TY - JOUR
T1 - Management of the axilla in patients with breast cancer and positive sentinel lymph node biopsy
T2 - An evidence-based update in a European breast center
AU - Garcia-Etienne, Carlos A.
AU - Ferrari, Alberta
AU - Della Valle, Angelica
AU - Lucioni, M.
AU - Ferraris, E.
AU - Di Giulio, Giuseppe
AU - Squillace, L.
AU - Bonzano, Elisabetta
AU - Lasagna, Angioletta
AU - Rizzo, Gianpiero
AU - Tancredi, Richard
AU - Scotti Foglieni, Andrea
AU - Dionigi, Francesca
AU - Grasso, Maurizia
AU - Arbustini, Eloisa
AU - Cavenaghi, Giorgio
AU - Pedrazzoli, P.
AU - Filippi, Andrea R.
AU - Dionigi, P.
AU - Sgarella, A.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - The 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 neoadjuvant chemotherapy and have planned breast conservation (BCS) with whole breast radiotherapy (WBRT). Cases with gross (>2 mm) ECE in SLNs are evaluated on individual basis for completion ALND, axillary radiotherapy or omission of both. Patients fulfilling the criteria listed above who undergo mastectomy, may also avoid axillary dissection after multidisciplinary discussion of individual cases for consideration of axillary irradiation. Women 70 years or older with hormone receptors positive invasive lesions ≤3 cm, clinically negative nodes, and serious or multiple comorbidities who undergo BCS with WBRT, may forgo axillary staging/surgery (if mastectomy or larger tumor, comorbidities and life expectancy are taken into account).
AB - The 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 neoadjuvant chemotherapy and have planned breast conservation (BCS) with whole breast radiotherapy (WBRT). Cases with gross (>2 mm) ECE in SLNs are evaluated on individual basis for completion ALND, axillary radiotherapy or omission of both. Patients fulfilling the criteria listed above who undergo mastectomy, may also avoid axillary dissection after multidisciplinary discussion of individual cases for consideration of axillary irradiation. Women 70 years or older with hormone receptors positive invasive lesions ≤3 cm, clinically negative nodes, and serious or multiple comorbidities who undergo BCS with WBRT, may forgo axillary staging/surgery (if mastectomy or larger tumor, comorbidities and life expectancy are taken into account).
KW - Axillary dissection
KW - Axillary lymph node dissection
KW - Axillary lymphadenectomy
KW - Positive sentinel node
KW - Sentinel lymph node biopsy
KW - Surgery for breast cancer
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U2 - 10.1016/j.ejso.2019.08.013
DO - 10.1016/j.ejso.2019.08.013
M3 - Review article
AN - SCOPUS:85070908774
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
SN - 0748-7983
ER -