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).

Journal

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
ISSN: 1532-2157
Titre abrégé: Eur J Surg Oncol
Pays: England
ID NLM: 8504356

Informations de publication

Date de publication:
06 Jan 2024
Historique:
received: 03 12 2023
revised: 17 12 2023
accepted: 05 01 2024
medline: 14 1 2024
pubmed: 14 1 2024
entrez: 13 1 2024
Statut: aheadofprint

Résumé

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. We reviewed the available literature offering data on the pathological nodal status of cN0 breast cancer patients. 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. 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.

Sections du résumé

BACKGROUND 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 METHODS
We reviewed the available literature offering data on the pathological nodal status of cN0 breast cancer patients.
RESULTS 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 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.

Identifiants

DOI: 10.1016/j.ejso.2024.107954 PMID: 38217946
pubmed: 38217946
pii: S0748-7983(24)00006-4
doi: 10.1016/j.ejso.2024.107954
pii:
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

107954

Informations de copyright

© 2024 Published by Elsevier Ltd.

Auteurs

Nicola Rocco (N)

Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy. Electronic address: nicola.rocco@unina.it.

Matteo Ghilli (M)

Breast Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.

Annalisa Curcio (A)

UOC Chirurgia Senologica, AUSL della Romagna, Forlì, Italy.

Marina Bortul (M)

SSD Chirurgia Senologica e Breast Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy Naples, Italy.

Stefano Burlizzi (S)

UOSD Chirurgia Senologica, Ospedale "A. Perrino", Brindisi, Italy.

Carlo Cabula (C)

Chirurgia Senologica Azienda Ospedaliera Brotzu, Cagliari, Italy.

Roberta Cabula (R)

Cagliari University Hospital, Surgery Unit, Cagliari, Italy.

Alberta Ferrari (A)

SSD Chirurgia Tumori eredo-famigliari, SC Chirurgia Generale 3, Senologia, Fondazione IRCCS Policlinico san Matteo, Pavia, Italy.

Secondo Folli (S)

SC di Chirurgia Oncologica-Senologia, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.

Lucio Fortunato (L)

Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy.

Patrizia Frittelli (P)

UOC Chirurgia senologica, Ospedale Isola Tiberina Gemelli Isola, Rome, Italy.

Oreste Gentilini (O)

Breast Unit, IRCCS Ospedale San Raffaele di Milano, Milan, Italy.

Sara Grendele (S)

Breast Surgery, Department of Functional Oncology, Alto Vicentino Hospital, Santorso, Vicenza, Italy.

Massimo Maria Grassi (MM)

Breast Unit, Humanitas Gavazzeni Clinical Institute, Bergamo, Italy.

Simona Grossi (S)

Breast Unit, P.O. "G. Bernabeo", Ortona, Italy.

Francesca Magnoni (F)

Division of Senology, European Institute of Oncology, IRCCS, Milan, Italy.

Roberto Murgo (R)

Chirurgia Senologica, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy.

Dante Palli (D)

UOC di Chirurgia Generale ad Indirizzo Senologico-Breast Unit AUSL Piacenza, Italy.

Francesca Rovera (F)

S.S.D. Breast Unit - Ospedale Universitario, Varese, Italy; Dipartimento di Medicina e Innovazione Tecnologica, Università degli Studi dell'Insubria, Varese, Italy.

Alessandro Sanguinetti (A)

SSD Chirurgia della Mammella - Dipartimento di Chirurgia, Azienda Ospedaliera "S.Maria", Terni, Italy.

Mario Taffurelli (M)

Breast Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.

Giovanni Tazzioli (G)

Breast Unit AOU Policlinico di Modena, Modena, Italy.

Daniela Andreina Terribile (DA)

Breast Unit, IRCCS Fondazione Policlinico Gemelli, Rome, Italy.

Francesco Caruso (F)

Breast Unit, Humanitas Istituto Clinico Catanese, Misterbianco, (CT), Italy; National Association of Breast Surgeons (ANISC), Italy.

Viviana Galimberti (V)

Division of Senology, European Institute of Oncology, IRCCS, Milan, Italy.

Classifications MeSH