Axillary management for patients with breast cancer after neoadjuvant chemotherapy: Results of a survey among Brazilian breast surgeons

• Published in: Journal of surgical oncology Vol. 122; no. 6; pp. 1247 - 1251
• Main Authors: Frasson, Antônio L., Resende, Heloísa M., Lichtenfels, Martina, Barbosa, Fernanda, Souza, Alessadra B. A., Miranda, Isabela, Falcone, Ana B.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.11.2020
• Subjects: Axilla; Biopsy; Brazil; Breast cancer; breast neoplasm; Breast Neoplasms - drug therapy; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Chemotherapy; Female; Humans; Lymph Node Excision - methods; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic system; Neoadjuvant Therapy; sentinel lymph node; Sentinel Lymph Node Biopsy - methods; Surgeons; Surgeons - statistics & numerical data; Surveys and Questionnaires; Brazil; breast neoplasm; sentinel lymph node; neoadjuvant therapy
• ISSN: 0022-4790; 1096-9098; 1096-9098
• DOI: 10.1002/jso.26104

Background Currently, there are broadly differing patterns in the management of the axilla after neoadjuvant chemotherapy (NAC) and no consensus with clinically strong evidence on the subject. A survey was performed to assess the current axillary management after NAC among Brazilian breast cancer surgeons. Methods The Brazilian Society of Mastology members were invited by email to complete an anonymous online survey and a total of 426 responses were collected. Results The majority of responders (67%) indicated performing routine axillary staging by physical exam, ultrasound, and fine needle biopsy in case of a suspicious node before NAC. Among breast surgeons working in the Brazilian Public Unified Health System, 11.3% answered that sentinel lymph node biopsy (SLNB) is not reasonable after NAC in their services. Seventy‐seven responders (18.2%) reported performing SLNB instead of axillary lymph node dissection (ALND) only in patients who are clinically node‐negative before NAC. Axillary complete pathologic response is necessary to omit ALND for 42.8% of responders. The molecular profile of a breast tumor is not considered when choosing axillary management after NAC for 73.7% of responders. Conclusions Our survey highlighted the trend towards de‐escalation of axillary surgery and observed high heterogeneity in axillary management after chemotherapy in a group of brazilian breast surgeons.