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1. Trends in axillary lymph node dissection for early-stage breast cancer in Europe: Impact of evidence on practice

Author

Danaei, Mahmoud, Stickeler, Elmar, Sarlos, Dimitri, Prové, Annemie, Pagani, Olivia, Berclaz, Gilles, Taffurelli, Mario, Cretella, Elisabetta, Verhoeven, Didier, Denk, Andreas, Carly, Birgit, Ballardini, Bettina, van Riet, Yvonne, Kimmig, Rainer, Reinisch, Mattea, Angiolini, Catia, Möbus, Volker, Emons, Gunter, Friedrichs, Kay, Schneeweiss, Andreas, Tinterri, Corrado, Egle, Daniel, Staelens, Gracienne, Kiechle, Marion, Harbeck, Nadia, Corsi, Fabio, Menghini, Lorenzo, Lombardi, Augusto, Fortunato, Lucio, Bortul, Marina, Huober, Jens, Badbanchi, Farzaneh, Tausch, Christoph, Garcia-Etienne, Carlos A., Mansel, Robert E., Tomatis, Mariano, Heil, Joerg, Biganzoli, Laura, Ferrari, Alberta, Marotti, Lorenza, Sgarella, Adele, and Ponti, Antonio

Published
2019
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2. Trends in axillary lymph node dissection for early-stage breast cancer in Europe: Impact of evidence on practice

Author

Garcia-Etienne, Carlos A., Mansel, Robert E., Tomatis, Mariano, Heil, Joerg, Biganzoli, Laura, Ferrari, Alberta, Marotti, Lorenza, Sgarella, Adele, Ponti, Antonio, Danaei, Mahmoud, Stickeler, Elmar, Sarlos, Dimitri, Prové, Annemie, Pagani, Olivia, Berclaz, Gilles, Taffurelli, Mario, Cretella, Elisabetta, Verhoeven, Didier, Denk, Andreas, Carly, Birgit, Ballardini, Bettina, van Riet, Yvonne, Kimmig, Rainer, Reinisch, Mattea, Angiolini, Catia, Möbus, Volker, Emons, Gunter, Friedrichs, Kay, Schneeweiss, Andreas, Tinterri, Corrado, Egle, Daniel, Staelens, Gracienne, Kiechle, Marion, Harbeck, Nadia, Corsi, Fabio, Menghini, Lorenzo, Lombardi, Augusto, Fortunato, Lucio, Bortul, Marina, Huober, Jens, Badbanchi, Farzaneh, Tausch, Christoph, EUSOMA Working Group, EUSOMA Working Grp, Garcia-Etienne, C. A., Mansel, R. E., Tomatis, M., Heil, J., Biganzoli, L., Ferrari, A., Marotti, L., Sgarella, A., Ponti, A., Danaei, M., Stickeler, E., Sarlos, D., Prove, A., Pagani, O., Berclaz, G., Taffurelli, M., Cretella, E., Verhoeven, D., Denk, A., Carly, B., Ballardini, B., van Riet, Y., Kimmig, R., Reinisch, M., Angiolini, C., Mobus, V., Emons, G., Friedrichs, K., Schneeweiss, A., Tinterri, C., Egle, D., Staelens, G., Kiechle, M., Harbeck, N., Corsi, F., Menghini, L., Lombardi, A., Fortunato, L., Bortul, M., Huober, J., Badbanchi, F., and Tausch, C.

Subjects
axillary lymph node dissection, axillary dissection, axillary surgery, axillary lymphadenectomy, positive sentinel node, Z0011, surgery for breast cancer, Medizin, Practice Patterns, Axillary dissection, 0302 clinical medicine, Axillary lymph node dissection, Breast, 030212 general & internal medicine, Practice Patterns, Physicians', Stage (cooking), Surgical approach, Lymph Node, Axillary lymphadenectomy, General Medicine, Middle Aged, 3. Good health, Europe, medicine.anatomical_structure, Homogeneous, 030220 oncology & carcinogenesis, Female, Axillary surgery, Positive sentinel node, Surgery for breast cancer, Adult, Aged, Axilla, Breast Neoplasms, Humans, Lymph Node Excision, Lymph Nodes, Breast Neoplasm, Human, medicine.medical_specialty, 03 medical and health sciences, Breast cancer, medicine, Physicians', Breast conservation, business.industry, General surgery, Background data, Axillary Lymph Node Dissection, medicine.disease, Surgery, Human medicine, business
Abstract

Background: Data from recently published trials have provided practice-changing recommendations for the surgical approach to the axilla in breast cancer. Patients with T1-2 lesions, treated with breast conservation, who have not received neoadjuvant chemotherapy and have 1-2 positive sentinel nodes (Z0011-criteria) may avoid axillary lymph node dissection (ALND). We aim to describe the dissemination of this practice in Europe over an extended period of time. Methods: Our source of data was the eusomaDB, a central data warehouse of prospectively collected information of the European Society of Breast Cancer Specialists (EUSOMA). We identified cases fulfilling Z0011-criteria from 2005 to 2016 from 34 European breast centers and report trends in ALND. Data derived from Germany, Italy, Belgium, Switzerland, Austria, and Netherlands. Results: 6671 patients fulfilled Z0011-criteria. Rates of ALND showed a statistically significant decrease from 2010 (89%) to 2011 (73%), reaching 46% in 2016 (p < 0.001). After multivariable analysis, factors associated with higher probability of ALND were earlier year of surgery, younger age, increasing tumor size and grade, and being operated in Italy (p < 0.001). The minimum and maximal rates of ALND in the most recent two-year period (2015-2016) were 0% and 83% in two centers located in different countries (p < 0.001). Conclusion: Our study demonstrates, a decrease in rates of ALND that started after year 2010 through the end of the study period. Wide differences were observed among centers and countries indicating the need to spread unified clinical guidelines in Europe to allow for homogeneous evidence-based practice patterns. (C) 2019 Elsevier Ltd. All rights reserved.

Published
2019

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