AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy: 2021 Update
Wissenschaftlicher Artikel/Review - 06.10.2021
Ditsch Nina, Rody Achim, Rhiem Kerstin, Reimer Toralf, Park-Simon Tjoung-Won, Nitz Ulrike, Mundhenke Christoph, Möbus Volker, Maass Nicolai, Lux Michael Patrick, Luftner Diana, Schmidt Marcus, Schneeweiss Andreas, Thill Marc, Wöckel Achim, Witzel Isabell, Untch Michael, Thomssen Christoph, Stickeler Elmar, Solomayer Erich-Franz, Solbach Christine, Sinn Hans-Peter, Schütz Florian, Loibl Sibylle, Kümmel Sherko, Blohmer Jens, Bauerfeind Ingo, Albert Ute-Susann, Krug David, Jackisch Christian, Kolberg-Liedtke Cornelia, Banys-Pachulowski Maggie, Müller Volkmar, Janni Wolfgang, Kühn Thorsten, Budach Wilfried, Dall Peter, Kreipe Hans-Heinrich, Huober Jens, Heil Jörg, Harbeck Nadia, Hanf Volker, Gluz Oleg, Gerber Bernd, Fehm Tanja, Fasching Peter A, Fallenberg Eva M, Friedrich Michael
For many decades, the standard procedure to treat breast cancer included complete dissection of the axillary lymph nodes. The aim was to determine histological node status, which was then used as the basis for adjuvant therapy, and to ensure locoregional tumour control. In addition to the debate on how to optimise the therapeutic strategies of systemic treatment and radiotherapy, the current discussion focuses on improving surgical procedures to treat breast cancer. As neoadjuvant chemotherapy is becoming increasingly important, the surgical procedures used to treat breast cancer, whether they are breast surgery or axillary dissection, are changing. Based on the currently available data, carrying out SLNE prior to neoadjuvant chemotherapy is not recommended. In contrast, surgical axillary management after neoadjuvant chemotherapy is considered the procedure of choice for axillary staging and can range from SLNE to TAD and ALND. To reduce the rate of false negatives during surgical staging of the axilla in pN+ stage before NACT and ycN0 after NACT, targeted axillary dissection (TAD), the removal of > 2 SLNs (SLNE, no untargeted axillary sampling), immunohistochemistry to detect isolated tumour cells and micro-metastases, and marking positive lymph nodes before NACT should be the standard approach. This most recent update on surgical axillary management describes the significance of isolated tumour cells and micro-metastasis after neoadjuvant chemotherapy and the clinical consequences of low volume residual disease diagnosed using SLNE and TAD and provides an overview of this year's AGO recommendations for surgical management of the axilla during primary surgery and in relation to neoadjuvant chemotherapy.