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Güth U, Elfgen C, Zadeh SN, Meier S, Varga Z, Tinguely M, Papassotiropoulos B, Däster K, Tausch CJ. The impact of intraoperative frozen section in patients with clinically node-negative breast cancer (cN0/ycN0) who received neoadjuvant systemic therapy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1423-1428. [PMID: 37183046 DOI: 10.1016/j.ejso.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND When surgical axillary staging reveals residual metastatic deposits in breast cancer (BC) patients who had received neoadjuvant chemotherapy (NACT), axillary lymphonodectomy is indicated. In this study, we investigate whether it is reasonable to perform intraoperative frozen section (FS) of the removed sentinel lymph nodes (SLNs) in cases where NACT had been administered in patients who had a clinically negative nodal status at the time of diagnosis. PATIENTS AND METHODS We analyzed data from 101 BCE patients with 103 carcinomas who were diagnosed between 2014 and 2021 and met the above-mentioned criteria. RESULTS In three cases (2.8% of the study group), histologically active tumor tissue was detected in the removed axillary LNs. Discontinuation of therapy/the use of a low-dose NACT regimen was a significant factor for positive LNs (p = 0.02) at the subsequent surgical procedure; tumor progression during therapy approached borderline significance (p = 0.058). Among patients who had completed NACT with the planned standard dose regimen, and in which the primary tumors showed a response to therapy (n = 94), only one case had histologically detected residual metastases in the SLNs. CONCLUSIONS Certified breast centers aim to improve the outcome of the patients. However, these specialized centers should also focus on economic aspects. This means that diagnostic and therapeutic procedures should be continuously critically reviewed in order to avoid unnecessary expenses. In BC patients with clinically node negative disease who completed NACT as planned and in which the tumor showed a good response to therapy, time consuming and costly FS of the SLNs removed should be omitted.
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Affiliation(s)
- Uwe Güth
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, CH-8008, Zurich, Switzerland; University of Basel, Faculty of Medicine, Klingelbergstrasse 61, CH-4056, Basel, Switzerland.
| | - Constanze Elfgen
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, CH-8008, Zurich, Switzerland; University of Witten/Herdecke, Faculty of Medicine, Alfred-Herrhausen-Strasse 50, 58448, Witten, Germany
| | - Shadi Najaf Zadeh
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, CH-8008, Zurich, Switzerland
| | - Simon Meier
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, CH-8008, Zurich, Switzerland
| | - Zsuzsanna Varga
- Institute of Pathology and Molecular Pathology, University Hospital of Zurich, Schmelzbergstrasse 12, CH-8091, Zurich, Switzerland
| | - Marianne Tinguely
- Institute of Pathology Enge, Hardturmstrasse 133, CH-8055, Zurich, Switzerland; University of Zurich, Medical Faculty, Pestalozzistrasse 3, CH-8032, Zurich, Switzerland
| | - Bärbel Papassotiropoulos
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, CH-8008, Zurich, Switzerland
| | - Kavitha Däster
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, CH-8008, Zurich, Switzerland
| | - Christoph J Tausch
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, CH-8008, Zurich, Switzerland; University of Basel, Faculty of Medicine, Klingelbergstrasse 61, CH-4056, Basel, Switzerland
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Franceschini G, DI Leone A, D'Archi S, Masetti R. De-escalation of axillary treatment in neoadjuvant setting: recommendations for a successful work. Minerva Surg 2021; 76:288-289. [PMID: 33855377 DOI: 10.23736/s2724-5691.21.08761-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gianluca Franceschini
- Unit of Multidisciplinary Breast, Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
| | - Alba DI Leone
- Unit of Multidisciplinary Breast, Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Sabatino D'Archi
- Unit of Multidisciplinary Breast, Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Riccardo Masetti
- Unit of Multidisciplinary Breast, Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
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