Is routine axillary lymph node dissection needed to tailor systemic treatments for breast cancer patients in the era of molecular oncology? A position paper of the Italian National Association of Breast Surgeons (ANISC).

Autor: Rocco N; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy. Electronic address: nicola.rocco@unina.it., Ghilli M; Breast Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy., Curcio A; UOC Chirurgia Senologica, AUSL della Romagna, Forlì, Italy., Bortul M; SSD Chirurgia Senologica e Breast Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy Naples, Italy., Burlizzi S; UOSD Chirurgia Senologica, Ospedale 'A. Perrino', Brindisi, Italy., Cabula C; Chirurgia Senologica Azienda Ospedaliera Brotzu, Cagliari, Italy., Cabula R; Cagliari University Hospital, Surgery Unit, Cagliari, Italy., Ferrari A; SSD Chirurgia Tumori eredo-famigliari, SC Chirurgia Generale 3, Senologia, Fondazione IRCCS Policlinico san Matteo, Pavia, Italy., Folli S; SC di Chirurgia Oncologica-Senologia, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy., Fortunato L; Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy., Frittelli P; UOC Chirurgia senologica, Ospedale Isola Tiberina Gemelli Isola, Rome, Italy., Gentilini O; Breast Unit, IRCCS Ospedale San Raffaele di Milano, Milan, Italy., Grendele S; Breast Surgery, Department of Functional Oncology, Alto Vicentino Hospital, Santorso, Vicenza, Italy., Grassi MM; Breast Unit, Humanitas Gavazzeni Clinical Institute, Bergamo, Italy., Grossi S; Breast Unit, P.O. 'G. Bernabeo', Ortona, Italy., Magnoni F; Division of Senology, European Institute of Oncology, IRCCS, Milan, Italy., Murgo R; Chirurgia Senologica, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy., Palli D; UOC di Chirurgia Generale ad Indirizzo Senologico-Breast Unit AUSL Piacenza, Italy., Rovera F; S.S.D. Breast Unit - Ospedale Universitario, Varese, Italy; Dipartimento di Medicina e Innovazione Tecnologica, Università degli Studi dell'Insubria, Varese, Italy., Sanguinetti A; SSD Chirurgia della Mammella - Dipartimento di Chirurgia, Azienda Ospedaliera 'S.Maria', Terni, Italy., Taffurelli M; Breast Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy., Tazzioli G; Breast Unit AOU Policlinico di Modena, Modena, Italy., Terribile DA; Breast Unit, IRCCS Fondazione Policlinico Gemelli, Rome, Italy., Caruso F; Breast Unit, Humanitas Istituto Clinico Catanese, Misterbianco, (CT), Italy; National Association of Breast Surgeons (ANISC), Italy., Galimberti V; Division of Senology, European Institute of Oncology, IRCCS, Milan, Italy.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2024 Feb; Vol. 50 (2), pp. 107954. Date of Electronic Publication: 2024 Jan 06.
DOI: 10.1016/j.ejso.2024.107954
Abstrakt: Background: De-escalation of axillary surgery in breast cancer (BC) management began when sentinel lymph node biopsy (SLNB) replaced axillary lymph node dissection (ALND) as standard of care in patients with node-negative BC. The second step consolidated ALND omission in selected subgroups of BC patients with up to two macrometastases and recognized BC molecular and genomic implication in predicting prognosis and planning adjuvant treatment. Outcomes from the recent RxPONDER and monarchE trials have come to challenge the previous cut-off of two SLN in order to inform decisions on systemic therapies for hormone receptor-positive (HR+), human epidermal growth factor receptor type-2 (HER2) negative BC, as the criteria included a cut-off of respectively three and four SLNs. In view of the controversy that this may lift in surgical practice, the Italian National Association of Breast Surgeons (Associazione Nazionale Italiana Senologi Chirurghi, ANISC) reviewed data regarding the latest trials on this topic and proposes an implementation in clinical practice.
Material and Methods: We reviewed the available literature offering data on the pathological nodal status of cN0 breast cancer patients.
Results: The rates of pN2 status in cN0 patients ranges from 3.5 % to 16 %; pre-surgical diagnostic definition of axillary lymph node status in cN0 patients by ultrasound could be useful to inform about a possible involvement of ≥4 lymph nodes in this specific sub-groups of women.
Conclusions: The Italian National Association of Breast Surgeons (ANISC) considers that for HR + HER2-/cN0-pN1(sn) BC patients undergoing breast conserving treatment the preoperative workup should be optimized for a more detailed assessment of the axilla and the technique of SLNB should be optimized, if considered appropriate by the surgeon, not considering routine ALND always indicated to determine treatment recommendations according to criteria of eligibility to RxPONDER and monarch-E trials.
(© 2024 Published by Elsevier Ltd.)
Databáze: MEDLINE
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