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
. 2024 Aug;206(3):465-471.
doi: 10.1007/s10549-024-07328-4. Epub 2024 May 10.

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

K Fairhurst  1 , S A McIntosh  2 , R I Cutress  3 , S Potter  4 ; Our Citable Collaborators
Collaborators, Affiliations

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

K Fairhurst et al. Breast Cancer Res Treat. 2024 Aug.

Abstract

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.

Keywords: Axillary node clearance; Breast cancer; Low volume nodal disease; Targeted axillary dissection; Trial feasibility.

PubMed Disclaimer

Conflict of interest statement

SMcI reports honoraria from MSD, Roche, BD, Lilly, Novartis and Astra Zeneca, conference travel and support from Roche, Lilly and MSD, and institutional research funding from Novartis. RIC declares institutional research support from SECA and Astra Zeneca. KF and SP have no conflicts of interest to declare.

References

    1. Cancer Research UK (Cruk). https://www.cancerresearchuk.org/health-Professional/Cancer-Statistics/S.... Accessed 20 Jul 2023
    1. National Institute for Health and Care Excellence (Nice) (2018) Early and locally advanced breast cancer: diagnosis and management [Ng101] - PubMed
    1. Disipio T, et al. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013;14(6):500–515. doi: 10.1016/S1470-2045(13)70076-7. - DOI - PubMed
    1. Wang L, et al. Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies. CMAJ. 2016;188(14):E352–E361. doi: 10.1503/cmaj.151276. - DOI - PMC - PubMed
    1. Giuliano AE, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: long-term follow-up from the American College of Surgeons Oncology Group (Alliance) Acosog Z0011 randomized trial. Ann Surg. 2016;264(3):413–420. doi: 10.1097/SLA.0000000000001863. - DOI - PMC - PubMed