| Title |
Decreasing Use of Axillary Dissection in Node-Positive Breast Cancer Patients Treated with Neoadjuvant Chemotherapy
|
|---|---|
| Published in |
Annals of Surgical Oncology, July 2018
|
| DOI | 10.1245/s10434-018-6637-9 |
| Pubmed ID | |
| Authors |
Toan T. Nguyen, Tanya L. Hoskin, Courtney N. Day, Amy C. Degnim, James W. Jakub, Tina J. Hieken, Judy C. Boughey |
| Abstract |
Neoadjuvant chemotherapy (NAC) may downstage axillary disease in node-positive breast cancer. Several clinical trials have shown that sentinel lymph node (SLN) surgery after NAC is feasible for these patients. We sought to evaluate the use of SLN surgery and ALND in cN1 patients undergoing NAC. We identified all patients with biopsy-proven cN1 breast cancer treated with NAC at our institution between January 2009 and December 2017. Approximated biologic subtype was determined by estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) status. Cochran-Armitage trend and Chi square tests were used for statistical analysis. Of 430 cN1 patients treated with NAC, 93 (22%) underwent SLN surgery only, 100 (23%) underwent SLN and ALND, and 237 (55%) underwent ALND only. The use of SLN surgery (± ALND) increased from 28% in 2009 to 86% in 2017 (p < 0.001), while the performance of ALND decreased from 100% in 2009 to 38% in 2017 (p < 0.001). Among SLN+ patients who underwent ALND, disease was limited to the SLNs in 25/73 (34%) patients. The nodal pathologic complete response rate was 46% and varied by tumor subtype (p < 0.001). Among patients undergoing SLN surgery, ALND was avoided in 48% of patients overall and varied by biologic subtype: 55% ER-/HER2+, 61% ER+/HER2+, 62% ER-/HER2-, and 31% ER+/HER2- (p = 0.001). With short-term follow-up, no nodal recurrences have occurred in patients without ALND. We observed a significant shift in axillary surgery for cN1 breast cancer patients treated with NAC, with increasing use of SLN surgery to assess nodal treatment response, and decreasing use of ALND. |
X Demographics
The data shown below were collected from the profiles of 2 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 1 | 50% |
| United States | 1 | 50% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Practitioners (doctors, other healthcare professionals) | 1 | 50% |
| Members of the public | 1 | 50% |
Mendeley readers
The data shown below were compiled from readership statistics for 46 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 46 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Other | 9 | 20% |
| Student > Ph. D. Student | 5 | 11% |
| Student > Bachelor | 5 | 11% |
| Researcher | 4 | 9% |
| Professor > Associate Professor | 3 | 7% |
| Other | 6 | 13% |
| Unknown | 14 | 30% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 25 | 54% |
| Nursing and Health Professions | 1 | 2% |
| Sports and Recreations | 1 | 2% |
| Agricultural and Biological Sciences | 1 | 2% |
| Social Sciences | 1 | 2% |
| Other | 1 | 2% |
| Unknown | 16 | 35% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 08 July 2018.
All research outputs
#15,539,088
of 23,094,276 outputs
Outputs from Annals of Surgical Oncology
#4,456
of 6,549 outputs
Outputs of similar age
#209,136
of 327,552 outputs
Outputs of similar age from Annals of Surgical Oncology
#110
of 126 outputs
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