In the era of conservative surgery, can patients presenting with node positive breast cancer be spared axillary node dissection post neoadjuvant chemotherapy? A meta-analysis and review of literature

2016 ◽  
Vol 42 (11) ◽  
pp. S245
Author(s):  
Hiba El Hage Chehade ◽  
Hannah Headon ◽  
Omar El Tokhy ◽  
Umar Wazir ◽  
Jennifer Heeney ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Meta Analysis ◽  
Conservative Surgery ◽  
Axillary Node ◽  
Axillary Node Dissection ◽  
Review Of Literature ◽  
Node Dissection ◽  
Node Positive ◽  
Positive Breast Cancer

scholarly journals EP.TH.166Evaluation of the impact of the COVID-19 pandemic on the practice of axillary node dissection

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Grant Harris ◽  
Alice Townend ◽  
Madgi Youssef
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Sentinel Node ◽  
Axillary Node ◽  
Axillary Node Dissection ◽  
Delayed Presentation ◽  
Positive Sentinel Node ◽  
Node Dissection ◽  
Node Positive ◽  
The Impact

Abstract Aims The Association of Breast Surgery's "COVID-altered" guidance for management of breast cancer during the COVID-19 pandemic, includes that neoadjuvant chemotherapy was only to be used only in inoperable disease and not to downstage the axilla. Delayed presentation with increased nodal involvement was also a concern. We aim to establish if axillary node dissection (AND) increased in the context of pandemic. Methods Patients undergoing surgery for breast cancer were identified from theatre coding in a UK breast unit. Pre-COVID (March 2018 - February 2020) and COVID pandemic (March - September 2020) cohorts were compared. Indication, tumour receptor status, neoadjuvant chemotherapy (NAC) and deviation from routine practice were ascertained for those undergoing AND. Trust Caldicott and audit department approval was obtained for this retrospective review of practice. Results AND was performed in 20.2% (23/114) of breast cancer operations during the pandemic compared with 18.97% (78/411) pre-COVID. Indication for AND during the pandemic and pre-COVID respectively - clinically node positive 82.6%/79.4%; positive sentinel node biopsy 4.3%/17.9%; recurrence or metastases from contralateral cancer 13%/2.5%. NAC preceded AND in 30% of cases in both cohorts. NAC for one node positive HER2+ cancer was omitted due to the pandemic and another patient had adjuvant chemotherapy omitted for a HER2+ cancer with a single positive sentinel node mandating an AND which yielded no further positive nodes. Conclusions The COVID-19 pandemic has not significantly impacted rates of AND in our practice. However, we identified 2 patients who may have avoided AND with normal chemotherapy protocols.

scholarly journals Sentinel Node Biopsy Alone versus Completion Axillary Node Dissection in Node Positive Breast Cancer: Systematic Review and Meta-Analysis

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Rachna Ram ◽  
Jasprit Singh ◽  
Eddie McCaig
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Sentinel Node ◽  
Axillary Dissection ◽  
Meta Analysis ◽  
Axillary Node ◽  
Axillary Node Dissection ◽  
Controlled Trials ◽  
Positive Sentinel Node ◽  
Node Dissection

Introduction. There has been recent interest in validity of completion axillary node dissection after a positive sentinel node. This systematic review aims to ascertain if sentinel lymph node dissection alone was noninferior to axillary lymph node dissection for breast cancer patients who have a positive sentinel node.Method. A systematic review of the electronic databases Embase, MEDLINE, and Cochrane Register of Controlled Trials was carried out. Only randomised trials that had patients with positive sentinel node as the study sample were included in the meta-analysis using the reported hazard ratios with a fixed effect model.Results. Three randomised controlled trials and five retrospective studies were identified. The pooled effect for overall survival was HR 0.94, 95% CI [0.79, 1.19], and for disease free survival was HR 0.83, 95% CI [0.60, 1.14]. The reported rates for locoregional recurrence were similar in both groups. The surgical morbidity was found to be significantly more in patients who had underwent axillary dissection.Conclusion. Amongst patients with micrometastasis in the sentinel node, no further axillary dissection is necessary. For patients with macrometastasis in the sentinel node, it is reasonable to consider omitting axillary dissection to avoid the morbidity of the procedure.

scholarly journals Survival in Cytologically Proven Node-Positive Breast Cancer Patients with Nodal Pathological Complete Response after Neoadjuvant Chemotherapy

Cancers ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2633
Author(s):  
Hitoshi Inari ◽  
Natsuki Teruya ◽  
Miki Kishi ◽  
Rie Horii ◽  
Futoshi Akiyama ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Pathological Complete Response ◽  
Complete Response ◽  
Axillary Node ◽  
Matched Pairs ◽  
Node Positive ◽  
Significant Difference ◽  
Positive Breast Cancer

Background: It is unknown whether patients with cytologically proven axillary node-positive breast cancer who achieve axillary pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) have comparable prognosis to patients with axillary pathological node-negative disease (pN-) without NAC. Methods: We retrospectively reviewed the data of patients with cytologically proven axillary node-positive disease who received NAC and those with axillary pN- without NAC for control between January 2007 and December 2012. We compared outcomes according to response in the axilla to NAC and between patients with axillary pCR and matched pairs with axillary pN- without NAC using propensity scores. Results: We included 596 patients with node-positive breast cancer who received NAC. The median follow-up period was 64 months. Patients with axillary pCR showed significantly better distant disease-free survival (DDFS) and overall survival (OS) than patients with residual axillary disease (both p < 0.01). There was no significant difference in DDFS and OS between patients with axillary pCR and matched pairs with axillary pN- without NAC. Conclusion: Axillary pCR was associated with improved prognosis. Patients with axillary pCR and matched pairs with axillary pN- without NAC had comparable outcomes. This information will be useful when considering the intensity of follow-up and adjuvant therapy.

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