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Background: Data from recently published trials have provided practice-changing recommendations for the surgical approach to the axilla in breast cancer. Patients with T1-2 lesions, treated with breast conservation, who have not received neoadjuvant chemotherapy and have 1-2 positive sentinel nodes (Z0011-criteria) may avoid axillary lymph node dissection (ALND). We aim to describe the dissemination of this practice in Europe over an extended period of time.

Methods: Our source of data was the eusomaDB, a central data warehouse of prospectively collected information of the European Society of Breast Cancer Specialists (EUSOMA). We identified cases fulfilling Z0011-criteria from 2005 to 2016 from 34 European breast centers and report trends in ALND. Data derived from Germany, Italy, Belgium, Switzerland, Austria, and Netherlands.

Results: 6671 patients fulfilled Z0011-criteria. Rates of ALND showed a statistically significant decrease from 2010 (89%) to 2011 (73%), reaching 46% in 2016 (p < 0.001). After multivariable analysis, factors associated with higher probability of ALND were earlier year of surgery, younger age, increasing tumor size and grade, and being operated in Italy (p < 0.001). The minimum and maximal rates of ALND in the most recent two-year period (2015-2016) were 0% and 83% in two centers located in different countries (p < 0.001).

Conclusion: Our study demonstrates, a decrease in rates of ALND that started after year 2010 through the end of the study period. Wide differences were observed among centers and countries indicating the need to spread unified clinical guidelines in Europe to allow for homogeneous evidence-based practice patterns.

Titel:	Trends in axillary lymph node dissection for early-stage breast cancer in Europe: Impact of evidence on practice.
Autor/in / Beteiligte Person:	Garcia-Etienne, CA ; Mansel, RE ; Tomatis, M ; Heil, J ; Biganzoli, L ; Ferrari, A ; Marotti, L ; Sgarella, A ; Ponti, A
Zeitschrift:	Breast (Edinburgh, Scotland), Jg. 45 (2019-06-01), S. 89-96
Veröffentlichung:	2002- : Amsterdam : Elsevier ; <i>Original Publication</i>: Edinburgh ; New York : Churchill Livingstone, c1992-, 2019
Medientyp:	academicJournal
ISSN:	1532-3080 (electronic)
DOI:	10.1016/j.breast.2019.03.002
Schlagwort:	Adult Aged Axilla Breast pathology Breast Neoplasms pathology Europe Female Humans Lymph Nodes pathology Lymph Nodes surgery Middle Aged Breast Neoplasms surgery Lymph Node Excision trends Practice Patterns, Physicians' trends
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Corporate Authors: EUSOMA Working Group Publication Type: Evaluation Study; Journal Article Language: English [Breast] 2019 Jun; Vol. 45, pp. 89-96. <i>Date of Electronic Publication: </i>2019 Mar 11. MeSH Terms: Breast Neoplasms / surgery ; Lymph Node Excision / trends ; Practice Patterns, Physicians' / *trends ; Adult ; Aged ; Axilla ; Breast / pathology ; Breast Neoplasms / pathology ; Europe ; Female ; Humans ; Lymph Nodes / pathology ; Lymph Nodes / surgery ; Middle Aged Contributed Indexing: Investigator: M Danaei, Brustcentrum Aachen Marienhospital, Aachen, Germany.; E Stickeler, University Medical Center and Luisenhospital, Aachen, Germany.; D Sarlos, Brustzentrum Mittelland Kantonsspitaeler Aarau/Olten, Switzerland.; A Prové, Breast Center Sint Augustinus, Wilrijk, Antwerpen, Belgium.; O Pagani, Centro di Senologia della Svizzera Italiana, Ospedali Regionali di Lugano, Bellinzona e Valli, Switzerland.; G Berclaz, Klinik Engeried, Breast Centre Bern, Division of Gynaecology & Surgical Oncology, Lindenhofgruppe, Bern, Switzerland.; M Taffurelli, Breast Cancer Unit, Policlinico Sant'Orsola Malpighi, University of Bologna, Italy.; E Cretella, GIPMa, Comprensorio Sanitario di Bolzano, Italy.; D Verhoeven, University of Antwerp, Breast Clinic Voorkempen, Brasschaat, Belgium.; A Denk, Brustzentrum St. Joseph-Stift, Bremen, Germany.; B Carly, Breast Unit and Prevention Center Isala, Department Gynecology-Obstetrics, CHU-UMC St Pierre, Brussels, Belgium.; B Ballardini, Centro Senologia Multimedica, Italy.; Y van Riet, Catharina Hospital, Eindhoven, the Netherlands.; R Kimmig, West German Cancer Center, Breast Unit, University Hospital Essen, Germany.; M Reinisch, Breast Unit, Kliniken Essen-Mitte, Germany.; C Angiolini, Breast Unit e Gruppo Oncologico Multidisciplinare Tumori della Mammella, DAI Oncologico e di Chirurgia ad indirizzo robotico, Azienda Ospedaliero Universitaria Careggi, Firenze, Florence, Italy.; V Möbus, Breast Unit, Klinikum Frankfurt Höchst, Academic Hospital, Frankfurt, Germany.; G Emons, Department of Obstetrics & Gynecology, University of Goettingen, Germany.; K Friedrichs, Mammazentrum, Hamburg, Germany.; A Schneeweiss, Breast Unit University of Heidelberg, Germany.; C Tinterri, Breast Unit Humanitas Cancer Center, Rozzano, Italy.; D Egle, Leitender Oberarzt BGZ Tirol Univ, Frauenklinik Innsbruck, Austria.; G Staelens, Borstkliniek Kortrijk AZ Groeninge, Belgium.; M Kiechle, University Hospital Klinkum Rechts der Isar, Department of Gynecology, Technical University Munich, Germany.; N Harbeck, Breast Center, University of Munich LMU, Germany.; F Corsi, Breast Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy.; L Menghini, AUSL Romagna, Breast Unit Rimini, Italy.; A Lombardi, Breast Surgery Unit, University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy.; L Fortunato, Centro di Senologia Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy.; M Bortul, SSD Breast Unit - ASUITS - Azienda Sanitaria Universitaria Integrata di Trieste, Italy.; J Huober, Comprehensive Cancer Center Ulm, Germany.; F Badbanchi, Breast Unit, Dr. Horst Schmidt Klinken, Wiesbaden, Germany.; C Tausch, Breast Center Zurich Seefeld, Switzerland. ; Keywords: Axillary dissection; Axillary lymph node dissection; Axillary lymphadenectomy; Axillary surgery; Positive sentinel node; Surgery for breast cancer; Z0011 Entry Date(s): Date Created: 20190330 Date Completed: 20191203 Latest Revision: 20191210 Update Code: 20240513

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Trends in axillary lymph node dissection for early-stage breast cancer in Europe: Impact of evidence on practice.