Hartmann Steffi, Kühn Thorsten, Hauptmann Michael, Stickeler Elmar, Thill Marc, Lux Michael P, Fröhlich Sarah, Ruf Franziska, Loibl Sibylle, Blohmer Jens-Uwe, Kolberg Hans-Christian, Thiemann Elisabeth, Weigel Michael, Solbach Christine, Kaltenecker Gabriele, Paluchowski Peter, Schrauder Michael G, Paepke Stefan, Watermann Dirk, Hahn Markus, Hufnagel Maria, Lefarth Jutta, Untch Michael, Banys-Paluchowski Maggie
Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Rostock, Rostock, Germany.
Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany.
Geburtshilfe Frauenheilkd. 2022 Sep 13;82(9):932-940. doi: 10.1055/a-1889-7883. eCollection 2022 Sep.
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. In this paper we analyzed data from patients enrolled in the AXSANA study at German study sites from June 2020 to March 2022. 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. 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.
迄今为止，新辅助化疗（NACT）后初始淋巴结阳性乳腺癌患者的最佳腋窝分期程序尚不清楚。AXSANA研究的目的是前瞻性地比较不同手术分期技术对患者肿瘤学结局和生活质量的影响。目前对德国的临床实践了解甚少。在本文中，我们分析了2020年6月至2022年3月在德国研究地点纳入AXSANA研究的患者数据。在调查期间，143个研究地点招募了1135名患者。22%的患者最初发现有三个以上可疑淋巴结。64%的病例标记了目标淋巴结（TLN）。其中83%的患者使用夹子/线圈标记，8%的患者使用磁性种子或碳悬浮液标记，1%的患者使用雷达标记。NACT后，48%的患者计划进行靶向腋窝清扫（TAD）或腋窝淋巴结清扫（ALND），2%的患者仅进行前哨淋巴结活检（SLNB）。临床上，65%的病例NACT后的淋巴结状态无异常。65%的患者通过触诊正确评估了组织学淋巴结状态，69%的患者通过超声正确评估。在德国AXSANA研究地点，TAD和ALND目前是NACT后初始淋巴结阳性乳腺癌患者最常用的手术分期程序。在NACT前用各种标记物标记TLN。鉴于NACT后腋窝淋巴结状态临床评估的准确性不足，是否应仅基于淋巴结状态的临床评估进行NACT后的腋窝清扫值得质疑。
