AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy: 2021 Update

Friedrich M, Kühn T, Janni W, Müller V, Banys-Pachulowski M, Kolberg-Liedtke C, Jackisch C, Krug D, Albert US, Bauerfeind I, Blohmer J, Budach W, Dall P, Fallenberg EM, Fasching P, Fehm T, Gerber B, Gluz O, Hanf V, Harbeck N, Heil J, Huober J, Kreipe HH, Kümmel S, Loibl S, Lüftner D, Lux MP, Maass N, Möbus V, Mundhenke C, Nitz U, Park-Simon TW, Reimer T, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Witzel I, Wöckel A, Thill M, Ditsch N (2021)

Publication Type: Journal article, Review article

Publication year: 2021

Journal

Book Volume: 81

Pages Range: 1112-1120

Journal Issue: 10

DOI: 10.1055/a-1499-8431

Abstract

For many decades, the standard procedure to treat breast cancer included complete dissection of the axillary lymph nodes. The aim was to determine histological node status, which was then used as the basis for adjuvant therapy, and to ensure locoregional tumour control. In addition to the debate on how to optimise the therapeutic strategies of systemic treatment and radiotherapy, the current discussion focuses on improving surgical procedures to treat breast cancer. As neoadjuvant chemotherapy is becoming increasingly important, the surgical procedures used to treat breast cancer, whether they are breast surgery or axillary dissection, are changing. Based on the currently available data, carrying out SLNE prior to neoadjuvant chemotherapy is not recommended. In contrast, surgical axillary management after neoadjuvant chemotherapy is considered the procedure of choice for axillary staging and can range from SLNE to TAD and ALND. To reduce the rate of false negatives during surgical staging of the axilla in pN+ CNBstage before NACT and ycN0 after NACT, targeted axillary dissection (TAD), the removal of > 2 SLNs (SLNE, no untargeted axillary sampling), immunohistochemistry to detect isolated tumour cells and micro-metastases, and marking positive lymph nodes before NACT should be the standard approach. This most recent update on surgical axillary management describes the significance of isolated tumour cells and micro-metastasis after neoadjuvant chemotherapy and the clinical consequences of low volume residual disease diagnosed using SLNE and TAD and provides an overview of this year's AGO recommendations for surgical management of the axilla during primary surgery and in relation to neoadjuvant chemotherapy.

Authors with CRIS profile

Involved external institutions

Charité - Universitätsmedizin Berlin Germany (DE) Universitätsmedizin Rostock Germany (DE) Universitätsklinikum Ulm Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Kliniken Essen-Mitte Germany (DE) Universitätsklinikum Düsseldorf Germany (DE) Klinikum der Universität München Germany (DE) Klinikum Fürth Germany (DE) Städtische Kliniken Esslingen Germany (DE) Universitätsklinikum Aachen (UKA) Germany (DE) Klinikum Augsburg Germany (DE) Universitätsklinikum Heidelberg Germany (DE) Johannes Gutenberg-Universität Mainz (JGU) Germany (DE) Universitätsklinikum Würzburg Germany (DE) Universitätsklinikum des Saarlandes (UKS) Germany (DE) Universitätsklinikum Köln Germany (DE) Städtisches Klinikum Lüneburg Germany (DE) Universitätsklinikum Frankfurt am Main (KGU) Germany (DE) Agaplesion Markus Krankenhaus Germany (DE) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Evangelisches Krankenhaus Bethesda Germany (DE) Klinikum Landshut Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Kooperatives Brustzentrum Paderborn Germany (DE) HELIOS Kliniken Germany (DE) Martin-Luther-Universität Halle-Wittenberg (MLU) Germany (DE) Diakonissen-Stiftungs-Krankenhaus Speyer Germany (DE) Sana Kliniken AG Germany (DE) GBG Forschungs GmbH (German Breast Group) Germany (DE)

How to cite

APA:

Friedrich, M., Kühn, T., Janni, W., Müller, V., Banys-Pachulowski, M., Kolberg-Liedtke, C.,... Ditsch, N. (2021). AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy: 2021 Update. Geburtshilfe und Frauenheilkunde, 81(10), 1112-1120. https://doi.org/10.1055/a-1499-8431

MLA:

Friedrich, Michael, et al. "AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy: 2021 Update." Geburtshilfe und Frauenheilkunde 81.10 (2021): 1112-1120.

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