Axillastaging nach neoadjuvanter Chemotherapie bei initial nodal positivem Mammakarzinom in Deutschland: Erste Daten aus der AXSANA-Studie

Introduction  To date, the optimal axillary staging procedure for initially node-positive breast carcinoma patients after neoadjuvant chemotherapy (NACT) has been unclear. The aim of the AXSANA study is to prospectively compare different surgical staging techniques with respect to the oncological outcome and quality of life for the patients. Little is known about current clinical practice in Germany. Material and Methods  In this paper we analyzed data from patients enrolled in the AXSANA study at German study sites from June 2020 to March 2022. Results  During the period under investigation, 1135 patients were recruited at 143 study sites. More than three suspicious lymph nodes were initially found in 22 of patients. The target lymph node (TLN) was marked in 64 of cases. This was done with clips/coils in 83 of patients, with magnetic seeds or carbon suspension in 8 each, and with a radar marker in 1 of patients. After NACT, targeted axillary dissection (TAD) or axillary lymphadenectomy (ALND) were each planned in 48 of patients, and sentinel lymph node biopsy alone (SLNB) in 2. Clinically, the nodal status after NACT was found to be unremarkable in 65 of cases. Histological lymph node status was correctly assessed by palpation in 65 of patients and by sonography in 69 of patients. Conclusion  At the German AXSANA study sites, TAD and ALND are currently used as the most common surgical staging procedures after NACT in initially node-positive breast cancer patients. The TLN is marked with various markers prior to NACT. Given the inadequate accuracy of clinical assessment of axillary lymph node status after NACT, it should be questioned whether axillary dissection after NACT should be performed based on clinical assessment of nodal status alone.