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

• Published in: Geburtshilfe und Frauenheilkunde 2021-10, Vol.81 (10), p.1112-1120
• Main Authors: Friedrich, Michael, Kühn, Thorsten, Janni, Wolfgang, Müller, Volkmar, Banys-Paluchowski, Maggie, Kolberg-Liedtke, Cornelia, Jackisch, Christian, Krug, David, Albert, Ute-Susann, Bauerfeind, Ingo, Blohmer, Jens, Budach, Wilfried, Dall, Peter, Fallenberg, Eva M., Fasching, Peter A., Fehm, Tanja, Gerber, Bernd, Gluz, Oleg, Hanf, Volker, Harbeck, Nadia, Heil, Jörg, Huober, Jens, Kreipe, Hans-Heinrich, Kümmel, Sherko, Loibl, Sibylle, Lüftner, Diana, Lux, Michael Patrick, Maass, Nicolai, Möbus, Volker, Mundhenke, Christoph, Nitz, Ulrike, Park-Simon, Tjoung-Won, Reimer, Toralf, Rhiem, Kerstin, Rody, Achim, Schmidt, Marcus, Schneeweiss, Andreas, Schütz, Florian, Sinn, Hans-Peter, Solbach, Christine, Solomayer, Erich-Franz, Stickeler, Elmar, Thomssen, Christoph, Untch, Michael, Witzel, Isabell, Wöckel, Achim, Thill, Marc, Ditsch, Nina
• Format: Article
• Language: English
• Subjects: GebFra Science
• ISSN: 0016-5751; 1438-8804
• 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+ 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 yearʼs AGO recommendations for surgical management of the axilla during primary surgery and in relation to neoadjuvant chemotherapy. Zusammenfassung Über viele Jahrzehnte war die komplette Ausräumung der axillären Lymphknoten im Sinne einer Axilladissektion ein Standardverfahren in der Therapie des Mammakarzinom. Die Zielsetzung lag in der Bestimmung des histologischen Nodalstatus für die Festlegung der adjuvanten Therapie sowie in der Sicherung der lokoregionären Tumorkontrolle. Neben der Diskussion zur Optimierung der Therapiestrategien in der systemischen Behandlung und in der Strahlentherapie fokussieren aktuelle Diskussionen insbesondere auch auf die Verbesserung der chirurgischen Maßnahmen beim Mammakarzinom. Unter Berücksichtigung der zunehmenden Bedeutung der neoadjuvanten Chemotherapie erfährt die operative Behandlung des Mammakarzinoms sowohl im Bereich der Brust