Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May;25(5):1463-1471.
doi: 10.1007/s12094-022-03049-6. Epub 2022 Dec 31.

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

Paula Munoz  1 , Sara Corral  2 , Fernando Martínez-Regueira  3 , Alejandro Paz  4 , Vicente Muñoz-Madero  4 , Antonio Mena  2 , Jacobo Cabañas  2 , Sonia Rivas  2
Affiliations

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

Paula Munoz et al. Clin Transl Oncol. 2023 May.

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.

Keywords: Axillary node dissection; Breast cancer; Neoadjuvant chemotherapy; Sentinel lymph node biopsy; Targeted axillary dissection.

PubMed Disclaimer

Similar articles

See all similar articles

References

    1. Mougalian SS, Soulos PR, Killelea BK, Lannin DR, Abu-Khalaf MM, Digiovanna MP, et al. Use of neoadjuvant chemotherapy for patients with stage i to III breast cancer in the United States. Cancer. 2015;121(15):2544–52. - DOI - PubMed
    1. Vugts G, Maaskant-Braat AJG, Nieuwenhuijzen GAP, Roumen RMH, Luiten EJT, Voogd AC. Patterns of care in the administration of neo-adjuvant chemotherapy for breast cancer. Popul Based Study Breast J. 2016;22(3):316–21.
    1. Hennessy BT, Hortobagyi GN, Rouzier R, Kuerer H, Sneige N, Buzdar AU, et al. Outcome after pathologic complete eradication of cytologically proven breast cancer axillary node metastases following primary chemotherapy. J Clin Oncol. 2005;23(36):9304–11. - DOI - PubMed
    1. Lim B. Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: Findings from the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial. Vol. 26, Breast Diseases. Academic Press Inc.; 2015. p. 249–50.
    1. Dominici LS, Negron Gonzalez VM, Buzdar AU, Lucci A, Mittendorf EA, Le-Petross HT, et al. Cytologically proven axillary lymph node metastases are eradicated in patients receiving preoperative chemotherapy with concurrent trastuzumab for HER2-positive breast cancer. Cancer. 2010;116(12):2884–9. - DOI - PubMed

LinkOut - more resources