Geburtshilfe und Frauenheilkunde
Geburtshilfe und Frauenheilkunde
3 years ago

AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy: 2021 UpdateAGO-Empfehlungen zur operativen Therapie der Axilla nach neoadjuvanter Chemotherapie: Update 2021

Michael Friedrich, Thorsten Kühn, Wolfgang Janni, Volkmar Müller, Maggie Banys-Pachulowski, Cornelia Kolberg-Liedtke, Christian Jackisch, David Krug, Ute-Susann Albert, Ingo Bauerfeind, Jens Blohmer, Wilfried Budach, Peter Dall, Eva M. Fallenberg, Peter A. Fasching, Tanja Fehm, Bernd Gerber, Oleg Gluz, Volker Hanf, Nadia Harbeck, Jörg Heil, Jens Huober, Hans-Heinrich Kreipe, Sherko Kümmel, Sibylle Loibl, Diana Lüftner, Michael Patrick Lux, Nicolai Maass, Volker Möbus, Christoph Mundhenke, Ulrike Nitz, Tjoung-Won Park-Simon, Toralf Reimer, Kerstin Rhiem, Achim Rody, Marcus Schmidt, Andreas Schneeweiss, Florian Schütz, Hans-Peter Sinn, Christine Solbach, Erich-Franz Solomayer, Elmar Stickeler, Christoph Thomssen, Michael Untch, Isabell Witzel, Achim Wöckel, Marc Thill, Nina Ditsch
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+CNB stage 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. Received: 21 April 2021

Accepted after revision: 04 May 2021

Publication Date:
06 October 2021 (online) © 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Publisher URL: http://dx.doi.org/10.1055/a-1499-8431

Open URL: http://www.thieme-connect.de/products/ejournals/pdf/10.1055/a-1499-8431.pdf

DOI: 10.1055/a-1499-8431

Open access
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