[Can We Avoid Axillary Lymph Node Dissection in Patients with Node Positive Invasive Breast Carcinoma?]

Susie Brousse, Clementine Lafond,Martin Schmitt,Sophie Guillermet,Sebastien Moliere,Carole Mathelin

GYNECOLOGIE OBSTETRIQUE FERTILITE & SENOLOGIE（2024）

Ctr Eugene Marquis | Hop Mercy | ICANS | CHRU

Cited 0|Views19

Abstract

Objectives. - The indications and modalities of breast and axillary surgery are undergoing profound change, with the aim of personalizing surgical management while avoiding over -treatment. To update best practices for axillary surgery, four questions were selected by the Senology Commission of the Colle`ge National des Gyne ' cologues et Obste ' triciens Franc,ais (CNGOF), focusing on, firstly, the definition and evaluation of targeted axillary dissection (TAD) techniques; secondly, the possibility of surgical deescalation in case of initial lymph node involvement while performing initial surgery; thirdly, in case of surgery following neo-adjuvant systemic therapy (NAST), and fourthly, contra -indications to deescalation of axillary surgery to allow access to particular adjuvant systemic therapies. Methods. - The Senology Commission based its responses primarily on an analysis of the international literature, clinical practice recommendations and national and international guidelines. Results. - Firstly, TAD is a technique that combines excision of clipped metastatic axillary node(s) and the axillary sentinel lymph nodes (ASLNs). The detection rate and sensitivity are increased but it still needs to be standardized and practices better evaluated. Secondly, TAD represents an alternative to axillary clearance in cases of metastatic involvement of a single node that can be resected. Thirdly, neither TAD nor ASLN alone is recommended in France after NAST outside of clinical trials, although it is used in several countries in cases of complete pathological response in the lymph nodes, and when at least three lymph nodes have been removed. Fourthly, as some adjuvant targeted therapies are indicated in cases of lymph node invasion of more than three lymph nodes, the place of TAD in this context remains to be defined. Conclusion. - Axillary surgical de-escalation can limit the morbidity of axillary clearance. Having proved that TAD does not reduce patient survival, it will most probably replace axillary clearance in well-defined indications. This will require prior standardization of the method and its indications and contraindications, particularly to enable the use of new targeted therapies. @ 2024 Elsevier Masson SAS. All rights reserved.

Translated text

Key words

Breast cancer,Surgery,Targeted axillary,dissection,Sentinel lymph node,Axillary lymph node

求助PDF

上传PDF

Bibtex

AI Read Science

AI Summary

AI Summary is the key point extracted automatically understanding the full text of the paper, including the background, methods, results, conclusions, icons and other key content, so that you can get the outline of the paper at a glance.

Example

Background

Key content

Introduction

Methods

Results

Related work

Fund

Key content

Pretraining has recently greatly promoted the development of natural language processing (NLP)
We show that M6 outperforms the baselines in multimodal downstream tasks, and the large M6 with 10 parameters can reach a better performance
We propose a method called M6 that is able to process information of multiple modalities and perform both single-modal and cross-modal understanding and generation
The model is scaled to large model with 10 billion parameters with sophisticated deployment, and the 10 -parameter M6-large is the largest pretrained model in Chinese
Experimental results show that our proposed M6 outperforms the baseline in a number of downstream tasks concerning both single modality and multiple modalities We will continue the pretraining of extremely large models by increasing data to explore the limit of its performance

Upload PDF to Generate Summary

Must-Reading Tree

Example

Generate MRT to find the research sequence of this paper