De-Escalating Axillary Surgery in Node-Positive Breast Cancer Treated with Neoadjuvant Systemic Therapy

S.R. de Wild*, J.M. Simons, MJTFDV Peeters, M.L. Smidt, L.B. Koppert

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

Abstract

Background: There is a trend towards de-escalating axillary staging and treatment in breast cancer patients. On account of neoadjuvant systemic therapy, node-positive breast cancer patients can achieve a pathological complete response of the axilla. It is hypothesized that these patients do not benefit from an axillary lymph node dissection (ALND), and thus may be spared the risk of severe post-surgical morbidity. In an effort to omit standard ALND, less invasive axillary staging procedures are being implemented to establish response-guided treatment. However, it is unclear which less invasive staging procedure is most accurate, and long-term data are missing with regard to their oncologic safety. Summary: This article provides an overview of the literature on currently used less invasive axillary staging procedures, the accuracy and feasibility of these procedures in clinical practice, important issues concerning axillary treatment, and issues to be addressed in ongoing or future studies. Key messages: More evidence is needed regarding the safety of replacing standard ALND by less invasive axillary staging procedures in terms of long-term prognosis. These less invasive staging procedures not only serve to select patients who may benefit from treatment de-escalation, but also to select patients who may benefit from treatment escalation.
Original languageEnglish
Pages (from-to)584-589
Number of pages6
JournalBreast Care
Volume16
Issue number6
Early online date17 Aug 2021
DOIs
Publication statusPublished - 2021

Keywords

  • Node-positive breast cancer
  • Neoadjuvant systemic therapy
  • Axillary surgery
  • PATHOLOGICAL COMPLETE RESPONSE
  • RADIOACTIVE IODINE SEEDS
  • SENTINEL-NODE
  • PREOPERATIVE CHEMOTHERAPY
  • LYMPH-NODES
  • DISSECTION
  • BIOPSY
  • MULTICENTER
  • TRIAL
  • LOCALIZATION

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