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This house believes that: MARI/TAD is better than sentinel node biopsy after PST for cN+ patients
The increasing use and effectiveness of primary systemic treatment (PST) enables tailored locoregional treatment. About one third of clinically node positive (cN+) breast cancer patients achieve pathologic complete response (pCR) of the axilla, with higher rates observed in Human Epidermal growth fa...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10432821/ https://www.ncbi.nlm.nih.gov/pubmed/37562108 http://dx.doi.org/10.1016/j.breast.2023.06.011 |
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author | van Hemert, Annemiek K.E. van Duijnhoven, Frederieke H. Vrancken Peeters, Marie-Jeanne T.F.D. |
author_facet | van Hemert, Annemiek K.E. van Duijnhoven, Frederieke H. Vrancken Peeters, Marie-Jeanne T.F.D. |
author_sort | van Hemert, Annemiek K.E. |
collection | PubMed |
description | The increasing use and effectiveness of primary systemic treatment (PST) enables tailored locoregional treatment. About one third of clinically node positive (cN+) breast cancer patients achieve pathologic complete response (pCR) of the axilla, with higher rates observed in Human Epidermal growth factor Receptor (HER)2-positive or triple negative (TN) breast cancer subtypes. Tailoring axillary treatment for patients with axillary pCR is necessary, as they are unlikely to benefit from axillary lymph node dissection (ALND), but may suffer complications and long-term morbidity such as lymphedema and impaired shoulder motion. By combining pre-PST and post-PST axillary staging techniques, ALND can be omitted in most cN + patients with pCR. Different post-PST staging techniques (MARI/TAD/SN) show low or ultra-low false negative rates for detection of residual disease. More importantly, trials using the MARI (Marking Axillary lymph nodes with Radioactive Iodine seeds) procedure or sentinel lymph node biopsy (SLNB) as axillary staging technique post-PST have already shown the safety of tailoring axillary treatment in patients with an excellent response. Tailored axillary treatment using the MARI procedure in stage I-III breast cancer resulted in 80% reduction of ALND and excellent five-year axillary recurrence free interval (aRFI) of 97%. Similar oncologic outcomes were seen for post-SLNB in stage I-II patients. The MARI technique requires only one invasive procedure pre-NST and a median of one node is removed post-PST, whereas for the SLNB and TAD techniques two to four nodes are removed. A disadvantage of the MARI technique is its use of radioactive iodine, which is subject to extensive regulations. |
format | Online Article Text |
id | pubmed-10432821 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-104328212023-08-18 This house believes that: MARI/TAD is better than sentinel node biopsy after PST for cN+ patients van Hemert, Annemiek K.E. van Duijnhoven, Frederieke H. Vrancken Peeters, Marie-Jeanne T.F.D. Breast Article(s) from the Special Issue on: De-escalation of loco-regional treatment; Edited by Oreste Gentilini, Philip Poortmans, Maria João Cardoso, Elzbieta Senkus-Konefka The increasing use and effectiveness of primary systemic treatment (PST) enables tailored locoregional treatment. About one third of clinically node positive (cN+) breast cancer patients achieve pathologic complete response (pCR) of the axilla, with higher rates observed in Human Epidermal growth factor Receptor (HER)2-positive or triple negative (TN) breast cancer subtypes. Tailoring axillary treatment for patients with axillary pCR is necessary, as they are unlikely to benefit from axillary lymph node dissection (ALND), but may suffer complications and long-term morbidity such as lymphedema and impaired shoulder motion. By combining pre-PST and post-PST axillary staging techniques, ALND can be omitted in most cN + patients with pCR. Different post-PST staging techniques (MARI/TAD/SN) show low or ultra-low false negative rates for detection of residual disease. More importantly, trials using the MARI (Marking Axillary lymph nodes with Radioactive Iodine seeds) procedure or sentinel lymph node biopsy (SLNB) as axillary staging technique post-PST have already shown the safety of tailoring axillary treatment in patients with an excellent response. Tailored axillary treatment using the MARI procedure in stage I-III breast cancer resulted in 80% reduction of ALND and excellent five-year axillary recurrence free interval (aRFI) of 97%. Similar oncologic outcomes were seen for post-SLNB in stage I-II patients. The MARI technique requires only one invasive procedure pre-NST and a median of one node is removed post-PST, whereas for the SLNB and TAD techniques two to four nodes are removed. A disadvantage of the MARI technique is its use of radioactive iodine, which is subject to extensive regulations. Elsevier 2023-07-10 /pmc/articles/PMC10432821/ /pubmed/37562108 http://dx.doi.org/10.1016/j.breast.2023.06.011 Text en © 2023 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Article(s) from the Special Issue on: De-escalation of loco-regional treatment; Edited by Oreste Gentilini, Philip Poortmans, Maria João Cardoso, Elzbieta Senkus-Konefka van Hemert, Annemiek K.E. van Duijnhoven, Frederieke H. Vrancken Peeters, Marie-Jeanne T.F.D. This house believes that: MARI/TAD is better than sentinel node biopsy after PST for cN+ patients |
title | This house believes that: MARI/TAD is better than sentinel node biopsy after PST for cN+ patients |
title_full | This house believes that: MARI/TAD is better than sentinel node biopsy after PST for cN+ patients |
title_fullStr | This house believes that: MARI/TAD is better than sentinel node biopsy after PST for cN+ patients |
title_full_unstemmed | This house believes that: MARI/TAD is better than sentinel node biopsy after PST for cN+ patients |
title_short | This house believes that: MARI/TAD is better than sentinel node biopsy after PST for cN+ patients |
title_sort | this house believes that: mari/tad is better than sentinel node biopsy after pst for cn+ patients |
topic | Article(s) from the Special Issue on: De-escalation of loco-regional treatment; Edited by Oreste Gentilini, Philip Poortmans, Maria João Cardoso, Elzbieta Senkus-Konefka |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10432821/ https://www.ncbi.nlm.nih.gov/pubmed/37562108 http://dx.doi.org/10.1016/j.breast.2023.06.011 |
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