Scholarlink

<p>The surgical removal of lymph nodes in breast cancer patients has increasingly shifted from a&#xa0;therapeutic to a&#xa0;diagnostic procedure. Data from recently published clinical trials and guideline modifications continued the trend for de-escalation of axillary surgery and led to new questions and controversies. In patients with involvement of 1–2&#xa0;sentinel axillary lymph nodes, dissection (ALND) has been omitted for several years, if breast-conserving therapy, including tangential irradiation of the breast was performed. In 2024, the SENOMAC trial was published that closed important knowledge gaps so that omission of ALND is also recommended in patients who undergo mastectomy and regional irradiation. While ALND is not associated with any therapeutic benefit, the target volumes for radiotherapy remain unclear. The SOUND and INSEMA studies are two randomized trials that compared SLNB with omission of axillary surgery in patients with small tumors, who underwent breast-conserving therapy and had negative lymph nodes on palpation and ultrasound. Omission of SLNB was not associated with increased recurrence rates, so that axillary surgery can be avoided in postmenopausal patients with small tumors (T1) and a&#xa0;low biological risk. The exact criteria for patient selection is still unclear and remains controversial. ALND is also increasingly abandoned in patients who underwent neoadjuvant chemotherapy. For patients who convert from a&#xa0;positive to a&#xa0;negative lymph node status, targeted axillary dissection has been widely adopted as a&#xa0;surgical staging procedure of the axilla. For patients with isolated tumor cells or micrometastases in the sentinel or target lymph node, ALND is also increasingly omitted.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Management der Axilla – Entwicklungen und aktuelle Kontroversen

  • 期刊论文

  • 发表日期：

    2025年8月26日

查看全文
  • T. Kühn,
  • W. Janni,
  • H. Schäffler,
  • D. Krug,
  • E. Leinert

摘要

The surgical removal of lymph nodes in breast cancer patients has increasingly shifted from a therapeutic to a diagnostic procedure. Data from recently published clinical trials and guideline modifications continued the trend for de-escalation of axillary surgery and led to new questions and controversies. In patients with involvement of 1–2 sentinel axillary lymph nodes, dissection (ALND) has been omitted for several years, if breast-conserving therapy, including tangential irradiation of the breast was performed. In 2024, the SENOMAC trial was published that closed important knowledge gaps so that omission of ALND is also recommended in patients who undergo mastectomy and regional irradiation. While ALND is not associated with any therapeutic benefit, the target volumes for radiotherapy remain unclear. The SOUND and INSEMA studies are two randomized trials that compared SLNB with omission of axillary surgery in patients with small tumors, who underwent breast-conserving therapy and had negative lymph nodes on palpation and ultrasound. Omission of SLNB was not associated with increased recurrence rates, so that axillary surgery can be avoided in postmenopausal patients with small tumors (T1) and a low biological risk. The exact criteria for patient selection is still unclear and remains controversial. ALND is also increasingly abandoned in patients who underwent neoadjuvant chemotherapy. For patients who convert from a positive to a negative lymph node status, targeted axillary dissection has been widely adopted as a surgical staging procedure of the axilla. For patients with isolated tumor cells or micrometastases in the sentinel or target lymph node, ALND is also increasingly omitted.