Safe and transparent introduction and evaluation of targeted axillary dissection in patients with node-positive breast cancer undergoing primary surgery: international consensus process
Year: 2025
Type: article
Abstract: BACKGROUND: Axillary node clearance is the current standard of care in patients with node-positive breast cancer undergoing primary surgery, despite a lack of evidence to demonstrate survival benefit and high rates of life-changing morbidity. Targeted axillary dissection (TAD) may be a safe alternative to axillary node clearance, but there is no agreement how primary TAD should be performed. TADPOLE-TOGETHER aimed to use international consensus methods to agree the key components of primary TAD to promote standardized introduction and evaluation of the technique within the TADPOLE trial. METHODS: A scoping review and key stakeholder interviews were used to generate a longlist of possible procedure steps for inclusion in the Delphi questionnaire. Two rounds of an international online survey were then used to agree the mandatory, optional, and prohibited steps of TAD, together with any standardization and training required. The final approach to primary TAD was agreed at an online consensus meeting. RESULTS: Thirteen potential steps of a TAD procedure were identified from the literature and expert interviews, together with information regarding standardization and training. Some 244 surgeons with global representation participated in the Round 1 survey, of whom 161 (66.0%) participated in Round 2. Seven mandatory steps of primary TAD, including localization and removal of the involved node, combined with a sentinel node biopsy, were agreed upon and ratified by 42 surgeons from the UK, Europe, and Asia who attended the consensus meeting. CONCLUSION: Robust international consensus methods have been used to agree how primary TAD should be performed, promoting safe and transparent introduction and evaluation of the technique.
Source: BJS Open
Authors: Shelley Potter, Ruth Mullan, Henry Cain, Edward R St John, Peter Barry, Yazan Massanat, James Harvey, Katherine Fairhurst, Adrienne Morgan, Margaret Perkins, Gregory Bruce Mann, Jocelyn Lippey, Katherine Cowan, Natalie Blencowe, Stuart A McIntosh, the TADPOLE Trial Management Group and the TADPOLE-TOGETHER Collaborative, Kerry Avery, Petra Baji, Indrani Bhattacharya, Ramsey Cutress, Lucy Culliford, David Dodwell, Jessica Frost, Jessica Harris, Hannah Markham, Elsa Marques, Kirsty Roberts, Sophie Rees, Mohamed Aamer, Nick Abbott, Youmna Abdelaziz, Khaled Abdelwahab, Hussain Abdulla, Belal Abufkhaida, Avi Agrawal, Zarka Ahmad, Mohamed Sherif Ali Ahmed, Shabir Ahmed, Suhair A L Saad, Mahmoud Alhussini, Lolwah Alriyees, Jeha Alshawi, Maila Aslam, Mohamed Attia, Kholoud Awaji, Chwanrow Baban, Abdoul Halim Bagué, Paulina Bajonero-Canonico, Seda Arzuman Baştürk, Faisal Bibal, Efren Bolivar, Maria Bramley, Victoria Brown, Mehmet Zeki Buldanlı, Rita Canotilho, Maria Isabel Carbonell Luna, Amtul R Carmichael, Alexandra Caziuc, Ching Wan Chan, Natalie Chand, Mysore Chandrashekar, Arun Chaubey, Samantha Chen, Iskra Daskalova, Dobromir Dimitrov, Matei Dordea, Stergios Douvetzemis, Mohammad Elahi, Kenneth Elder, Beatrix Elsberger, Sahar Elzein, Angela Fanshawe, Rosa Félix, Clare Fowler, Elena Gallini, Joan Gan, Nidhi Garg, Rares Georgescu, Wafaa Ghazali, Octav Ginghina, Amy R Godden, Omar Gomez-Quiñones, Victoria Graham, Melih Can Gul, Oğuz Hançerlioğulları, Claudia Harding-Mackean, Anita Hargreaves, Grant Harris, Frederick Hartley, James Harvey, Iram Hassan, Saddaqat Hayat, Christopher Holcombe, Jonathan Horsnell, Thomas Hubbard, Alison Hunter-Smith, Rabia Ikram, Tracey Irvine, Gareth Irwin, Jen Isherwood, Arda Isik, Sharmin Islam, Abdulrhman Jaber, Yasmin Jauhari, Marta Jiménez Gómez, Goonj Johri, Charlotte Kallaway, Kemal Erdinc Kamer, Guldeniz Karadeniz Cakmak, Haluk Kerim Karakullukcu, Martin Karamanliev, Isha Karwasra, Vasileios Karydakis, Monika Kaushik, Mah Muneer Khan, Hazem Khout, Stephen Kirk, Cliona Clare Kirwan, Loukiani Kitsikosta, Nurhilal Kiziltoprak, Hannah Knight, Hande Köksal, Petr Krsicka, Katherine Krupa, Jaroslaw Krupa, Gultekin Ozan Kucuk, Risha Lane, Siobhan Laws, Valentina Lefemine, Begonia Lipp Von Wattenwyl, Jocelyn Lippey, Maria Jesús López-Rodriguez, Aoife Lowery, Mhd Zuhri Nanda Rizki Lubis, Emma Macinnes, Draga Mandi, Baris Mantoglu, Patricia Marques Lauria, Lee Martin, Teresa De Jesus Martins Dias, Eleanore Massey, Tahir Masudi, Helen Mathers, Ross Mclean, Ufuk Memiş, Ecem Memişoğlu, Louise Merker, Aikaterini Micha, Ioannis Michalakis, Maria Mir Jan, Geraldine Mitchell, Fatima Mohammed, Radha Raman Mondal, Jenna Morgan, Samantha Muktar, Michelle Mullan, Claire Murphy, Syeda Rifaat Qamar Naqvi, Saman Naz, Harish Neelamraju Lakshmi, Rachel L O'Connell, Enciu Octavian, Bunmi Odofin, Sisse Olsen, Olubukola Omidiji, Hisham Osman, Omer Faruk Ozkan, Lazaros Papadopoulos, Inge Peerlinck, Helena Pereira, Simon Pilgrim, Antonio Piñero-Madrona, Susanna Polotto, Lydia Prusty, Saed Ramzi, Fabio Rapisarda, Rathi Rathinaezhil, Tim Rattay, Jacqueline Rees-Lee, Jaime Alonso Resendiz-Colosia, Catia Ribeiro, Nicola Rocco, Nicola Roche, Fabio Rodrigues, Matthias Rohr, Laszlo Romics, Matthew Rowland, Jennifer Rusby, Sunita Saha, Yasmeen Sajid, Reem Salman, Amtul Shafee Sami, Alejandro Martin Sanchez, Jose I Sanchez-Mendez, Ahmet Necati Sanli, Norah Scally, Lorenzo Scardina, Maria Sciamannini, Natasha Shafique, Lisa Sheehan, Spoorthi Shetty, Meri Shoshkova, Duncan Simpson, Brendan L Skelly, Roslyn Stanton, Nishith Sudhir Mandal, Marios Konstantinos Tasoulis, Amanda Taylor, Natasha Thakur, Rob Thomas, Mangesh Thorat, Amanda Thorne, Dragomir Timbur, Alice Townend, Nora Trabulsi, Hussein Tuffaha, Burak Uçaner, Kalliope Valassiadou, Nikolaos Vassos, Jamie Vatish, Maria Vernet-Tomas, Maria Verroiotou, Rebecca L Wilson, Merve Yesilsancak, Anneza Yiallourou, Ali Cihat Yildirim, Tsanko Yotsov, Charles Zammit, Luis Abraham Zuñiga Vazquez
Institutions: North Bristol NHS Trust, Southmead Hospital, University of Bristol, Queen's University Belfast, Newcastle upon Tyne Hospitals NHS Foundation Trust, Portsmouth Hospitals NHS Trust, University of Portsmouth, Royal Marsden NHS Foundation Trust, Broomfield Hospital, Manchester University NHS Foundation Trust, The Royal Melbourne Hospital, Royal Women's Hospital, The University of Melbourne, Breast Cancer Trials, St Vincent's Hospital Melbourne
Language: English
Subfield: Cancer Research
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $2,881
Funders: University Hospital Southampton NHS Foundation Trust, University Hospitals of Leicester NHS Trust, NIHR Bristol Biomedical Research Centre, Swansea Bay University Health Board, İstanbul Medeniyet Üniversitesi, National Institute for Health and Care Research, University of Exeter, University of Southampton, Instituto Mexicano del Seguro Social, Health Technology Assessment Programme
Awards: G1353937062, G1961608442, Targeted Axillary Dissection versus axillary node clearance in patients with POsitive axillary Lymph nodes in Early breast cancer: A multicentre, pragmatic, phase III randomised controlled trial, The BRaveR Study - Methods to develop and deliver Better ReseArch to improVe outcomes and inform practice in brEast Reconstruction
OpenAlex ID: W4415719289