TY - JOUR
T1 - Changes in Surgical Management of the Axilla Over 11 Years – Report on More Than 1500 Breast Cancer Patients Treated with Neoadjuvant Chemotherapy on the Prospective I-SPY2 Trial
AU - Boughey, Judy C.
AU - Yu, Hongmei
AU - Dugan, Catherine Lu
AU - Piltin, Mara A.
AU - Postlewait, Lauren
AU - Son, Jennifer D.
AU - Edmiston, Kirsten K.
AU - Godellas, Constantine V.
AU - Lee, Marie C.
AU - Carr, Michael J.
AU - Tonneson, Jennifer E.
AU - Crown, Angelena
AU - Lancaster, Rachel B.
AU - Woriax, Hannah E.
AU - Ewing, Cheryl A.
AU - Chau, Harrison S.
AU - Patterson, Anne K.
AU - Wong, Jasmine M.
AU - Alvarado, Michael D.
AU - Yang, Rachel L.
AU - Chan, Theresa W.
AU - Sheade, Jori B.
AU - Ahrendt, Gretchen M.
AU - Larson, Kelsey E.
AU - Switalla, Kayla
AU - Tuttle, Todd M.
AU - Tchou, Julia C.
AU - Rao, Roshni
AU - Tamirisa, Nina
AU - Singh, Puneet
AU - Gould, Rebekah E.
AU - Terando, Alicia
AU - Sauder, Candice
AU - Hewitt, Kelly
AU - Chiba, Akiko
AU - Esserman, Laura J.
AU - Mukhtar, Rita A.
N1 - Publisher Copyright:
© 2023, Society of Surgical Oncology.
PY - 2023/10
Y1 - 2023/10
N2 - Background: Axillary surgery after neoadjuvant chemotherapy (NAC) is becoming less extensive. We evaluated the evolution of axillary surgery after NAC on the multi-institutional I-SPY2 prospective trial. Methods: We examined annual rates of sentinel lymph node (SLN) surgery with resection of clipped node, if present), axillary lymph node dissection (ALND), and SLN and ALND in patients enrolled in I-SPY2 from January 1, 2011 to December 31, 2021 by clinical N status at diagnosis and pathologic N status at surgery. Cochran-Armitage trend tests were calculated to evaluate patterns over time. Results: Of 1578 patients, 973 patients (61.7%) had SLN-only, 136 (8.6%) had SLN and ALND, and 469 (29.7%) had ALND-only. In the cN0 group, ALND-only decreased from 20% in 2011 to 6.25% in 2021 (p = 0.0078) and SLN-only increased from 70.0% to 87.5% (p = 0.0020). This was even more striking in patients with clinically node-positive (cN+) disease at diagnosis, where ALND-only decreased from 70.7% to 29.4% (p < 0.0001) and SLN-only significantly increased from 14.6% to 56.5% (p < 0.0001). This change was significant across subtypes (HR−/HER2−, HR+/HER2−, and HER2+). Among pathologically node-positive (pN+) patients after NAC (n = 525) ALND-only decreased from 69.0% to 39.2% (p < 0.0001) and SLN-only increased from 6.9% to 39.2% (p < 0.0001). Conclusions: Use of ALND after NAC has significantly decreased over the past decade. This is most pronounced in cN+ disease at diagnosis with an increase in the use of SLN surgery after NAC. Additionally, in pN+ disease after NAC, there has been a decrease in use of completion ALND, a practice pattern change that precedes results from clinical trials.
AB - Background: Axillary surgery after neoadjuvant chemotherapy (NAC) is becoming less extensive. We evaluated the evolution of axillary surgery after NAC on the multi-institutional I-SPY2 prospective trial. Methods: We examined annual rates of sentinel lymph node (SLN) surgery with resection of clipped node, if present), axillary lymph node dissection (ALND), and SLN and ALND in patients enrolled in I-SPY2 from January 1, 2011 to December 31, 2021 by clinical N status at diagnosis and pathologic N status at surgery. Cochran-Armitage trend tests were calculated to evaluate patterns over time. Results: Of 1578 patients, 973 patients (61.7%) had SLN-only, 136 (8.6%) had SLN and ALND, and 469 (29.7%) had ALND-only. In the cN0 group, ALND-only decreased from 20% in 2011 to 6.25% in 2021 (p = 0.0078) and SLN-only increased from 70.0% to 87.5% (p = 0.0020). This was even more striking in patients with clinically node-positive (cN+) disease at diagnosis, where ALND-only decreased from 70.7% to 29.4% (p < 0.0001) and SLN-only significantly increased from 14.6% to 56.5% (p < 0.0001). This change was significant across subtypes (HR−/HER2−, HR+/HER2−, and HER2+). Among pathologically node-positive (pN+) patients after NAC (n = 525) ALND-only decreased from 69.0% to 39.2% (p < 0.0001) and SLN-only increased from 6.9% to 39.2% (p < 0.0001). Conclusions: Use of ALND after NAC has significantly decreased over the past decade. This is most pronounced in cN+ disease at diagnosis with an increase in the use of SLN surgery after NAC. Additionally, in pN+ disease after NAC, there has been a decrease in use of completion ALND, a practice pattern change that precedes results from clinical trials.
KW - Axillary dissection
KW - Neoadjuvant chemotherapy
KW - Sentinel lymph node surgery
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UR - http://www.scopus.com/inward/citedby.url?scp=85163624841&partnerID=8YFLogxK
U2 - 10.1245/s10434-023-13759-y
DO - 10.1245/s10434-023-13759-y
M3 - Article
C2 - 37380911
AN - SCOPUS:85163624841
SN - 1068-9265
VL - 30
SP - 6401
EP - 6410
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 11
ER -