Couto Henrique Lima, Hassan Augusto Tufi, Steinmacher Dalton Ivan, Pessoa Eduardo Carvalho, Millen Eduardo Camargo, Zerwes Felipe, Cavalcante Francisco Pimentel, Tosello Giuliano, Novita Guilherme, Machado Badan Gustavo, Esteves Francisco José Luis, Soares Leonardo Ribeiro, Budel Lucas Roskamp, Fernandes Chala Luciano, Fernandes Raquel Civolani Marques, Freitas-Junior Ruffo, de Oliveira Vilmar Marques, Budel Vinicius Milani, Mattar André
Brazilian Society of Mastology, Rio de Janeiro, RJ, Brazil.
Redimama - Redimasto, Belo Horizonte, MG, Brazil.
Front Oncol. 2024 Oct 9;14:1393417. doi: 10.3389/fonc.2024.1393417. eCollection 2024.
INTRODUCTION/OBJECTIVES: The precise location of the tumor site is essential for the success of surgical treatment. Neoadjuvant chemotherapy (NAC) is a challenge for preoperative tumor and node localization. Thus, the knowledge and attitudes of the affiliated members of the Brazilian Society of Mastology (SBM) regarding breast and axilla marking were evaluated and a consensus regarding management and treatment was reached.
METHODS: This was an online survey conducted between June and December 2022. All 1,742 active mastologists affiliated to the SBM were invited anonymously. The online form contained 28 objective questions, of which 22 were formulated on a Likert scale. These questions addressed relevant aspects related to breast and axilla marking in the neoadjuvant setting. Responses that reached 70% agreement were considered consensual. Statistical analysis was performed using the SPSS program version 26.0. analysis was performed when appropriate and the significance level was set at p < 0.05. Polychoric regression analyses were conducted using VGAM package.
RESULTS: In total, 468 mastologists answered the questionnaire (26.8%), with a predominance of professionals aged between 40-49 years (32.1%). Most professionals were board-certified (84,8%). The indication of tumor marking in the breast prior to NAC was consensual (96.4%) and the metal clip was the preferred method (69.7%). There was no consensus regarding the indication of pre-NAC histologically positive lymph node marking (49.8% disagree and 42.8% agree). However, there was consensus that the clinical and imaging evaluation was insufficient for staging the axilla as N1 (71.6%). The contraindication of breast and node marking in T4b tumors (71.2%) was consensual. There was consensus on the indication of sentinel lymph node biopsy (SLNB) for initially cN1 (92.3%) or cN2 (72.7%) tumors that became cN0 after NAC, with 67.5% opting for dual staining with technetium and patent blue. When <3 lymph nodes were retrieved 41.0% of mastologists performed axillary lymphadenectomy. Among the 28 questions, consensus was reached on only 11 (39.3%).
CONCLUSION: The indication of pre-NAC breast marking is consensual among Brazilian mastologists, although axillary nodal marking is not. There is a great divergence of attitudes among Brazilian surgeons in relation to the many issues related to pre-NAC breast and axilla marking.
引言/目的：肿瘤部位的精确位置对于手术治疗的成功至关重要。新辅助化疗（NAC）对术前肿瘤和淋巴结定位是一项挑战。因此，对巴西乳腺病学会（SBM）的相关成员关于乳房和腋窝标记的知识及态度进行了评估，并就管理和治疗达成了共识。 方法：这是一项在2022年6月至12月期间进行的在线调查。匿名邀请了SBM的所有1742名活跃乳腺病专家。在线表格包含28个客观问题，其中22个问题采用李克特量表形式。这些问题涉及新辅助治疗背景下与乳房和腋窝标记相关的各个方面。达成70%一致意见的回答被视为达成共识。使用SPSS 26.0版程序进行统计分析。在适当情况下进行分析，显著性水平设定为p<0.05。使用“VGAM”软件包进行多序回归分析。 结果：共有468名乳腺病专家回答了问卷（26.8%），其中40 - 49岁的专业人员占多数（32.1%）。大多数专业人员具有专业认证（84.8%）。NAC前乳房肿瘤标记的指征达成了共识（96.4%），金属夹是首选方法（69.7%）。对于NAC前组织学阳性淋巴结标记的指征未达成共识（49.8%不同意，42.8%同意）。然而，对于将腋窝分期为N1，临床和影像学评估不足这一点达成了共识（71.6%）。T4b肿瘤中乳房和淋巴结标记的禁忌证达成了共识（71.2%）。对于NAC后初始为cN1（92.3%）或cN2（72.7%）且变为cN0的肿瘤，前哨淋巴结活检（SLNB）的指征达成了共识，67.5%的人选择锝和专利蓝双重染色。当取出的淋巴结少于3个时，41.0%的乳腺病专家进行腋窝淋巴结清扫术。在28个问题中，仅11个（39.3%）达成了共识。 结论：巴西乳腺病专家对NAC前乳房标记的指征达成了共识，尽管腋窝淋巴结标记未达成共识。巴西外科医生在与NAC前乳房和腋窝标记相关的许多问题上态度差异很大。
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