Year: 2021
Type: article
Abstract: FNR) compared to ALND, several current national guidelines recommend the use of SLNB for patients undergoing NST with initial clinically node negative disease only (FNR still about 7%) and use of targeted axillary dissection (TAD; removal of biopsied and clipped nodes plus SLNB) for patients with initial nodal disease converting to node negative disease after NST (FNR then about 2%).However, while the de-escalation of axillary surgery for exceptional responder to NST is already implemented in clinical practice, high level evidence on oncological outcome data is still lacking for SLNB and TAD after NST.For the primary tumor in the breast, breast conserving surgery (BCS) is the current standard of care.The use of NST instead of adjuvant treatment has facilitated more BCS instead of mastectomy with equal survival.Although BCS is a low morbidity procedure compared to other oncologic surgeries, it causes morbidity relevant to patients: (1) About 30% of patients undergoing BCS and SLNB report moderate, persistent pain two years after surgery, (2) the reduction in patientreported quality of life up to 8 years after surgery is comparable between patients undergoing BCS or mastectomy, and (3) adverse event rates especially among elderly patients are considerably high with about 30%.In the light of increasing ypT0 rates, current research evaluates alternative diagnostic procedures than BCS to identify these exceptional responders to NST who achieve ypT0.Imaging (ultrasound, mammography, MRI, PET-CT) is insufficiently accurate to reliably exclude residual disease (FNR about 20% for US and mammography) and/ or specificity is suboptimal (MRI, PET-CT).Vacuum-assisted biopsies (VAB) showed promising results in some pilot trials which could, however, not be confirmed in larger confirmatory multicenter trials: FNRs for VAB were 18% and 50%, respectively.These trials showed that a VAB alone may be at risk of missing small, heterogeneous responding tumor foci.To address this issue, the concept of an "intelligent VAB" was recently introduced: modern machine learning algorithms incorporating the complex interactions between VAB, patient, imaging, and tumor variables (called "intelligent VAB") showed a FNR of 0% in an albeit small external validation set while maintaining good specificity.Considering that axillary disease in patients with negative nodes before NST and a pathologic complete response in the breast is very rare (<2%), the use of a diagnostic intelligent VAB may spare these women diagnostic axillary and breast surgery in the future.Conflict of Interest: No significant relationships.
Source: The Breast
Author: L. Carey
Language: English
Subfield: Cancer Research
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $2,100
OpenAlex ID: W3136516529