Evidence-Based De-Escalation in Axillary Management—Is Less Really More?
Menée à l'aide de données d'une étude allemande multicentrique portant sur 199 patientes ayant reçu un traitement systémique pour un cancer du sein avec envahissement ganglionnaire (âge médian : 52 ans ; durée de suivi : 43 mois), cette étude analyse la sécurité à 3 ans d'une exérèse axillaire ciblée seule ou suivie d'un curage axillaire
Since the Halstedian era, high-quality evidence has resulted in a trend toward de-escalation of surgery without compromise to oncologic outcomes for patients with breast cancer. Management of the axilla has seen the historical standard of axillary lymph node dissection (ALND) give way to sentinel lymph node biopsy (SLNB) for most patients with breast cancer who proceed to upfront surgery. However, in patients with confirmed axillary metastasis (cN+) who receive neoadjuvant systemic therapy (NST), management of the axilla remains controversial.The landmark Sentinel Neoadjuvant (SENTINA) study and the American College of Surgeons Oncology Group (ACOSOG) Z1071 trial evaluated the accuracy of post-NST SLNB in cN+ disease and found false-negative rates (FNRs) of 14.6% and 12.6%, respectively, raising questions about the safety of SLNB in this population. In the ACOSOG Z1071 trial, dual-agent mapping and excision of the clipped node reduced the FNR to 10.8% and 6.8%, respectively. Caudle et al formalized the practice of targeted axillary dissection (TAD), which includes removal of the clipped node with SLNB and demonstrated an FNR of 2%. To date, however, there are limited data on oncologic outcomes after TAD.
JAMA Surgery , éditorial, 2022