Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00000020.xml
CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2022; 82(10): 1031-1043
DOI: 10.1055/a-1904-6231
DOI: 10.1055/a-1904-6231
GebFra Science
Recommendation/Empfehlung
AGO Recommendations for the Surgical Therapy of Breast Cancer: Update 2022
Article in several languages: English | deutsch
Abstract
The recommendations of the AGO Breast Committee on the surgical therapy of breast cancer were last updated in March 2022 (www.ago-online.de). Since surgical therapy is one of several partial steps in the treatment of breast cancer, extensive diagnostic and oncological expertise of a breast surgeon and good interdisciplinary cooperation with diagnostic radiologists is of great importance. The most important changes concern localization techniques, resection margins, axillary management in the neoadjuvant setting and the evaluation of the meshes in reconstructive surgery. Based on meta-analyses of randomized studies, the level of recommendation of an intraoperative breast ultrasound for the localization of non-palpable lesions was elevated to “++”. Thus, the technique is considered to be equivalent to wire localization, provided that it is a lesion which can be well represented by sonography, the surgeon has extensive experience in breast ultrasound and has access to a suitable ultrasound device during the operation. In invasive breast cancer, the aim is to reach negative resection margins (“no tumor on ink”), regardless of whether an extensive intraductal component is present or not. Oncoplastic operations can also replace a mastectomy in selected cases due to the large number of existing techniques, and are equivalent to segmental resection in terms of oncological safety at comparable rates of complications. Sentinel node excision is recommended for patients with cN0 status receiving neoadjuvant chemotherapy after completion of chemotherapy. Minimally invasive biopsy is recommended for initially suspect lymph nodes. After neoadjuvant chemotherapy, patients with initially 1 – 3 suspicious lymph nodes and a good response (ycN0) can receive the targeted axillary dissection and the axillary dissection as equivalent options.
Publication History
Received: 18 June 2022
Accepted: 18 July 2022
Article published online:
30 September 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References/Literatur
- 1 Ditsch N, Woeckel A, Untch M. et al. AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer (EBC): Update 2022. Breast Care 2022; DOI: 10.1159/000524879.
- 2 Veronesi U, Cascinelli N, Mariani L. et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002; 347: 1227-1232
- 3 Fisher B, Jeong JH, Anderson S. et al. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med 2002; 347: 567-575
- 4 Agarwal S, Pappas L, Neumayer L. et al. Effect of breast conservation therapy vs. mastectomy on disease-specific survival for early-stage breast cancer. JAMA Surg 2014; 149: 267-274
- 5 Hofvind S, Holen A, Aas T. et al. Women treated with breast conserving surgery do better than those with mastectomy independent of detection mode, prognostic and predictive tumor characteristics. Eur J Surg Oncol 2015; 41: 1417-1422
- 6 van Maaren MC, de Munck L, de Bock GH. et al. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study. Lancet Oncol 2016; 17: 1158-1170
- 7 de Boniface J, Szulkin R, Johansson ALV. Survival After Breast Conservation vs. Mastectomy Adjusted for Comorbidity and Socioeconomic Status: A Swedish National 6-Year Follow-up of 48986 Women. JAMA Surg 2021; 156: 628-637
- 8 Christiansen P, Carstensen SL, Ejlertsen B. et al. Breast conserving surgery versus mastectomy: overall and relative survival-a population based study by the Danish Breast Cancer Cooperative Group (DBCG). Acta Oncol 2018; 57: 19-25
- 9 [Anonym] Jahresbericht der zertifizierten Brustkrebszentren: Auditjahr 2019/Kennzahlenjahr 2018. Herausgeber: Deutsche Krebsgesellschaft (DKG), Berlin in Zusammenarbeit mit OnkoZert, Neu-Ulm. 2020. Accessed September 02, 2022 at: https://www.onkozert.de/2022/04/20/jahresberichte-der-zertifizierungssysteme-2022/
- 10 Athanasiou C, Mallidis E, Tuffaha H. Comparative effectiveness of different localization techniques for non-palpable breast cancer. A systematic review and network meta-analysis. Eur J Surg Oncol 2022; 48: 53-59
- 11 Banys-Paluchowski M, Rubio IT, Karadeniz Cakmak G. et al. Intraoperative Ultrasound-Guided Excision of Non-Palpable and Palpable Breast Cancer: Systematic Review and Meta-Analysis. Ultraschall Med 2022; DOI: 10.1055/a-1821-8559.
- 12 Volders JH, Haloua MH, Krekel NM. et al. Intraoperative ultrasound guidance in breast-conserving surgery shows superiority in oncological outcome, long-term cosmetic and patient-reported outcomes: Final outcomes of a randomized controlled trial (COBALT). Eur J Surg Oncol 2017; 43: 649-657
- 13 Hoffmann J, Marx M, Hengstmann A. et al. Ultrasound-Assisted Tumor Surgery in Breast Cancer – A Prospective, Randomized, Single-Center Study (MAC001). Ultraschall Med 2019; 40: 326-332
- 14 Krishna KL, Srinath BS, Santosh D. et al. A comparative study of perioperative techniques to attain negative margins and spare healthy breast tissue in breast conserving surgery. Breast Dis 2020; 39: 127-135
- 15 Narod SA, Iqbal J, Giannakeas V. et al. Breast Cancer Mortality After a Diagnosis of Ductal Carcinoma In Situ. JAMA Oncol 2015; 1: 888-896
- 16 Hoffmann J, Wallwiener D. Classifying breast cancer surgery: a novel, complexity-based system for oncological, oncoplastic and reconstructive procedures, and proof of principle by analysis of 1225 operations in 1166 patients. BMC Cancer 2009; 9: 108
- 17 Hai Y, Chong W, Lazar MA. Extended Prophylactic Antibiotics for Mastectomy with Immediate Breast Reconstruction: A Meta-analysis. Plast Reconstr Surg Glob Open 2020; 8: e2613
- 18 Yamin F, Nouri A, McAuliffe P. et al. Routine Postoperative Antibiotics After Tissue Expander Placement Postmastectomy Does Not Improve Outcome. Ann Plast Surg 2021; 87: S28-S30
- 19 Masià J. iBAG Working Group. The largest multicentre data collection on prepectoral breast reconstruction: The iBAG study. J Surg Oncol 2020; 122: 848-860
- 20 Thill M, Faridi A, Meire A. et al. Patient reported outcome and cosmetic evaluation following implant-based breast-reconstruction with a titanized polypropylene mesh (TiLOOP(R) Bra): A prospective clinical study in 269 patients. Eur J Surg Oncol 2020; 46: 1484-1490
- 21 Saldanha IJ, Cao W, Broyles JM. et al. Breast Reconstruction After Mastectomy: A Systematic Review and Meta-Analysis [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2021. Report No.: 21-EHC027
- 22 Ganesh Kumar N, Berlin NL, Kim HM. et al. Development of an evidence-based approach to the use of acellular dermal matrix in immediate expander-implant-based breast reconstruction. J Plast Reconstr Aesthet Surg 2021; 74: 30-40
- 23 Cabalag MS, Rostek M, Miller GS. et al. Alloplastic adjuncts in breast reconstruction. Gland Surg 2016; 5: 158-173
- 24 Liu X, Zhou L, Pan F. et al. Comparison of the postoperative incidence rate of capsular contracture among different breast implants: a cumulative meta-analysis. PLoS One 2015; 10: e0116071
- 25 Hallberg H, Rafnsdottir S, Selvaggi G. et al. Benefits and risks with acellular dermal matrix (ADM) and mesh support in immediate breast reconstruction: a systematic review and meta-analysis. J Plast Surg Hand Surg 2018; 52: 130-147
- 26 Samargandi OA, Joukhadar N, Al Youha S. et al. Antibiotic Irrigation of Pocket for Implant-Based Breast Augmentation to Prevent Capsular Contracture: A Systematic Review. Plast Surg (Oakv) 2018; 26: 110-119
- 27 Wang Y, Tian J, Liu J. Suppressive Effect of Leukotriene Antagonists on Capsular Contracture in Patients Who Underwent Breast Surgery with Prosthesis: A Meta-Analysis. Plast Reconstr Surg 2020; 145: 901-911
- 28 Sood A, Xue EY, Sangiovanni C. et al. Breast Massage, Implant Displacement, and Prevention of Capsular Contracture After Breast Augmentation With Implants: A Review of the Literature. Eplasty 2017; 17: e41
- 29 Mammographie-Screening-Programm. Geschäftsbericht 2021. 2022. Accessed September 2, 2022 at: https://newsroom.mammo-programm.de/
- 30 Friedrich M, Kuhn T, Janni W. et al. AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy: 2021 Update. Geburtshilfe Frauenheilkd 2021; 81: 1112-1120
- 31 Schwartz GF, Guiliano AE, Veronesi U. Proceeding of the consensus conference of the role of sentinel lymph node biopsy in carcinoma or the breast April 19–22, 2001, Philadelphia, PA, USA. Breast J 2002; 8: 124-138
- 32 Lyman GH, Temin S, Edge SB. et al. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2014; 32: 1365-1383
- 33 Elfgen C, Güth U, Gruber G. et al. Breast-conserving surgery with intraoperative radiotherapy in recurrent breast cancer: the patientʼs perspective. Breast Cancer 2020; 27: 1107-1113
- 34 Rao R, Euhus D, Mayo HG. et al. Axillary node interventions in breast cancer: a systematic review. JAMA 2013; 310: 1385-1394
- 35 Gerber B, Stachs A, Veselinovic K. et al. Patient reported outcomes (PROS) for the intergroup sentinel mammastudie INSEMA: Persistent impact of axillary surgery on arm and breast. San Antonio Breast Cancer Symposium 2021, 07-10122021.
- 36 Brackstone M, Baldassarre FG, Perera FE. et al. Management of the Axilla in Early-Stage Breast Cancer: Ontario Health (Cancer Care Ontario) and ASCO Guideline. J Clin Oncol 2021; 39: 3056-3082
- 37 Moo TA, Jochelson MS, Zabor EC. et al. Is Clinical Exam of the Axilla Sufficient to Select Node-Positive Patients Who Downstage After NAC for SLNB? A Comparison of the Accuracy of Clinical Exam Versus MRI. Ann Surg Oncol 2019; 26: 4238-4243
- 38 Gerber B, Schneeweiss A, Möbus V. et al. Pathological Response in the Breast and Axillary Lymph Nodes after Neoadjuvant Systemic Treatment in Patients with Initially Node-Positive Breast Cancer Correlates with Disease Free Survival: An Exploratory Analysis of the GeparOcto Trial. Cancers (Basel) 2022; 14: 521
- 39 Barron AU, Hoskin TL, Day CN. et al. Association of Low Nodal Positivity Rate Among Patients With ERBB2-Positive or Triple-Negative Breast Cancer and Breast Pathologic Complete Response to Neoadjuvant Chemotherapy. JAMA Surg 2018; 153: 1120-1126 DOI: 10.1001/jamasurg.2018.2696.
- 40 Tadros AB, Yang WT, Krishnamurthy S. et al. Identification of Patients With Documented Pathologic Complete Response in the Breast After Neoadjuvant Chemotherapy for Omission of Axillary Surgery. JAMA Surg 2017; 152: 665-670
- 41 Heil J, Pfob A, Sinn HP. et al. Diagnosing Pathologic Complete Response in the Breast After Neoadjuvant Systemic Treatment of Breast Cancer Patients by Minimal Invasive Biopsy: Oral Presentation at the San Antonio Breast Cancer Symposium on Friday, December 13, 2019, Program Number GS5-03. Ann Surg 2022; 275: 576-581
- 42 Pfob A, Sidey-Gibbons C, Rauch G. et al. Intelligent Vacuum-Assisted Biopsy to Identify Breast Cancer Patients With Pathologic Complete Response (ypT0 and ypN0) After Neoadjuvant Systemic Treatment for Omission of Breast and Axillary Surgery. J Clin Oncol 2022; 40: 1903-1915 DOI: 10.1200/jco.21.02439.
- 43 Banys-Paluchowski M, Gasparri ML, de Boniface J. et al. The Axsana Study Group. Surgical Management of the Axilla in Clinically Node-Positive Breast Cancer Patients Converting to Clinical Node Negativity through Neoadjuvant Chemotherapy: Current Status, Knowledge Gaps, and Rationale for the EUBREAST-03 AXSANA Study. Cancers (Basel) 2021; 13: 1565
- 44 Schwentner L, Helms G, Nekljudova V. et al. Using ultrasound and palpation for predicting axillary lymph node status following neoadjuvant chemotherapy – Results from the multi-center SENTINA trial. Breast 2017; 31: 202-207
- 45 Banys-Paluchowski M, Gruber IV, Hartkopf A. et al. Axillary ultrasound for prediction of response to neoadjuvant therapy in the context of surgical strategies to axillary dissection in primary breast cancer: a systematic review of the current literature. Arch Gynecol Obstet 2020; 301: 341-353
- 46 Kirkilesis G, Constantinidou A, Kontos M. False Negativity of Targeted Axillary Dissection in Breast Cancer. Breast Care (Basel) 2021; 16: 532-538
- 47 Barrio AV, Montagna G, Mamtani A. et al. Nodal Recurrence in Patients With Node-Positive Breast Cancer Treated With Sentinel Node Biopsy Alone After Neoadjuvant Chemotherapy-A Rare Event. JAMA Oncol 2021; 7: 1851-1855 DOI: 10.1001/jamaoncol.2021.4394.
- 48 Caudle AS, Yang WT, Krishnamurthy S. et al. Improved Axillary Evaluation Following Neoadjuvant Therapy for Patients With Node-Positive Breast Cancer Using Selective Evaluation of Clipped Nodes: Implementation of Targeted Axillary Dissection. J Clin Oncol 2016; 34: 1072-1078