AGO Breast Commission recommendations for the surgical therapy of breast cancer: Working Group on Gynecologic Cancers (AGO) update 2025

Reimer T, Kuehn T, Mueller V, Ditsch N, Fehm T, Albert US, Bartsch R, Bauerfeind I, Bjelic-Radisic V, Blohmer JU, Budach W, Dall P, Fallenberg EM, Fasching P, Friedrich M, Gerber B, Gluz O, Harbeck N, Hartkopf A, Heil J, Hoerner-Rieber J, Huober J, Janni W, Kreipe HH, Krug D, Kuemmel S, Loibl S, Lueftner D, Lux MP, Maass N, Mundhenke C, Park-Simon TW, Reinisch M, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schuetz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, van Mackelenbergh M, Witzel I, Woeckel A, Wuerstlein R, Banys-Paluchowski M, Thill M (2025)

Publication Type: Journal article, Review article

Publication year: 2025

Journal

Book Volume: 51

Article Number: 110445

Journal Issue: 11

DOI: 10.1016/j.ejso.2025.110445

Abstract

The German Guideline Commission (AGO: Working Group on Gynecologic Cancers) updated its recommendations on the diagnosis and treatment of breast cancer in March 2025. Chapters on oncological and oncoplastic-reconstructive surgery are coordinated with the Working Group for Plastic, Aesthetic, and Reconstructive Surgery in Gynecology (AWOgyn). The most important changes include the incorporation of INSEMA and SOUND trial results into the guidelines. In patients with low-risk characteristics, defined as age ≥50 years, postmenopausal status, hormone receptor-positive/HER2-negative subtype, tumor grading G1-2 with a maximum preoperative size of 2 cm, and unsuspicious axillary ultrasound and clinical examination, the sentinel lymph node biopsy (SLNB) can be omitted if breast-conserving surgery and whole-breast irradiation are planned. In patients with 1–2 macrometastatic sentinel lymph nodes (SLNs) undergoing a mastectomy and postoperative irradiation, completion axillary lymph node dissection (ALND) is no longer recommended. After neoadjuvant systemic therapy (NST), ALND is recommended if the targeted axillary dissection (TAD) shows macrometastases in the sentinel and/or in the target lymph node (the node that was marked and had a macrometastasis in the biopsy before NST). Patients with isolated tumor cells in the sentinel and/or target lymph node should not receive ALND after NST. In case of ypN1mi status, the decision to perform a completion ALND should be made on a case-by-case basis. Oncoplastic surgery is safe and may replace a mastectomy in select cases.

Authors with CRIS profile

Involved external institutions

Universitätsklinikum Ulm Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Universität Augsburg Germany (DE) Universitätsklinikum Düsseldorf Germany (DE) Städtisches Klinikum Lüneburg Germany (DE) Klinikum der Universität München (LMU Klinikum) Germany (DE) HELIOS Kliniken Germany (DE) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Universitätsspital Zürich (USZ) Switzerland (CH) Universitätsklinikum Würzburg Germany (DE) Agaplesion Markus Krankenhaus Germany (DE) Universitätsmedizin Rostock Germany (DE) Evangelisches Krankenhaus Bethesda Germany (DE) Universitätsklinikum Heidelberg Germany (DE) Universitätsklinikum Frankfurt am Main (KGU) Germany (DE) Universitätsklinikum des Saarlandes (UKS) Germany (DE) Medizinische Universität Wien Austria (AT) Klinikum Landshut Germany (DE) Universität Witten/Herdecke Germany (DE) Charité - Universitätsmedizin Berlin Germany (DE) Kantonsspital St.Gallen Switzerland (CH) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Kliniken Essen-Mitte Germany (DE) GBG Forschungs GmbH (German Breast Group) Germany (DE) Medizinische Hochschule Brandenburg "Theodor Fontane" / Brandenburg Medical School "Theodor Fontane" Germany (DE) St. Vincenz-Kliniken GmbH Germany (DE) Klinikum Bayreuth Germany (DE) Universitätsklinikum Mannheim / University Medical Centre Mannheim (Universitätsmedizin Mannheim) Germany (DE) Universitätsklinikum Köln Germany (DE) Johannes Gutenberg-Universität Mainz (JGU) Germany (DE) Universitätsklinikum Tübingen Germany (DE) Klinik Sankt Elisabeth GmbH Germany (DE) Deutsches Krebsforschungszentrum (DKFZ) Germany (DE) Diakonissen-Stiftungs-Krankenhaus Speyer Germany (DE) Universitätsklinikum Aachen (UKA) Germany (DE) Martin-Luther-Universität Halle-Wittenberg (MLU) Germany (DE)

How to cite

APA:

Reimer, T., Kuehn, T., Mueller, V., Ditsch, N., Fehm, T., Albert, U.S.,... Thill, M. (2025). AGO Breast Commission recommendations for the surgical therapy of breast cancer: Working Group on Gynecologic Cancers (AGO) update 2025. European Journal of Surgical Oncology, 51(11). https://doi.org/10.1016/j.ejso.2025.110445

MLA:

Reimer, Toralf, et al. "AGO Breast Commission recommendations for the surgical therapy of breast cancer: Working Group on Gynecologic Cancers (AGO) update 2025." European Journal of Surgical Oncology 51.11 (2025).

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