Axillary Staging after Neoadjuvant Chemotherapy for Initially Node-Positive Breast Carcinoma in Germany
Abstract Introduction To date, the optimal axillary staging procedure for initially node-positive breast carcinoma patients after neoadjuvant chemotherapy (NACT) has been unclear. The aim of the AXSANA study is to prospectively compare different surgical staging techniques with respect to the oncolo...
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Veröffentlicht in: | Geburtshilfe und Frauenheilkunde 2022-09, Vol.82 (9), p.932-940 |
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Zusammenfassung: | Abstract
Introduction
To date, the optimal axillary staging procedure for initially node-positive breast carcinoma patients after neoadjuvant chemotherapy (NACT) has been unclear. The aim of
the AXSANA study is to prospectively compare different surgical staging techniques with respect to the oncological outcome and quality of life for the patients. Little is known about current
clinical practice in Germany.
Material and Methods
In this paper we analyzed data from patients enrolled in the AXSANA study at German study sites from June 2020 to March 2022.
Results
During the period under investigation, 1135 patients were recruited at 143 study sites. More than three suspicious lymph nodes were initially found in 22% of patients. The
target lymph node (TLN) was marked in 64% of cases. This was done with clips/coils in 83% of patients, with magnetic seeds or carbon suspension in 8% each, and with a radar marker in 1% of
patients. After NACT, targeted axillary dissection (TAD) or axillary lymphadenectomy (ALND) were each planned in 48% of patients, and sentinel lymph node biopsy alone (SLNB) in 2%.
Clinically, the nodal status after NACT was found to be unremarkable in 65% of cases. Histological lymph node status was correctly assessed by palpation in 65% of patients and by sonography
in 69% of patients.
Conclusion
At the German AXSANA study sites, TAD and ALND are currently used as the most common surgical staging procedures after NACT in initially node-positive breast cancer
patients. The TLN is marked with various markers prior to NACT. Given the inadequate accuracy of clinical assessment of axillary lymph node status after NACT, it should be questioned whether
axillary dissection after NACT should be performed based on clinical assessment of nodal status alone.
Zusammenfassung
Einleitung
Das optimale axilläre Stagingverfahren für initial nodal positive MammakarzinompatientInnen nach neoadjuvanter Chemotherapie (NACT) ist bislang unklar. Die AXSANA-Studie
wird mit dem Ziel durchgeführt, die verschiedenen operativen Stagingtechniken hinsichtlich ihres onkologischen Outcomes und der Lebensqualität prospektiv miteinander zu vergleichen. Über die
aktuelle klinische Praxis in Deutschland ist wenig bekannt.
Material und Methoden
Die Daten der von Juni 2020 bis März 2022 an deutschen Studienzentren in die AXSANA-Studie aufgenommenen PatientInnen wurden analysiert.
Ergebnisse
Im Untersuchungszeitraum wurden 1135 PatientInnen an 143 Studienstandorten rekrutiert. Bei 22 |
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ISSN: | 0016-5751 1438-8804 |
DOI: | 10.1055/a-1889-7883 |