Axillary Surgery in Breast Cancer Patients Treated with Breast-Conserving Surgery at German Breast Cancer Centers Within the Last 14 Years – Comparison of a University Center and a Community Hospital

Abstract Background Guideline recommendations for axillary surgical approach in breast cancer (BC) treatment changed over the last decade. Methods Data from all invasive BC patients (n = 5344) treated with breast conserving surgery (BCS) at the breast cancer centers of the University Hospital Ulm (U-BCC) and the community hospital Dachau (D-BCC) were included into a retrospective analysis for assessing information on axillary surgery between 2003 and 2016 based on the documented cancer registry data. Results The average annual rate of sentinel node biopsy (SNB) was 85.5% and 87.2% in Ulm and Dachau, respectively. SNB was performed more precisely at the U-BCC with a median of 2.4 resected lymph nodes (LN) compared to a median of 3.2 resected LN in Dachau. Median number of resected LN for axillary lymph node dissection (ALNE) showed a statistically significant reduction over time in Ulm (rs = − 0.82; p < 0.001) and Dachau (rs = − 0.76; p = 0.002). The rate of secondary ALNE (after SNB; 2° ALNE) decreased significantly in U-BCC (rs = − 0.76; p = 0.002) while it remained stable in D-BCC. The influential publication of the Z0011 study in 2010 resulted in a significant reduction of secondary ALNE (24.1% preZ0011 and 14.4% postZ0011; p < 0.001) in Ulm. Conclusion Changes in axillary surgery over time can be seen in the annual statistics of the reviewed BCCs. With BCS, mostly SNB was performed and numbers of removed LN in ALNE have decreased. In the U-BCC, the rate of 2° ALNE dropped after the publication of the Z0011 data. The fact that no such decrease for 2° ALNE was found in D-BCC suggests that university hospitals implement new data and research results into clinical routine earlier than peripheral community hospitals.

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Axillary surgery in breast cancer patients treated with breast-conserving surgery at german breast cancer centers within the last 14 years – comparison of a university center and a community hospital

Senologie - Zeitschrift für Mammadiagnostik und -therapie ◽

10.1055/a-0868-8241 ◽

2019 ◽

Vol 16 (01) ◽

pp. 59-66

Author(s):

Amelie de Gregorio ◽

Peter Widschwendter ◽

Susanne Albrecht ◽

Nikolaus de Gregorio ◽

Thomas Friedl ◽

...

Keyword(s):

Breast Cancer ◽

Community Hospital ◽

Breast Conserving Surgery ◽

University Hospital ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

University Hospitals ◽

Cancer Centers ◽

Axillary Surgery ◽

Over Time

Abstract Background Guideline recommendations for axillary surgical approach in breast cancer (BC) treatment changed over the last decade. Methods Data from all invasive BC patients (n = 5344) treated with breast conserving surgery (BCS) at the breast cancer centers of the University Hospital Ulm (U‑BCC) and the community hospital Dachau (D‑BCC) were included into a retrospective analysis for assessing information on axillary surgery between 2003 and 2016 based on the documented cancer registry data. Results The average annual rate of sentinel node biopsy (SNB) was 85.5 % and 87.2 % in Ulm and Dachau, respectively. SNB was performed more precisely at the U‑BCC with a median of 2.4 resected lymph nodes (LN) compared to a median of 3.2 resected LN in Dachau. Median number of resected LN for axillary lymph node dissection (ALNE) showed a statistically significant reduction over time in Ulm (rs = − 0.82; p < 0.001) and Dachau (rs = − 0.76; p = 0.002). The rate of secondary ALNE (after SNB; 2° ALNE) decreased significantly in U‑BCC (rs = − 0.76; p = 0.002) while it remained stable in D‑BCC. The influential publication of the Z0011 study in 2010 resulted in a significant reduction of secondary ALNE (24.1 % pre Z0011 and 14.4 % postZ0011; p < 0.001) in Ulm. Conclusion Changes in axillary surgery over time can be seen in the annual statistics of the reviewed BCCs. With BCS, mostly SNB was performed and numbers of removed LN in ALNE have decreased. In the U‑BCC, the rate of 2° ALNE dropped after the publication of the Z0011 data. The fact that no such decrease for 2° ALNE was found in D‑BCC suggests that university hospitals implement new data and research results into clinical routine earlier than peripheral community hospitals.

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The Value of Ultrasound Diagnosed Axillary Lymph Node in Avoiding Axillary Surgery in Early Breast Cancer Patients

10.21203/rs.3.rs-81453/v1 ◽

2020 ◽

Author(s):

Na Liu ◽

Liu Yang ◽

Xinle Wang ◽

Meiqi Wang ◽

Ruoyang Li ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Cancer Patients ◽

Axillary Lymph Node ◽

Histological Grade ◽

False Negative ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Ki 67 ◽

Axillary Surgery

Abstract Background: Axillary lymph node dissection can be avoided in early stage breast cancer patients with negative sentinel lymph node biopsy. However, the possibility of avoiding axillary surgery in patients without axillary lymph node metastasis (ALNM) by preoperative imaging is still under exploration. Thus, the objectives of this study were to investigate the high-risk factors of false negative of ALNM diagnosed by preoperative ultrasound (US) and to find out who could be avoided axillary surgery in the US negative ALNM patients.Methods: This study retrospectively analyzed 3,361 patients with primary early breast cancer diagnosed in the Breast Center of the Fourth Hospital of Hebei Medical University from January 2010 to December 2012. All patients had undergone routine preoperative US and then axillary lymph node dissected. This study investigated the clinicopathological features of axillary lymph node (ALN) negative patients diagnosed by preoperative US and its correlation with prognosis. The follow-up data for disease-free survival (DFS) and overall survival (OS) were obtained from 2,357 patients. Results: The sensitivity, specificity and accuracy of axillary US in this cohort were 66.24%, 76.62% and 73.87%. The proportion of patients in the false negative group was higher than that in true negative in the group of age < 50 years old (P = 0.002), tumor size > 2cm (P = 0.008), estrogen receptor (ER) positive (P = 0.005), progesterone receptor (PR) high expression (P = 0.007), nuclear-associated antigen Ki-67 (Ki-67) >20% (P = 0.030), visible vascular tumor thrombus (P < 0.001) and histological grade>2 (P < 0.001). Prognostic analysis of false negative and true negative ultrasonographic diagnosis of ALN metastasis: when ALNM was not found by preoperative ultrasound, there was no significant difference in patients with ALNM≤3 compared with patients without lymph node metastasis in patients of age ≥ 50 years old, tumor size ≤ 2cm, Ki-67 ≤ 20%, or histological grade ≤ 2. Conclusion: The surgery of ALN may be avoided for the preoperative US diagnosed ALNs negative in early breast cancer patients who had advanced age, small tumor size, low expression of Ki-67 and low histological grade.

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Omitting radiotherapy is safe in breast cancer patients ≥ 70 years old after breast-conserving surgery without axillary lymph node operation

Scientific Reports ◽

10.1038/s41598-020-76663-5 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Ying Zhong ◽

Yali Xu ◽

Yidong Zhou ◽

Feng Mao ◽

Yan Lin ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Axillary Lymph Node ◽

Breast Conserving Surgery ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Breast Radiotherapy ◽

Metastasis Rate

Abstract To verify whether omitting radiotherapy from breast cancer treatment for patients ≥ 70 years old following breast-conserving surgery (BCS) without axillary lymph node dissection is safe. Previous studies have shown that omitting breast radiotherapy after BCS and axillary lymph node dissection is safe for elderly breast cancer patients. We aimed to evaluate the safety of BCS without axillary surgery or breast radiotherapy (BCSNR) in elderly patients with breast cancer and clinically negative axillary lymph nodes. We performed a retrospective analysis of 481 patients with breast cancer, aged ≥ 70 years, between 2010 and 2016. Of these, 302 patients underwent BCSNR and 179 underwent other, larger scope operations. Local recurrence rate, ipsilateral breast tumor recurrence (IBTR) rate, distant metastasis rate, breast-related death, disease-free survival (DFS), and overall survival (OS) were compared between the two groups. After a median follow-up of 60 months, no significant differences in local recurrence, distant metastasis rate, breast-related death, and DFS were noted. The OS was similar (P = 0.56) between the BCSNR group (91.7%) and other operations group (93.0%). The IBTR rate was considered low in both groups, however resulted greater (P = 0.005) in the BCSNR group (5.3%) than in other operations group (1.6%). BCSNR did not affect the survival of elderly patients with breast cancer with clinically negative axillary lymph nodes. IBTR was infrequent in both groups; however, there was a significant difference between the two groups. BCSNR is a feasible treatment modality for patients with breast cancer ≥ 70 years old with clinically negative axillary lymph nodes.

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Impact of the ACOSOG Z0011 Trial on Surgical Practice in Asian Patients: Comparison of Trends in Axillary Surgery for Breast Cancer Between Korean and Dutch Cohorts

10.21203/rs.3.rs-629894/v1 ◽

2021 ◽

Author(s):

CHIHWAN CHA ◽

Eun Young Kim ◽

Sung Yong Kim ◽

Jai Min Ryu ◽

Min Ho Park ◽

...

Keyword(s):

Breast Cancer ◽

Breast Conserving Surgery ◽

Lymphatic Invasion ◽

Downward Trend ◽

Axillary Lymph ◽

Annual Percent Change ◽

Axillary Surgery ◽

Z0011 Trial ◽

The Impact ◽

Dutch Cohort

Abstract PurposeSince the publication of the Z0011 trial, practice-changing clinical guidelines for breast surgery have been developed. Although recent studies confirmed the feasibility of the Z0011 strategy in Asian populations, there has been no study on the trends of axillary surgery in Asian cohort. This study aimed to investigate the time trend of axillary surgery for breast cancer in Korea and compare it with that in Dutch cohort to understand the impact of the Z0011 trial.MethodsWe collected prospectively constructed data from the nationwide Korean Breast Cancer Registry (KBCR). We identified patients who underwent sentinel node biopsy followed by breast-conserving surgery from 2011 to 2018 and were found to have pathological stage T1-2N1-3M0 disease. Regression analyses were performed to compare the downward trend of axillary lymph node dissection (ALND) in our cohort with that previously reported in a Dutch cohort.Results From KBCR data, 7,478 patients met the inclusion criteria. The proportion of ALND significantly decreased from 2011 (76.6%) to 2018 (47.5%). Multivariate analysis revealed that earlier year at diagnosis, larger tumor size, and lymphatic invasion were associated with a higher odds ratio of performing ALND. Compared to Dutch cohort, the downward trend of ALND in Korea was significantly more gradual (annual percent change: 30.1% vs. 5.8%, P < 0.001).ConclusionsThis study demonstrated a downward trend of ALND in Korean patients with breast cancer. However, the rate of decrease was significantly slower than that in Dutch cohort, indicating the need to spread the Z0011 strategy in Asia.

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What has changed in the management of breast cancer in the past 25 years at the Istanbul University Hospital?

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.27_suppl.184 ◽

2011 ◽

Vol 29 (27_suppl) ◽

pp. 184-184 ◽

Cited By ~ 1

Author(s):

F. Aydogan ◽

E. Gazioglu ◽

E. Canbay ◽

I. Aydin ◽

T. Aydogan ◽

...

Keyword(s):

Breast Cancer ◽

Breast Conserving Surgery ◽

Lymph Node Biopsy ◽

University Hospital ◽

Operation Technique ◽

Breast Cancer Patients ◽

The Past ◽

Node Biopsy ◽

Number Of Patients ◽

Stage 1

184 Background: There have been important changes in diagnosis and treatment of the breast cancer during the last century. Diagnosing the cancer in early stages brought the new approaches such as breast conserving surgery instead of mastectomy and sentinel lymph node biopsy instead of direct axillary disection. In this study our purpose is to compare the operations which were performed in 1983 and 2008 on breast cancer patients of our clinic and to search the differences in their ages and tumor characteristics. Methods: In each group the files of 100 patients, who were operated in 1983 and 2008, were compared with each other including the variabilities such as size of the tumor, age of the patient and operation technique. Results: There were 100 patients in both of the groups. Six of the patients (6%), who were operated on in 1983, were found to be between the ages of 20-39 and this percentage was found to be much higher as 19% (19 patients) in 2008. In 1983, there wasn't any patient at stage 0 and the number of patients at stage 1 was 15 (15%), in 2008 the number of stage 0 patient was 9 (9%) and stage 1 patient was 25 (25%). Breast conserving surgery rate was found to be 9% in 1983 and 41% in 2008. Conclusions: According to the data of this study, breast cancer is now being seen at younger ages when compared to 25 years ago. Currently the patients have diagnosis at earlier stages and the breast conserving surgery is much more prevalent. Earlier-stage diagnosis can be explained by widespread use of screening mamographies and increasing consciousness of the patients.

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