Third national surgical consensus conference of the Italian Association of Breast Surgeons (ANISC) on management after neoadjuvant chemotherapy: The difficulty in reaching a consensus

• Published in: European journal of surgical oncology Vol. 50; no. 7; p. 108351
• Main Authors: Ventimiglia, Fabrizio, Taffurelli, Mario, Caruso, Francesco, Gentilini, Oreste Davide, Del Mastro, Lucia, Livi, Lorenzo, Bernardi, Daniela, Minelli, Mauro, Zanotti, Simone, Ceccarossi, Virginia, Cosentino, Luigi Marino, Amaturo, Giuseppe, Bondioli, Paola, Meattini, Icro, Luca, Alessandro De, Gala, Antonia, Thodas, Alexios, Lozupone, Antonia, Botticella, Maria Antonietta, Grassi, Massimo, Santoro, Valeria, Carfora, Elisabetta, Cappelli, Sonia, Nunzi, Martina, Mastropietro, Tiziana, Meneghini, Graziano, Morichetti, Doriana, Pozzi, Giada, Soatti, Carlo Pietro, Puccica, Ilaria, Leone, Alba Di, Giuliani, Giuliana, Conte, Anna Maria, Foroni, Moira, Lippi, Andrea, Giaccherini, Lucia, Calzolaro, Adele, Neri, Anna, Di Marzio, Enrico, Venturini, Annalisa, Gattuso, Maria Ilaria, Sicignano, Margherita, Amabile, Maria Ida, Baldissera, Antonella, Sibilio, Andrea, Chiavilli, Stefano, Gennari, Roberto, Germano, Alessandro, Bonanni, Alessio, Tondo, Salvatore, Marchetti, Vania, Stani, Simonetta, Custodero, Olindo, Pellegrini, Francesco, Cremonini, Anna, Aristei, Cynthia, Roncella, Manuela, Folli, Secondo, Gentile, Damiano, Galimberti, Viviana, Trapani, Anna, Curella, Luciano, Panizza, Pietro, Pensa, Anna, De Rosa, Antonia, Borri, Filippo, Camilletti, Anna Chiara, Ruggieri, Annamaria, Andrulli, Angela Damiana, Silvia, Asioli, Terribile, Daniela Andreina, Accardo, Giuseppe, Raviele, Paola Rafaniello, Santini, Donatella, Costarelli, Leopoldo, Angelini, Lucia, Santoni, Marcello, Magni, Carla, Cima, Simona, Minafra, Marina, Giorgini, Sara, Grossi, Simona, Cumbo, Jacopo, Campanella, Barbara, Fante, Rossella, Pinta, Massimo La, Manna, Elena, Santini, Elena, Teggi, Silvia, Sanguinetti, Alessandro, Giacobbe, Felicia, Pellegrini, Alice, Papi, Simona, Pieroni, Marzia, Guadagno, Elia, Perfetti, Alessandra, Vignutelli, Patrizia, Apicella, Giuseppina, Natale, Maria, Rocco, Nicola
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.07.2024
• Subjects: Axilla; Axillary surgery; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Breast Neoplasms - therapy; Breast surgery; Chemotherapy, Adjuvant; Consensus; Female; Humans; Italy; Lymph Node Excision; Magnetic Resonance Imaging; Neoadjuvant chemotherapy; Neoadjuvant Therapy; Neoplasm, Residual; Sentinel Lymph Node Biopsy; Italy; Neoadjuvant chemotherapy; Breast cancer; Axillary surgery; Consensus; Breast surgery
• ISSN: 0748-7983; 1532-2157; 1532-2157
• DOI: 10.1016/j.ejso.2024.108351

Neoadjuvant chemotherapy (NAC) has a profound impact on surgical management of breast cancer. For this reason, the Italian Association of Breast Surgeons (ANISC) promoted the third national Consensus Conference on this subject, open to multidisciplinary specialists. The Consensus Conference was held on-line in November 2022, and after an introductory session with five core-team experts, participants were asked to vote on eleven controversial issues, while results were collected in real-time with a polling system. A total of 164 dedicated specialists from 74 Breast Centers participated. Consensus was reached for only three of the eleven issues, including: 1) the indication to assess the response with Magnetic Resonance Imaging (79 %); 2) the need to re-assess the biological factors of the residual tumor if present (96 %); 3) the possibility of omitting a formal axillary node dissection for cN1 patients if a pathologic Complete Response (pCR) was confirmed with analysis of one or more sentinel lymph nodes (82 %). The majority voted in favor of mapping both the breast and nodal lesions pre-NAC (59 %), and against the omission of sentinel lymph node biopsy in cN0 patients in the case of pathologic or clinical Complete Response (69 %). In cases of cT3/cN1+ tumors with pCR, only 8 % of participants considered appropriate the omission of Post-Mastectomy Radiation Therapy. There is still a wide variability in surgical approaches after NAC in the “real world”. As NAC is increasingly used, multidisciplinary teams should be attuned to conforming their procedures to the rapid advances in this field.