Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Department of Gynecology and Obstetrics, Helios Klinikum Berlin-Buch, Berlin, Germany.
Arch Gynecol Obstet. 2023 May;307(5):1547-1556. doi: 10.1007/s00404-022-06804-w. Epub 2022 Oct 10.
In the last 2 decades, the optimal management of the axilla in breast cancer patients receiving neoadjuvant chemotherapy (NACT) has been one of the most frequently discussed topics. Little is known about the attitudes of surgeons/radiologists towards new developments such as targeted axillary dissection. Therefore, the NOGGO conducted a survey to evaluate the current approach to axillary management.
A standardized digital questionnaire was sent out to > 200 departments in Germany between 7/2021 and 5/2022. The survey was supported by EUBREAST.
In total, 116 physicians completed the survey. In cN0 patients scheduled to receive NACT, 89% of respondents recommended sentinel lymph node biopsy (SLNB) after NACT. In case of ypN1mi(sn), 44% advised no further therapy, while 31% proposed ALND and 25% axillary irradiation. 64% of respondents recommended a minimally invasive axillary biopsy to cN + patients. TAD was used at the departments of 82% of respondents and was offered to all cN + patients converting to ycN0 by 57% and only to selected patients, usually based on the number of suspicious nodes at time of presentation, by 43%. The most common marking technique was a clip/coil. 67% estimated that the detection rate of their marker was very good or good.
This survey shows a heterogenous approach towards axillary management in the neoadjuvant setting in Germany. Most respondents follow current guidelines. Since only two-thirds of respondents experienced the detection rate of the marker used at their department as (very) good, future studies should focus on the comparative evaluation of different marking techniques.
在过去的 20 年中，接受新辅助化疗（NACT）的乳腺癌患者腋窝的最佳管理一直是讨论最多的话题之一。对于新发展，如靶向腋窝解剖，外科医生/放射科医生的态度知之甚少。因此，NOGGO 进行了一项调查，以评估当前的腋窝管理方法。
2021 年 7 月至 2022 年 5 月，在德国向超过 200 个科室发送了标准化数字问卷。该调查得到了 EUBREAST 的支持。
共有 116 名医生完成了调查。在计划接受 NACT 的 cN0 患者中，89%的受访者建议在 NACT 后进行前哨淋巴结活检（SLNB）。对于 ypN1mi（sn），44%建议不进行进一步治疗，31%建议进行 ALND，25%建议进行腋窝放疗。64%的受访者建议对 cN+患者进行微创腋窝活检。82%的受访者使用 TAD，57%的受访者建议将所有转化为 ycN0 的 cN+患者进行 TAD，43%的受访者仅建议对某些患者进行 TAD，通常基于就诊时可疑淋巴结的数量。最常见的标记技术是夹/圈。67%的受访者估计他们使用的标记物的检出率非常好或好。
这项调查显示，德国新辅助治疗中腋窝管理的方法存在异质性。大多数受访者遵循当前的指南。由于只有三分之二的受访者认为其所在科室使用的标记物的检出率（非常）好，因此未来的研究应集中在不同标记技术的比较评估上。
