Axillary dissection for low-volume nodal involvement after neoadjuvant therapy in breast cancer: multicentre AXSANA cohort study

British journal of surgery, vol. 112

Abstract

BACKGROUND: Completion axillary lymph node dissection (cALND) is often recommended for patients with isolated tumour cells (ITCs) or micrometastases in the sentinel lymph node (SLN) or target lymph node (TLN) to assess the definite nodal tumour burden after neoadjuvant chemotherapy (NACT). The aim of this study was to investigate the upgrade of N stage by cALND in patients with low-volume metastases in the SLN/TLN after NACT from the prospective, international, multicentre AXSANA cohort study. METHODS: NACT-treated patients that converted from a positive to a negative clinical lymph node status and underwent cALND based on low-volume SLN/TLN involvement were included. The association between the final N stage, the pathological tumour response in the breast, and the clinical impact of cALND on post-NACT treatment decisions was determined. RESULTS: Among 5329 patients recruited between June 2020 and March 2024, 2194 were scheduled for SLN biopsy (SLNB), targeted axillary dissection (TAD), or TLN biopsy (TLNB). Among 16 patients with ypN0i+(SLN/TLN), one patient was upgraded to ypN1a by cALND, while five of the 71 patients with ypN1mi(SLN/TLN) were upstaged to ypN2 and one of the 71 patients with ypN1mi(SLN/TLN) was upstaged to ypN3. None of these patients had a pCR in the breast and thus nodal upstaging had no impact on post-NACT treatment decisions. CONCLUSION: Despite substantial additional nodal involvement in low-volume SLN/TLN disease, cALND does not provide clinically meaningful information for post-NACT systemic treatment modifications and should not be encouraged for diagnostic purposes alone.

Authors 86

1. Thorsten Kuehn corresponding

   Universität Ulm

   Affiliation as printed

   Breast Centre, Die Filderklinik gGmbH , Filderstadt ,

   Department of Gynaecology and Obstetrics, University of Ulm , Ulm ,

2. Maggie Banys‐Paluchowski

   University Hospital Schleswig-Holstein

   Affiliation as printed

   Department of Obstetrics and Gynaecology, University Hospital of Schleswig-Holstein, Campus Lübeck , Lübeck ,

3. Nina Caroline Ditsch

   University Hospital Augsburg

   Affiliation as printed

   Department of Gynaecology and Obstetrics, University Hospital Augsburg , Augsburg ,

4. Elmar Stickeler Aachen Department of Gynaecology and Obstetrics

   Universitätsklinikum Aachen

   Affiliation as printed

   Department of Gynaecology and Obstetrics, University Hospital Aachen , Aachen ,

5. Michael Hauptmann

   Medizinische Hochschule Brandenburg Theodor Fontane

   Affiliation as printed

   Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane , Neuruppin ,

6. Jennifer Schroth

   Medizinische Hochschule Brandenburg Theodor Fontane

   Affiliation as printed

   Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane , Neuruppin ,

7. Guldeniz Karadeniz Cakmak

   Zonguldak Bülent Ecevit University

   Affiliation as printed

   Breast and Endocrine Unit, General Surgery Department, The School of Medicine, Zonguldak BEUN , Zonguldak ,

8. Markus Hahn

   Universitätsklinikum Tübingen · University of Tübingen

   Affiliation as printed

   Department of Gynaecology and Obstetrics, University Hospital Tübingen , Tübingen ,

9. Marc Thill

   Agaplesion Markus Hospital

   Affiliation as printed

   Department of Gynaecology and Gynaecological Oncology, Agaplesion Markus Hospital , Frankfurt ,

10. Toralf Reimer

    Universitätsmedizin Rostock · University of Rostock

    Affiliation as printed

    Department of Gynaecology and Obstetrics, University Hospital Rostock , Rostock ,

11. Sarah Fröhlich

    Universitätsmedizin Rostock · University of Rostock

    Affiliation as printed

    Department of Gynaecology and Obstetrics, University Hospital Rostock , Rostock ,

12. Kristina Wihlfahrt
    Affiliation as printed

    Department for Gynaecology and Obstetrics, Practice Wihlfahrt , Kiel ,

13. Tomasz Berger
    Affiliation as printed

    Department of Gynaecology and Obstetrics, Müritz-Klinikum Waren , Waren ,

14. Timo Basali

    Klinikum Esslingen

    Affiliation as printed

    Department of Gynaecology and Obstetrics, Hospital Esslingen , Esslingen ,

15. Franziska Ruf

    University Hospital Schleswig-Holstein

    Affiliation as printed

    Department of Obstetrics and Gynaecology, University Hospital of Schleswig-Holstein, Campus Lübeck , Lübeck ,

16. A Rief

    Medical University of Graz

    Affiliation as printed

    Department of Gynaecology and Obstetrics, Medical University of Graz , Graz ,

17. Michael Patrick Lux
    Affiliation as printed

    Department of Gynaecology and Obstetrics, Frauenklinik St Louise , Paderborn ,

    Frauenklinik St Josefs-Krankenhaus, Salzkotten, St Vincenz Kliniken , Paderborn ,

18. Hans‐Christian Kolberg

    Marienhospital Bottrop

    Affiliation as printed

    Department of Gynaecology and Obstetrics, Marienhospital Bottrop , Bottrop ,

19. Isabel Teresa Rubio

    Clinica Universidad de Navarra

    Affiliation as printed

    Breast Surgical Unit, Clínica Universidad de Navarra , Madrid ,

20. Maria Luisa Gasparri

    Ospedale regionale di Lugano · Università della Svizzera italiana

    Affiliation as printed

    Department of Gynaecology and Obstetrics, Ente Ospedaliero Cantonale, Ospedale Regionale di Lugano , Lugano ,

    Faculty of Biomedicine, University of Italian-Speaking Switzerland (USI) , Lugano ,

21. Michalis Kontos

    National and Kapodistrian University of Athens

    Affiliation as printed

    Department of Surgery, Laiko Hospital, National and Kapodistrian University of Athens , Athens ,

22. Eduard-Alexandru Bonci

    Iuliu Hațieganu University of Medicine and Pharmacy · Institute of Oncology Prof. Dr. Ion Chiricuta

    Affiliation as printed

    Department of Oncological Surgery and Gynaecological Oncology, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy , Cluj-Napoca ,

    Department of Surgical Oncology, ‘Prof. Dr. Ion Chiricuță’ Institute of Oncology , Cluj-Napoca ,

23. Laura Niinikoski

    University of Helsinki · Helsinki University Hospital

    Affiliation as printed

    Breast Surgery Unit, Comprehensive Cancer Centre, Helsinki University Hospital, University of Helsinki , Helsinki ,

24. Dawid Murawa

    University of Zielona Góra

    Affiliation as printed

    Department of General Surgery and Surgical Oncology, The Regional Hospital in Poznan—The Greater Poland Specialist Centre , Poznan ,

    Surgery and Oncology Collegium Medicum, University of Zielona Góra , Zielona Góra ,

25. David Pinto

    Champalimaud Foundation

    Affiliation as printed

    Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation , Lisboa ,

26. Florentia Peintinger

    Medical University of Graz

    Affiliation as printed

    Department of Gynaecology and Obstetrics, Medical University of Graz , Graz ,

    Institute of Pathology, Medical University of Graz , Graz ,

27. Ellen Schlichting

    Oslo University Hospital

    Affiliation as printed

    Department of Oncology, Oslo University Hospital , Oslo ,

28. Helidon Nina
    Affiliation as printed

    Department of Surgery, Oncology Hospital , Tirana ,

29. Hagigat Valiyeva Qanimat

    Azerbaijan Medical University

    Affiliation as printed

    Oncological Clinic, Azerbaijan Medical University , Baku ,

30. Marian Vanhoeij

    Universitair Ziekenhuis Brussel

    Affiliation as printed

    Breast Clinic, Universitair Ziekenhuis Brussel , Brussel ,

31. Lia Pamela Rebaza
    Affiliation as printed

    Breast Surgery, Oncosalud , Lima ,

32. Bilge Aktas Sezen
    Affiliation as printed

    EUBREAST e.V. , Esslingen ,

33. Katharina Jursik
    Affiliation as printed

    EUBREAST e.V. , Esslingen ,

34. Geeta Kadayaprath

    Max Healthcare

    Affiliation as printed

    Breast Surgical Oncology and Oncoplastic Surgery, MAX Hospital, Patparganj , New Delhi ,

35. Lukáš Dostálek

    Charles University · General University Hospital in Prague

    Affiliation as printed

    Gynaecological Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University, General University Hospital , Prague ,

36. Ashutosh S. Kothari

    Guy's Hospital · Guy's and St Thomas' NHS Foundation Trust

    Affiliation as printed

    Breast Unit, Guy’s & St Thomas’ NHS Foundation Trust , London ,

37. Andraž Perhavec

    Institute of Oncology Ljubljana

    Affiliation as printed

    Department of Surgical Oncology, Center for Breast Diseases, Institute of Oncology Ljubljana , Ljubljana ,

38. Tsvetomir M. Ivanov
    Affiliation as printed

    Department of General Surgery, Heart and Brain Hospital , Pleven ,

39. Douglas B. Zippel

    Sheba Medical Center

    Affiliation as printed

    Surgical Oncology Unit, Chaim Sheba Medical Centre , Ramat Gan ,

40. Sarun Thongvitokomarn

    King Chulalongkorn Memorial Hospital

    Affiliation as printed

    Queen Sirikit Centre for Breast Cancer , King Chulalongkorn Memorial Hospital, Bangkok ,

41. Meryem Günay Gürleyik

    Haydarpaşa Numune Eğitim ve Araştırma Hastanesi · Sağlık Bilimleri Üniversitesi

    Affiliation as printed

    Department of General Surgery, Istanbul Haydarpasa Numune Training and Research Hospital, University of Health Sciences Turkey , İstanbul ,

42. Dirk Otto Watermann

    Evangelisches Diakoniekrankenhaus

    Affiliation as printed

    Department of Gynaecology and Obstetrics, Ev. Diakoniekrankenhaus , Freiburg ,

43. Mauro Porpiglia

    Ospedale Sant'Anna

    Affiliation as printed

    Breast Unit, S. Anna Hospital , Turin ,

44. Annette Lebeau

    Universität Hamburg · University Medical Center Hamburg-Eppendorf

    Affiliation as printed

    Institute of Pathology, University Hamburg-Eppendorf , Hamburg ,

    Private Group Practice for Pathology , Lübeck ,

45. Rosa Di Micco

    IRCCS Ospedale San Raffaele

    Affiliation as printed

    Breast Surgery Unit, IRCCS Ospedale San Raffaele , Milan ,

46. Oreste ­Gentilini

    Vita-Salute San Raffaele University · IRCCS Ospedale San Raffaele

    Affiliation as printed

    Breast Surgery Unit, IRCCS Ospedale San Raffaele , Milan ,

    Faculty of Medicine and Surgery, Vita-Salute San Raffaele University , Milan ,

47. Jana de Boniface

    Karolinska Institutet · Saint Göran Hospital

    Affiliation as printed

    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet , Stockholm ,

    Department of Surgery, Breast Centre, Capio St Göran’s Hospital , Stockholm ,

48. Steffi Hartmann

    Universitätsmedizin Rostock · University of Rostock

    Affiliation as printed

    Department of Gynaecology and Obstetrics, University Hospital Rostock , Rostock ,

49. Agnieszka Kołacińska
50. Alessandro Fancellu
51. A Hein
52. A Thodas
53. Ana-Maria Mușină
54. A Fleuster
55. Andrea Stefek
56. Andrzej J. Lorek
57. Anke Kleine-Tebbe
58. Ann Smeets
59. Anna Madej-Mierzwa
60. Alexander Bachmann
61. A Lebrecht
62. Antje Nixdorf
63. Alicia Córdoba
64. Antonio Marano
65. Atakan Sezer
66. Axel Gatzweiler
67. Bruna Leite
68. Beata Adamczyk
69. Benno Lex
70. B Königs-El-Amrawy
71. Catharine Kline Cipolla
72. C Paschold
73. C Schulte-Tiwisinia
74. Carolin Nestle-Krämling
75. Christian Schindlbeck
76. Christine Ankel
77. Christine Solbach
78. Christine Zeder-Göß
79. Christoph Anthuber
80. C Großmann
81. Cihan Uras
82. Christian Maurer
83. C Neumann
84. Cornelia Meisel
85. C. Fuhljahn
86. Christina Kühn