Trends in axillary lymph node dissection for early-stage breast cancer in Europe: Impact of evidence on practice

EUSOMA Working Group

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Data from recently published trials have provided practice-changing recommendations for the surgical approach to the axilla in breast cancer. Patients with T1-2 lesions, treated with breast conservation, who have not received neoadjuvant chemotherapy and have 1–2 positive sentinel nodes (Z0011-criteria) may avoid axillary lymph node dissection (ALND). We aim to describe the dissemination of this practice in Europe over an extended period of time. Methods: Our source of data was the eusomaDB, a central data warehouse of prospectively collected information of the European Society of Breast Cancer Specialists (EUSOMA). We identified cases fulfilling Z0011-criteria from 2005 to 2016 from 34 European breast centers and report trends in ALND. Data derived from Germany, Italy, Belgium, Switzerland, Austria, and Netherlands. Results: 6671 patients fulfilled Z0011-criteria. Rates of ALND showed a statistically significant decrease from 2010 (89%) to 2011 (73%), reaching 46% in 2016 (p < 0.001). After multivariable analysis, factors associated with higher probability of ALND were earlier year of surgery, younger age, increasing tumor size and grade, and being operated in Italy (p < 0.001). The minimum and maximal rates of ALND in the most recent two-year period (2015–2016) were 0% and 83% in two centers located in different countries (p < 0.001). Conclusion: Our study demonstrates, a decrease in rates of ALND that started after year 2010 through the end of the study period. Wide differences were observed among centers and countries indicating the need to spread unified clinical guidelines in Europe to allow for homogeneous evidence-based practice patterns.

Original languageEnglish
Pages (from-to)89-96
Number of pages8
JournalBreast
Volume45
DOIs
Publication statusPublished - Jun 1 2019

Fingerprint

Lymph Node Excision
Breast Neoplasms
Italy
Breast
Axilla
Austria
Evidence-Based Practice
Information Storage and Retrieval
Belgium
Switzerland
Netherlands
Statistical Factor Analysis
Germany
Guidelines
Drug Therapy
Neoplasms

Keywords

  • Axillary dissection
  • Axillary lymph node dissection
  • Axillary lymphadenectomy
  • Axillary surgery
  • Positive sentinel node
  • Surgery for breast cancer
  • Z0011

ASJC Scopus subject areas

  • Surgery

Cite this

Trends in axillary lymph node dissection for early-stage breast cancer in Europe : Impact of evidence on practice. / EUSOMA Working Group.

In: Breast, Vol. 45, 01.06.2019, p. 89-96.

Research output: Contribution to journalArticle

@article{ab4ea7f600d14d1c84ebe01cd9b7bf5e,
title = "Trends in axillary lymph node dissection for early-stage breast cancer in Europe: Impact of evidence on practice",
abstract = "Background: Data from recently published trials have provided practice-changing recommendations for the surgical approach to the axilla in breast cancer. Patients with T1-2 lesions, treated with breast conservation, who have not received neoadjuvant chemotherapy and have 1–2 positive sentinel nodes (Z0011-criteria) may avoid axillary lymph node dissection (ALND). We aim to describe the dissemination of this practice in Europe over an extended period of time. Methods: Our source of data was the eusomaDB, a central data warehouse of prospectively collected information of the European Society of Breast Cancer Specialists (EUSOMA). We identified cases fulfilling Z0011-criteria from 2005 to 2016 from 34 European breast centers and report trends in ALND. Data derived from Germany, Italy, Belgium, Switzerland, Austria, and Netherlands. Results: 6671 patients fulfilled Z0011-criteria. Rates of ALND showed a statistically significant decrease from 2010 (89{\%}) to 2011 (73{\%}), reaching 46{\%} in 2016 (p < 0.001). After multivariable analysis, factors associated with higher probability of ALND were earlier year of surgery, younger age, increasing tumor size and grade, and being operated in Italy (p < 0.001). The minimum and maximal rates of ALND in the most recent two-year period (2015–2016) were 0{\%} and 83{\%} in two centers located in different countries (p < 0.001). Conclusion: Our study demonstrates, a decrease in rates of ALND that started after year 2010 through the end of the study period. Wide differences were observed among centers and countries indicating the need to spread unified clinical guidelines in Europe to allow for homogeneous evidence-based practice patterns.",
keywords = "Axillary dissection, Axillary lymph node dissection, Axillary lymphadenectomy, Axillary surgery, Positive sentinel node, Surgery for breast cancer, Z0011",
author = "{EUSOMA Working Group} and Garcia-Etienne, {Carlos A.} and Mansel, {Robert E.} and Mariano Tomatis and Joerg Heil and Laura Biganzoli and Alberta Ferrari and Lorenza Marotti and Adele Sgarella and Antonio Ponti and Mahmoud Danaei and Elmar Stickeler and Dimitri Sarlos and Annemie Prov{\'e} and Olivia Pagani and Gilles Berclaz and Mario Taffurelli and Elisabetta Cretella and Didier Verhoeven and Andreas Denk and Birgit Carly and Bettina Ballardini and {van Riet}, Yvonne and Rainer Kimmig and Mattea Reinisch and Catia Angiolini and Volker M{\"o}bus and Gunter Emons and Kay Friedrichs and Andreas Schneeweiss and Corrado Tinterri and Daniel Egle and Gracienne Staelens and Marion Kiechle and Nadia Harbeck and Fabio Corsi and Lorenzo Menghini and Augusto Lombardi and Lucio Fortunato and Marina Bortul and Jens Huober and Farzaneh Badbanchi and Christoph Tausch",
year = "2019",
month = "6",
day = "1",
doi = "10.1016/j.breast.2019.03.002",
language = "English",
volume = "45",
pages = "89--96",
journal = "Breast",
issn = "0960-9776",
publisher = "Churchill Livingstone",

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T1 - Trends in axillary lymph node dissection for early-stage breast cancer in Europe

T2 - Impact of evidence on practice

AU - EUSOMA Working Group

AU - Garcia-Etienne, Carlos A.

AU - Mansel, Robert E.

AU - Tomatis, Mariano

AU - Heil, Joerg

AU - Biganzoli, Laura

AU - Ferrari, Alberta

AU - Marotti, Lorenza

AU - Sgarella, Adele

AU - Ponti, Antonio

AU - Danaei, Mahmoud

AU - Stickeler, Elmar

AU - Sarlos, Dimitri

AU - Prové, Annemie

AU - Pagani, Olivia

AU - Berclaz, Gilles

AU - Taffurelli, Mario

AU - Cretella, Elisabetta

AU - Verhoeven, Didier

AU - Denk, Andreas

AU - Carly, Birgit

AU - Ballardini, Bettina

AU - van Riet, Yvonne

AU - Kimmig, Rainer

AU - Reinisch, Mattea

AU - Angiolini, Catia

AU - Möbus, Volker

AU - Emons, Gunter

AU - Friedrichs, Kay

AU - Schneeweiss, Andreas

AU - Tinterri, Corrado

AU - Egle, Daniel

AU - Staelens, Gracienne

AU - Kiechle, Marion

AU - Harbeck, Nadia

AU - Corsi, Fabio

AU - Menghini, Lorenzo

AU - Lombardi, Augusto

AU - Fortunato, Lucio

AU - Bortul, Marina

AU - Huober, Jens

AU - Badbanchi, Farzaneh

AU - Tausch, Christoph

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Background: Data from recently published trials have provided practice-changing recommendations for the surgical approach to the axilla in breast cancer. Patients with T1-2 lesions, treated with breast conservation, who have not received neoadjuvant chemotherapy and have 1–2 positive sentinel nodes (Z0011-criteria) may avoid axillary lymph node dissection (ALND). We aim to describe the dissemination of this practice in Europe over an extended period of time. Methods: Our source of data was the eusomaDB, a central data warehouse of prospectively collected information of the European Society of Breast Cancer Specialists (EUSOMA). We identified cases fulfilling Z0011-criteria from 2005 to 2016 from 34 European breast centers and report trends in ALND. Data derived from Germany, Italy, Belgium, Switzerland, Austria, and Netherlands. Results: 6671 patients fulfilled Z0011-criteria. Rates of ALND showed a statistically significant decrease from 2010 (89%) to 2011 (73%), reaching 46% in 2016 (p < 0.001). After multivariable analysis, factors associated with higher probability of ALND were earlier year of surgery, younger age, increasing tumor size and grade, and being operated in Italy (p < 0.001). The minimum and maximal rates of ALND in the most recent two-year period (2015–2016) were 0% and 83% in two centers located in different countries (p < 0.001). Conclusion: Our study demonstrates, a decrease in rates of ALND that started after year 2010 through the end of the study period. Wide differences were observed among centers and countries indicating the need to spread unified clinical guidelines in Europe to allow for homogeneous evidence-based practice patterns.

AB - Background: Data from recently published trials have provided practice-changing recommendations for the surgical approach to the axilla in breast cancer. Patients with T1-2 lesions, treated with breast conservation, who have not received neoadjuvant chemotherapy and have 1–2 positive sentinel nodes (Z0011-criteria) may avoid axillary lymph node dissection (ALND). We aim to describe the dissemination of this practice in Europe over an extended period of time. Methods: Our source of data was the eusomaDB, a central data warehouse of prospectively collected information of the European Society of Breast Cancer Specialists (EUSOMA). We identified cases fulfilling Z0011-criteria from 2005 to 2016 from 34 European breast centers and report trends in ALND. Data derived from Germany, Italy, Belgium, Switzerland, Austria, and Netherlands. Results: 6671 patients fulfilled Z0011-criteria. Rates of ALND showed a statistically significant decrease from 2010 (89%) to 2011 (73%), reaching 46% in 2016 (p < 0.001). After multivariable analysis, factors associated with higher probability of ALND were earlier year of surgery, younger age, increasing tumor size and grade, and being operated in Italy (p < 0.001). The minimum and maximal rates of ALND in the most recent two-year period (2015–2016) were 0% and 83% in two centers located in different countries (p < 0.001). Conclusion: Our study demonstrates, a decrease in rates of ALND that started after year 2010 through the end of the study period. Wide differences were observed among centers and countries indicating the need to spread unified clinical guidelines in Europe to allow for homogeneous evidence-based practice patterns.

KW - Axillary dissection

KW - Axillary lymph node dissection

KW - Axillary lymphadenectomy

KW - Axillary surgery

KW - Positive sentinel node

KW - Surgery for breast cancer

KW - Z0011

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U2 - 10.1016/j.breast.2019.03.002

DO - 10.1016/j.breast.2019.03.002

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EP - 96

JO - Breast

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SN - 0960-9776

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