Axillary Staging after Neoadjuvant Chemotherapy for Initially Node-Positive Breast Carcinoma in Germany
Geburtshilfe und Frauenheilkunde, vol. 82, pp. 932–940
Abstract
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.
Authors 24
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Universitätsmedizin Rostock · University of Rostock
Affiliation as printed
Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Rostock, Rostock, Germany
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Thorsten Kühn corresponding
Affiliation as printed
Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
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Medizinische Hochschule Brandenburg Theodor Fontane
Affiliation as printed
Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
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Affiliation as printed
Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
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Affiliation as printed
Klinik für Gynäkologie und Gynäkologische Onkologie, AGAPLESION MARKUS KRANKENHAUS, Frankfurt am Main, Germany
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Brüderkrankenhaus St. Josef Paderborn
Affiliation as printed
Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Paderborn, Germany
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Universitätsmedizin Rostock · University of Rostock
Affiliation as printed
Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Rostock, Rostock, Germany
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University Hospital Schleswig-Holstein
Affiliation as printed
Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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Affiliation as printed
Centrum für Hämatologie und Onkologie Bethanien, Frankfurt am Main, Germany
German Breast Group Forschungs GmbH, Neu-Isenburg, Germany
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Charité - Universitätsmedizin Berlin
Affiliation as printed
Gynäkologie mit Brustzentrum, Charité – Universitätsmedizin, Berlin, Germany
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Affiliation as printed
Marienhospital, Bottrop, Germany
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Affiliation as printed
Brustzentrum Osnabrück – Niels-Stensen-Kliniken, Osnabrück, Germany
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Leopoldina Krankenhaus Schweinfurt
Affiliation as printed
Brustzentrum Schweinfurt-Mainfranken, Leopoldina-Krankenhaus, Schweinfurt, Germany
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Goethe University Frankfurt · University Hospital Frankfurt
Affiliation as printed
Klinik für Gynäkologie und Geburtshilfe, Universität Frankfurt, Brustzentrum, Frankfurt am Main, Germany
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Städtisches Klinikum Karlsruhe
Affiliation as printed
Frauenklinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
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Affiliation as printed
Regio Klinikum Pinneberg, Pinneberg, Germany
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Affiliation as printed
Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
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TUM Klinikum · Technical University of Munich
Affiliation as printed
Klinikum rechts der Isar, interdisziplinäres Brustzentrum, Technische Universität München, München, Germany
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Evangelisches Diakoniekrankenhaus
Affiliation as printed
Evangelisches Diakoniekrankenhaus, Brustzentrum Südbaden, Freiburg im Breisgau, Germany
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Affiliation as printed
Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Tübingen, Tübingen, Germany
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Affiliation as printed
Brustzentrum Sana Klinikum Lichtenberg, Berlin, Germany
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Affiliation as printed
Klinik für Gynäkologie und Geburtshilfe, Klinikum Memmingen, Memmingen, Germany
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Affiliation as printed
Klinik für Gynäkologie und Geburtshilfe, interdisziplinäres Brustzentrum, HELIOS Klinikum Berlin Buch, Berlin, Germany
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University Hospital Schleswig-Holstein · Heinrich Heine University Düsseldorf
Affiliation as printed
Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
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