Changing practice patterns in axillary management for patients with node-positive breast cancer towards increased use of sentinel lymph node biopsy-alone after neoadjuvant chemotherapy: results of a survey (MF17-01) among Turkish surgeons.

backgroundThis study aimed to determine the knowledge of major benchmark trials among Turkish general surgeons to investigate if they have adopted the results in their practice.

methodsA total of 101 general surgeons from the Turkish Federation of Breast Diseases Society (TFBDS) were asked to complete a survey that included 24 multiple-choice questions regarding the surgical practice in axillary surgery for early and locally advanced breast cancer.

resultsMost surgeons were familiar with prospective axillary surgery studies including ACOSOG Z0011 (n = 77, 76.2%), AMAROS (n = 76, 75.2%), IBCSG 23 - 01 (n = 58, 57.4%), ACOSOG Z1071 (n = 63, 62.4%), and SENTINA (n = 67, 66.3%). Among the surgeons participating in the present survey, breast surgeons (38.6%) were less likely to perform axillary lymph node dissection (ALND) in early stage patients with a 1-2 positive sentinel lymph node biopsy (SLNB) with micro- or macrometastases, as opposed to those who defined themselves as general surgeons (ALND; 36.8% vs. 63.9%, p = 0.015). Almost all surgeons suggested neoadjuvant chemotherapy (NAC) for patients presenting with T4 (94.8%) or N2-3 disease (92.0%), whereas almost half of the surgeons (40.5%) always proceeded with NAC in patients with clinically node-positive cN1 breast cancer. Overall, 86.1% of surgeons performed SLNB in patients whose axilla became clinically negative after NAC. More than half of the surgeons (55.2%) preferred blue dye as the SLNB technique and 37 (42.5%) used the combined method. Among 87 surgeons, 24.1% (n = 21) always, 39.1% (n = 34) sometimes, and 36.8% (n = 32) never preferred clip marking of axillary metastatic lymph nodes before NAC, whereas 56.4% performed targeted axillary dissection (TAD) after NAC. In cN+ patients before NAC, the majority of surgeons (74.3%) did not perform ALND in patients with at least three lymph nodes removed and SLNB negative. Of note, more than half of the surgeons (51.5%) did not perform ALND in the presence of isolated tumor cells or micrometastases among the three SLNs as long as regional nodal irradiation was received. However, 54.5% of the patients routinely underwent ALND in the presence of macrometastatic residual nodal disease after NAC.

conclusionDeescalating strategies in axillary surgery have been increasing in both initially clinically node-negative and-positive breast cancers as long as nodal radiation is provided.