Abstract Background There is no consensus on axillary management after neoadjuvant therapy (NAT) in patients with clinically node-positive (cN+) breast cancer. To investigate current clinical practice, an international survey was conducted among breast surgeons and radiation oncologists. The aim of the first part of the survey was to provide a snapshot of international discrepancies regarding axillary surgery in this context. Methods The European Breast Cancer Research Association of Surgical Trialists (EUBREAST) developed a web-based survey containing 39 questions describing clinical scenarios in the setting of axillary management in patients with cN1 disease converting to ycN0 after NAT. The survey was then distributed to breast surgeons and radiation oncologists via 14 breast cancer societies between April and October 2021. Results Responses from 349 physicians in 45 countries were recorded. The most common post-NAT axillary surgery in patients with cN1 disease converting to ycN0 was targeted axillary dissection (54.2 per cent), followed by sentinel lymph node biopsy (SLNB) alone (20.9 per cent), level 1–2 axillary lymph node dissection (ALND) (18.4 per cent), level 1–3 ALND (4 per cent), and targeted lymph node biopsy (2.5 per cent). For SLNB alone, dual tracers were most commonly used (62.3 per cent). Management varied widely in patients with ambiguous axillary status before initiation of treatment or a residual metastatic burden in the axilla after NAT. In patients with ycN+ tumours, ALND was the preferred surgical approach for 66.8 per cent of respondents. Conclusion These results highlight the wide heterogeneity in surgical approaches to the axilla after NAT. To standardize the guidelines, further data from clinical research are urgently needed, which underlines the importance of the ongoing AXSANA (EUBREAST-3) study.

中文翻译：

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初始淋巴结阳性乳腺癌新辅助治疗后腋窝手术：国际 EUBREAST 调查

摘要 背景对于临床淋巴结阳性（cN+）乳腺癌患者新辅助治疗（NAT）后的腋窝处理尚未达成共识。为了调查当前的临床实践，对乳腺外科医生和放射肿瘤学家进行了一项国际调查。调查第一部分的目的是提供有关腋窝手术的国际差异的概况。 方法欧洲乳腺癌研究外科试验协会 (EUBREAST) 开发了一项基于网络的调查，其中包含 39 个问题，描述了 cN1 疾病在 NAT 后转为 ycN0 患者的腋窝治疗中的临床情况。随后，该调查于 2021 年 4 月至 10 月期间通过 14 个乳腺癌协会分发给乳腺外科医生和放射肿瘤学家。 结果记录了 45 个国家 349 名医生的反应。对于 cN1 疾病转为 ycN0 的患者，最常见的 NAT 后腋窝手术是靶向腋窝淋巴结清扫术（54.2%），其次是单独的前哨淋巴结活检 (SLNB)（20.9%）、1-2 级腋窝淋巴结清扫术(ALND) (18.4%)、1-3 级 ALND (4%) 和靶向淋巴结活检 (2.5%)。仅就 SLNB 而言，最常用的是双示踪剂（62.3%）。对于开始治疗前腋窝状态不明确或 NAT 后腋窝残留转移负担的患者，治疗方法差异很大。在 ycN+ 肿瘤患者中，66.8% 的受访者认为 ALND 是首选手术方法。 结论这些结果凸显了 NAT 后腋窝手术方法的广泛异质性。为了使指南标准化，迫切需要临床研究的进一步数据，这凸显了正在进行的 AXSANA (EUBREAST-3) 研究的重要性。