear evidence concerning less invasive staging procedures and their oncological safety, to ensure consistent recommendations in surgical practice.

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Abbreviations

NAC:

Neoadjuvant systemic therapy

cN + :

Clinical node positive

AEC:

Asociación española de Cirujanos

SEOQ:

Sociedad española de Oncología Quirúrgica

AECIMA:

Asociación española de cirujanos de mama

SEGO:

Sociedad Española de Ginecología y Obstetricia

SLNB:

Sentinel lymph node biopsy

US:

Ultrasound

ALND:

Axillary lymph node dissection

HER2:

Human epidermal growth factor receptor 2

TLNB:

Targeted lymph node biopsy

TAD:

Targeted axillary dissection

FNR:

False-negative rate

MRI:

Magnetic resonance imaging

PET TC:

Positron emission tomography

I125:

Iodine-125

ITC:

Isolated tumor cells

RT:

Radiotherapy

pCR:

Complete pathological response

SN:

Sentinel node

IHQ:

Immunohistochemistry

OSNA:

One-step nucleic acid amplification

LRNI:

Locoregional nodal irradiation

WBRT:

Whole breast radiotherapy

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Funding

Non-financial interests.

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Authors and Affiliations

  1. General and Digestive Surgery, Hospital Quironsalud Torrevieja, Torrevieja, Alicante, Spain

    Paula Munoz, Alejandro Paz & Vicente Muñoz-Madero

  2. General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain

    Sara Corral, Antonio Mena, Jacobo Cabañas & Sonia Rivas

  3. General and Digestive Surgery, Clínica Universidad de Navarra, Pamplona, Spain

    Fernando Martínez-Regueira

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  1. Paula Munoz
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Correspondence to Paula Munoz.

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This study has been approved by the research ethics committee – institutional review board- of Ramon y Cajal Hospital (Madrid).

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Munoz, P., Corral, S., Martínez-Regueira, F. et al. Axillary staging and management of cN + breast cancer patients treated with neoadjuvant chemotherapy: results of a survey among breast cancer surgeons in Spain. Clin Transl Oncol 25, 1463–1471 (2023). https://doi.org/10.1007/s12094-022-03049-6

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