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Identifying Gaps in the Locoregional Management of Early Breast Cancer: Highlights from the Kyoto Consensus Conference

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

A consensus conference was held to investigate issues related to the local management of early breast cancer. Here, we highlight the major topics discussed at the conference and propose ideas for future studies. Regarding axillary management, we examined three major issues. First, we discussed whether the use of axillary reverse mapping could clarify the lymphatic system of breast and whether the ipsilateral arm might help avoid lymphedema. Second, the use of an indocyanine green fluorescent navigation system was discussed for intraoperative lymphatic mapping. These new issues should be examined further in practice. Finally, some agreement was reached on the importance of “four-node diagnosis” to aid in the diagnostic accuracy of sentinel nodes. Regarding breast treatment, there was general agreement that the clinical value of surgical margins in predicting local failure was dependent on the tumor’s intrinsic biology and subtypes. For patients treated with preoperative chemotherapy, less extensive excision may be feasible in those who respond to systemic therapy in an acceptable manner. Most trials of preoperative chemotherapy lack outcome data on local recurrence. Therefore, there is a need for such data for overview analysis. We also agreed that radiation after mastectomy may be beneficial in node-positive cases where more than four nodes are involved. Throughout the discussions for both invasive and noninvasive disease, the investigation of nomograms was justified for major issues in the decision-making process, such as the presence or absence of microinvasion and the involvement of nonsentinel nodes in sentinel node-positive patients.

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Acknowledgment

We thank Dr. Masahiro Hiraoka, Chairman of the Department of Radiation Oncology and Image-applied Therapy at Kyoto University, the executive advisor to this project. We are also grateful to Dr. Fabrizio Michelassi, Chairman of the Department of Surgery at New York Presbyterian Hospital, Weill Cornell Medical Center, for providing guidance regarding the consensus questionnaire. We thank the Kyoto University Foundation for their generous donation of funds. The conference was part of a program, “Raising Proficient Oncologists,” run by the Japanese Ministry of Education, Culture, Sports, Science, and Technology. We acknowledge the kind support of the Japan Breast Cancer Society. We express sincere thanks to the doctors who completed the consensus questionnaire. We are grateful to Dr. Hiroshi Ishiguro for his valuable help and scientific advice. We also thank Ms. Aya Morotomi, Mr. David Graham, Ms. Mihoko Yamamoto, Ms. Nastajia Burke, Ms. Chisa Takano, and Ms. Nobuko Yagi for their invaluable support. Moderators: S. K. Apple (University of California, Los Angeles), J. R. Benson (Addenbrooke’s Hospital and University of Cambridge, Cambridge), W. C. Chow (UNIMED Medical Institute/Hong Kong University, Hong Kong), J. F. Forbes (The University of Newcastle, Newcastle), M. Golshan (Dana-Farber Cancer Institute, Brigham & Women’s Cancer Center, Boston), T. Inamoto (Kitano Hospital, Osaka), V. S. Klimberg (University of Arkansas for Medical Sciences, Arkansas), M. Mitsumori (Kyoto University, Kyoto), S. Noguchi (Osaka University, Osaka), J. F. R. Robertson (The University of Nottingham, Nottingham), D. H. Roukos (University of Ioannina, Ioannina), H. Sasano (Tohoku University, Sendai), E. A. Strom (The University of Texas M.D. Anderson Cancer Center, Houston), M. Toi (Kyoto University, Kyoto), G. Von Minckwitz (The Centre for Gynecology and Obstetrics at the University of Frankfurt, Frankfurt), E. P. Winer (Dana-Farber Cancer Institute, Brigham & Women’s Cancer Center, Boston), and A. Yamauchi (Kitano Hospital, Osaka). Discussants and organizers: S. Akashi-Tanaka (National Cancer Center Hospital, Tokyo), R. Arriagada (Karolinska institute, Stockholm/Institut Gustave-Roussy, Paris), J. Chen (Cancer Hospital of Fudan University, Shanghai), S.C. Chen (Chang Gung University, Taoyuan), S.W. Ha (Seoul National University Hospital, Seoul), S. Han (Inje University Sanggye Paik Hospital, Kyungnam), C. S. Huang and T. Ikeda (Teikyo University, Tokyo), S. Imoto (Kyorin University, Tokyo), H. Inaji (Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka), T. Iwase (The Cancer Institute Hospital of JFCR, Tokyo), H. Iwata (Aichi Cancer Center, Nagoya), R. V. Jakesz (University of Vienna, Vienna), H. Jinno (Keio University, Tokyo), H. Kawabata (Toranomon Hospital, Tokyo), T. Kinoshita (National Cancer Center Hospital, Tokyo), T. Kitai (Nara Social Insurance Hospital, Nara), N. Kohno (Tokyo Medical University, Tokyo), I. E. Krop (Dana-Farber Cancer Institute, Brigham and Women’s Cancer Center, Boston), I. Kunkler (University of Edinburgh, Edinburgh), J. Kurebayashi (Kawasaki Medical University, Kurashiki), K. Kuroi (Tokyo Metropolitan Cancer and Infectious Disease Center, Tokyo), E. S. Lee (Korea University Anam-Hospital, Seoul), S. J. Lee (Yeungnam University, Gyeongsan), N. Masuda (Osaka National Hospital, Osaka), Y. Mikami (Kyoto University, Kyoto), S. Nakamura (St. Luke’s International Hospital, Tokyo), D. Y. Noh (Seoul National University, Seoul), S. Ohno (National Kyushu Cancer Center, Fukuoka), N. S. Paik (Konkuk University Medical Center, Seoul), M. D. Pegram (University of Miami, Miller School of Medicine, Miami), T. Saeki (Saitama Medical University, Saitama), M. Shafir (Mount Sinai Hospital and School of Medicine, New York), H. Takei (Saitama Cancer Center, Saitama), H. Sonoo (Kawasaki Medical School Hospital, Kurashiki), T. Sugie (Kyoto University, Kyoto), M. Takada (Kyoto University, Kyoto), Y. Tanaka (Kyoto University, Kyoto), T. Ueno (Kyoto University, Kyoto), T. Varughese (Lakeshore Hospital and Research Centre, Cochin), and K. Yamagami (Shinko Hospital, Kobe).

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Authors and Affiliations

  1. Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawara-cho, Sakyo-ku, Kyoto, Japan

    Masakazu Toi MD

  2. Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

    Eric P. Winer MD

  3. Department of Breast Surgery, Kitano Hospital, Osaka, Japan

    Takashi Inamoto MD & Akira Yamauchi MD

  4. Cambridge Breast Unit, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK

    John R. Benson MD

  5. Department of Surgical Oncology, University of Newcastle, Newcastle, Australia

    John F. Forbes MD

  6. Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine at Kyoto University, Kyoto, Japan

    Michihide Mitsumori MD

  7. Professorial Unit of Surgery, Division of Breast Surgery, University of Nottingham, Nottingham, UK

    John F. R. Robertson MD

  8. Department of Pathology, Tohoku University School of Medicine, Sendai, Japan

    Hironobu Sasano MD

  9. Department of Gynecology and Obstetrics, Goethe University, Frankfurt am Main, Germany

    Gunter von Minckwitz MD

  10. Division of Breast Surgical Oncology, Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    V. Suzanne Klimberg MD

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  1. Masakazu Toi MD
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  2. Eric P. Winer MD
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  3. Takashi Inamoto MD
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  4. John R. Benson MD
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  6. Michihide Mitsumori MD
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  7. John F. R. Robertson MD
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  8. Hironobu Sasano MD
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  9. Gunter von Minckwitz MD
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  10. Akira Yamauchi MD
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  11. V. Suzanne Klimberg MD
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Corresponding author

Correspondence to Masakazu Toi MD.

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This study is conducted on behalf of the 2009 Kyoto Breast Cancer Consensus Conference panelists.

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Toi, M., Winer, E.P., Inamoto, T. et al. Identifying Gaps in the Locoregional Management of Early Breast Cancer: Highlights from the Kyoto Consensus Conference. Ann Surg Oncol 18, 2885–2892 (2011). https://doi.org/10.1245/s10434-011-1666-7

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  • DOI: https://doi.org/10.1245/s10434-011-1666-7

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