Impact of imaging-guided localization on performance of tailored axillary surgery in patients with clinically node-positive breast cancer: Prospective cohort study within TAXIS (OPBC-03, SAKK 23/16, IBCSG 57-18, ABCSG-53, GBG 101) Journal Article
| Authors: | Weber, W. P.; Heidinger, M.; Hayoz, S.; Matrai, Z.; Tausch, C.; Henke, G.; Zwahlen, D. R.; Gruber, G.; Zimmermann, F.; Montagna, G.; Andreozzi, M.; Goldschmidt, M.; Schulz, A.; Mueller, A.; Ackerknecht, M.; Tampaki, E. C.; Bjelic-Radisic, V.; Kurzeder, C.; Sávolt, Á; Smanykó, V.; Hagen, D.; Müller, D. J.; Gnant, M.; Loibl, S.; Fitzal, F.; Markellou, P.; Bekes, I.; Egle, D.; Heil, J.; Knauer, M. |
| Article Title: | Impact of imaging-guided localization on performance of tailored axillary surgery in patients with clinically node-positive breast cancer: Prospective cohort study within TAXIS (OPBC-03, SAKK 23/16, IBCSG 57-18, ABCSG-53, GBG 101) |
| Abstract: | Background: Tailored axillary surgery (TAS) is a novel surgical concept for clinical node-positive breast cancer. It consists of the removal of the sentinel lymph nodes (LNs), as well as palpably suspicious nodes. The TAS technique can be utilized in both the upfront and neoadjuvant chemotherapy (NACT) setting. This study assessed whether/how imaging-guided localization (IGL) influenced TAS. Patients and Methods: This was a prospective observational cohort study preplanned in the randomized phase-III OPBC-03/TAXIS trial. IGL was performed at the surgeon’s discretion for targeted removal of LNs during TAS. Immediate back-up axillary lymph node dissection (ALND) followed TAS according to TAXIS randomization. Results: Five-hundred patients were included from 44 breast centers in six countries, 151 (30.2%) of whom underwent NACT. IGL was performed in 84.4% of all patients, with significant variation by country (77.6–100%, p < 0.001). No difference in the median number of removed (5 vs. 4, p = 0.3) and positive (2 vs. 2, p = 0.6) LNs by use of IGL was noted. The number of LNs removed during TAS with IGL remained stable over time (p = 0.8), but decreased significantly without IGL, from six (IQR 4–6) in 2019 to four (IQR 3–4) in 2022 (p = 0.015). An ALND was performed in 249 patients, removing another 12 (IQR 9–17) LNs, in which a median number of 1 (IQR 0–4) was positive. There was no significant difference in residual nodal disease after TAS with or without IGL (68.0% vs. 57.6%, p = 0.2). Conclusions: IGL did not significantly change either the performance of TAS or the volume of residual nodal tumor burden. Trial registration: ClinicalTrials.gov Identifier: NCT03513614. © 2023, The Author(s). |
| Keywords: | adult; controlled study; aged; major clinical study; clinical trial; histopathology; treatment planning; adjuvant therapy; cancer radiotherapy; neoadjuvant therapy; nuclear magnetic resonance imaging; lymph node metastasis; antineoplastic agent; lymph node dissection; lymph nodes; lymphatic metastasis; prospective study; lymph node excision; prospective studies; sentinel lymph node biopsy; quality of life; computer assisted tomography; breast cancer; echomammography; mastectomy; randomized controlled trial; cohort analysis; pathology; diagnostic imaging; breast neoplasms; iodine 125; breast tumor; lymph node; needle biopsy; phase 3 clinical trial; neoadjuvant chemotherapy; axilla; axillary lymph node metastasis; observational study; breast surgery; titanium; axillary lymph node dissection; breast-conserving surgery; axillary dissection; multimodal imaging; procedures; sentinel lymph node metastasis; stainless steel; radioactive seed; humans; human; female; article; axillary staging; breast radiotherapy; ductal breast carcinoma in situ; tailored axillary surgery; sentinel lymph node procedure; nitinol |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 31 |
| Issue: | 1 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2024-01-01 |
| Start Page: | 344 |
| End Page: | 355 |
| Language: | English |
| DOI: | 10.1245/s10434-023-14404-4 |
| PUBMED: | 37903951 |
| PROVIDER: | scopus |
| PMCID: | PMC10695869 |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
