Can A Selective Policy After Primary Chemotherapy (PC) reduce the need for full dissection of the Initially Positive Axilla?
Association of Breast Surgery ePoster Library. Sluckis B. 05/15/17; 166203; P057
Mr. Ben Sluckis
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Abstract
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Introduction: We have previously shown that PC converts over 50% of node positive patients to node negativity or single node positivity. In 2013, we switched to a selective policy whereby radiological assessments directed post-chemotherapy axillary surgery. We reviewed the results to assess the practicality and safety of this policy.
Methods: Consecutive biopsy-proven node positive patients were reviewed. Patients with only one positive node had coil insertion and were selected for post-chemotherapy sentinel / coiled node / sample (SCNS) whereas patients with two or more nodes underwent an axillary dissection. We assessed the total and positive node count in each group and compared this to our previous patients who all underwent axillary clearance.
Results: 36 patients were identified. 18 were selected for SCNS (mean 3.2 nodes per patient (2-7)) whereas 18 had a full clearance (13.7 nodes (8-43)). 11 of the SCNS patients had converted to node negativity and the other 7 had only a single positive node. In the entire group of (36), the positive node harvest was a mean of 2.5 per patient (0-29) which is very similar to our previous series where all patients underwent clearance.
Conclusion: By careful selection, 50% of patients avoided a full clearance. However the number of positive nodes per patient did not alter, suggesting that the policy did not compromise safety by leaving undetected positive nodes in-situ.
Methods: Consecutive biopsy-proven node positive patients were reviewed. Patients with only one positive node had coil insertion and were selected for post-chemotherapy sentinel / coiled node / sample (SCNS) whereas patients with two or more nodes underwent an axillary dissection. We assessed the total and positive node count in each group and compared this to our previous patients who all underwent axillary clearance.
Results: 36 patients were identified. 18 were selected for SCNS (mean 3.2 nodes per patient (2-7)) whereas 18 had a full clearance (13.7 nodes (8-43)). 11 of the SCNS patients had converted to node negativity and the other 7 had only a single positive node. In the entire group of (36), the positive node harvest was a mean of 2.5 per patient (0-29) which is very similar to our previous series where all patients underwent clearance.
Conclusion: By careful selection, 50% of patients avoided a full clearance. However the number of positive nodes per patient did not alter, suggesting that the policy did not compromise safety by leaving undetected positive nodes in-situ.
Introduction: We have previously shown that PC converts over 50% of node positive patients to node negativity or single node positivity. In 2013, we switched to a selective policy whereby radiological assessments directed post-chemotherapy axillary surgery. We reviewed the results to assess the practicality and safety of this policy.
Methods: Consecutive biopsy-proven node positive patients were reviewed. Patients with only one positive node had coil insertion and were selected for post-chemotherapy sentinel / coiled node / sample (SCNS) whereas patients with two or more nodes underwent an axillary dissection. We assessed the total and positive node count in each group and compared this to our previous patients who all underwent axillary clearance.
Results: 36 patients were identified. 18 were selected for SCNS (mean 3.2 nodes per patient (2-7)) whereas 18 had a full clearance (13.7 nodes (8-43)). 11 of the SCNS patients had converted to node negativity and the other 7 had only a single positive node. In the entire group of (36), the positive node harvest was a mean of 2.5 per patient (0-29) which is very similar to our previous series where all patients underwent clearance.
Conclusion: By careful selection, 50% of patients avoided a full clearance. However the number of positive nodes per patient did not alter, suggesting that the policy did not compromise safety by leaving undetected positive nodes in-situ.
Methods: Consecutive biopsy-proven node positive patients were reviewed. Patients with only one positive node had coil insertion and were selected for post-chemotherapy sentinel / coiled node / sample (SCNS) whereas patients with two or more nodes underwent an axillary dissection. We assessed the total and positive node count in each group and compared this to our previous patients who all underwent axillary clearance.
Results: 36 patients were identified. 18 were selected for SCNS (mean 3.2 nodes per patient (2-7)) whereas 18 had a full clearance (13.7 nodes (8-43)). 11 of the SCNS patients had converted to node negativity and the other 7 had only a single positive node. In the entire group of (36), the positive node harvest was a mean of 2.5 per patient (0-29) which is very similar to our previous series where all patients underwent clearance.
Conclusion: By careful selection, 50% of patients avoided a full clearance. However the number of positive nodes per patient did not alter, suggesting that the policy did not compromise safety by leaving undetected positive nodes in-situ.
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