Management of the axilla in patients with breast cancer and positive sentinel lymph node biopsy: An evidence-based update in a European breast center

Publication date: Available online 13 August 2019Source: European Journal of Surgical OncologyAuthor(s): Carlos A. Garcia-Etienne, Alberta Ferrari, Angelica Della Valle, Marco Lucioni, Elisa Ferraris, Giuseppe Di Giulio, Luigi Squillace, Elisabetta Bonzano, Angioletta Lasagna, Gianpiero Rizzo, Richard Tancredi, Andrea Scotti Foglieni, Francesca Dionigi, Maurizia Grasso, Eloisa Arbustini, Giorgio Cavenaghi, Paolo Pedrazzoli, Andrea R. Filippi, Paolo Dionigi, Adele SgarellaAbstractThe surgical approach to the axilla in breast cancer has been a controversial issue for more than three decades. Data from recently published trials have provided practice-changing recommendations in this scenario. However, further controversies have been triggered in the surgical community, resulting in heterogeneous diffusion of these recommendations.The development of clinical guidelines for the management of the axilla in patients with breast cancer is a work in progress. A multidisciplinary team discussion was held at the research hospital Policlinico San Matteo from the Università degli Studi di Pavia with the aim to update recommendations for the management of the axilla in patients with breast cancer. An evidence-based approach is presented.Our multidisciplinary panel determined that axillary dissection after a positive sentinel lymph node biopsy may be avoided in cN0 patients with micro/macrometastasis to ≤2 sentinel nodes, with age ≥40y, lesions ≤3 cm, who have not received...
Source: European Journal of Surgical Oncology (EJSO) - Category: Surgery Source Type: research

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Conclusion: Despite the fact that OS was performed in patients with worse tumour conditions and in more demanding patients, OS allowed similar cosmetic results to classical BCT.Breast Care
Source: Breast Care - Category: Cancer & Oncology Source Type: research
To the Editor The main claim of the authors of the secondary analysis of the BrighTNess randomized clinical trial is that “patients with stages II to III TNBC who are not eligible for breast-conserving therapy (BCT) at presentation have an approximately 50% likelihood of converting to BCT eligible with neoadjuvant systemic therapy (NST).” This resulted in an overall increase in BCT eligibility of 7% (from 76.5% to 83.5%). However, the actual BCT rate after NST in 599 patients with pre- NST and post-NST evaluations for BCT eligibility was 57%, which is about 20% less than initially planned, and in agreement with...
Source: JAMA Surgery - Category: Sports Medicine Source Type: research
Abstract PURPOSE: To develop recommendations for management of patients with breast cancer (BC) with germline mutations in BC susceptibility genes. METHODS: The American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology convened an Expert Panel to develop recommendations based on a systematic review of the literature and a formal consensus process. RESULTS: Fifty-eight articles met eligibility criteria and formed the evidentiary basis for the local therapy recommendations; six randomized controlled trials of systemic therapy met eligibility criteria. ...
Source: Clinical Genitourinary Cancer - Category: Cancer & Oncology Authors: Tags: J Clin Oncol Source Type: research
AbstractBackgroundNeoadjuvant chemotherapy (NAC) for breast cancer increases breast-conserving surgery (BCS) rates, but many women opt for mastectomy with contralateral prophylactic mastectomy (CPM). Here we evaluate factors associated with CPM use in women undergoing mastectomy post-NAC.MethodsA retrospective institutional NAC database review identified women with clinical stage I-III, unilateral invasive breast cancer undergoing unilateral mastectomy (UM) or CPM mastectomy from 9/2013 to 12/2017. Clinical/pathologic characteristics, imaging, and presence of contraindications to BCS post-NAC were compared, with subset ana...
Source: Annals of Surgical Oncology - Category: Cancer & Oncology Source Type: research
AbstractBackgroundWe compared the prognosis of patients with breast cancer according to surgical options including mastectomy with reconstruction after neoadjuvant chemotherapy (NAC). We also assessed the association between prognosis and surgical options according to clinical stage and clinical response in patients with neoadjuvant chemotherapy.MethodsA total of 140,712 patients were enrolled in the Korean Breast Cancer Society Registry database between 2000 and 2014 in Korea. We compared the prognosis of three groups; 1) patients who underwent breast-conserving surgery (BCS), 2) patients who underwent mastectomy, and 3) ...
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
ConclusionWith the increasing number of elderly primigravida amongst the urban population, a clear understanding of PABC is becoming more important. A multidisciplinary team approach shall help the clinician not only in reducing the heavy burden of patient responsibility but more importantly, in guaranteeing better quality of treatment, avoiding unnecessary delays in providing interventions and providing adequate treatment.
Source: The Journal of Obstetrics and Gynecology of India - Category: OBGYN Source Type: research
This study explores these efforts to preserve the patient ’s breast contour.Patients and MethodsAll patients who underwent surgery for invasive breast cancer in The Netherlands between January 2011 and December 2015 were selected from the Dutch national breast cancer audit (n = 61,309). The breast-contour-preserving procedures (BCPP) rate was defined as the rate of primary BCS, BCS after NAC, or mastectomy with IBR. BCPP rates were calculated and compared by year of diagnosis, age categories, and individual hospitals.ResultsThe rate of primary BCS remained stable (53%) while the BCPP rate increased from...
Source: Annals of Surgical Oncology - Category: Cancer & Oncology Source Type: research
Conclusions: This study is the first to demonstrate a dose-response relationship between risk of complications and near Dmax, where hypofractionated regimen or boost RT can play an important role. Rigorous RT-quality assurance program and modification of dose constraints could be considered as a critically important component for ongoing trials of hypofractionation. Based on our findings, we initiated a multi-center retrospective study (KROG 18-04) and a prospective study (NCT03523078) to validate our findings. Introduction Breast reconstruction provides important psychosocial, cosmetic, and quality of life benefits ...
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research
Authors: Nurudeen S, Hunt KK Abstract The care of patients with breast cancer in the modern era involves a multimodal approach to treating locoregional and distant disease. Recent studies have demonstrated that the extent of surgical intervention in both the breast and axilla can be minimized through a personalized approach based on breast cancer stage, subtype, and planned adjuvant therapies. The older approach focused on complete removal of the axillary contents for appropriate staging and to determine the need for adjuvant systemic therapy and radiation. This approach has been replaced by sentinel lymph node bio...
Source: Clinical Advances in Hematology and Oncology - Category: Cancer & Oncology Tags: Clin Adv Hematol Oncol Source Type: research
CONCLUSIONS: We reported satisfying long-term outcomes of 487 cases treated by LTDF. LTDF is a suitable oncoplastic technique for BCS. PMID: 30847663 [PubMed - as supplied by publisher]
Source: Breast Cancer - Category: Cancer & Oncology Authors: Tags: Breast Cancer Source Type: research
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