Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Oct 9:14:1393417.
doi: 10.3389/fonc.2024.1393417. eCollection 2024.

Breast and axillary marking in the neoadjuvant setting: survey results from experts of the Brazilian society of mastology

Henrique Lima Couto  1   2 , Augusto Tufi Hassan  1   3 , Dalton Ivan Steinmacher  1   4 , Eduardo Carvalho Pessoa  1   5 , Eduardo Camargo Millen  1   6 , Felipe Zerwes  1   7 , Francisco Pimentel Cavalcante  1   8 , Giuliano Tosello  1   9 , Guilherme Novita  1   10 , Gustavo Machado Badan  1   11 , José Luis Esteves Francisco  1   12 , Leonardo Ribeiro Soares  1   13 , Lucas Roskamp Budel  1   14 , Luciano Fernandes Chala  15 , Raquel Civolani Marques Fernandes  16 , Ruffo Freitas-Junior  1   13 , Vilmar Marques de Oliveira  1   11 , Vinicius Milani Budel  1   14 , André Mattar  1   17
Affiliations

Breast and axillary marking in the neoadjuvant setting: survey results from experts of the Brazilian society of mastology

Henrique Lima Couto et al. Front Oncol. .

Abstract

Introduction/objectives: The precise location of the tumor site is essential for the success of surgical treatment. Neoadjuvant chemotherapy (NAC) is a challenge for preoperative tumor and node localization. Thus, the knowledge and attitudes of the affiliated members of the Brazilian Society of Mastology (SBM) regarding breast and axilla marking were evaluated and a consensus regarding management and treatment was reached.

Methods: This was an online survey conducted between June and December 2022. All 1,742 active mastologists affiliated to the SBM were invited anonymously. The online form contained 28 objective questions, of which 22 were formulated on a Likert scale. These questions addressed relevant aspects related to breast and axilla marking in the neoadjuvant setting. Responses that reached 70% agreement were considered consensual. Statistical analysis was performed using the SPSS program version 26.0. Post hoc analysis was performed when appropriate and the significance level was set at p < 0.05. Polychoric regression analyses were conducted using `VGAM` package.

Results: In total, 468 mastologists answered the questionnaire (26.8%), with a predominance of professionals aged between 40-49 years (32.1%). Most professionals were board-certified (84,8%). The indication of tumor marking in the breast prior to NAC was consensual (96.4%) and the metal clip was the preferred method (69.7%). There was no consensus regarding the indication of pre-NAC histologically positive lymph node marking (49.8% disagree and 42.8% agree). However, there was consensus that the clinical and imaging evaluation was insufficient for staging the axilla as N1 (71.6%). The contraindication of breast and node marking in T4b tumors (71.2%) was consensual. There was consensus on the indication of sentinel lymph node biopsy (SLNB) for initially cN1 (92.3%) or cN2 (72.7%) tumors that became cN0 after NAC, with 67.5% opting for dual staining with technetium and patent blue. When <3 lymph nodes were retrieved 41.0% of mastologists performed axillary lymphadenectomy. Among the 28 questions, consensus was reached on only 11 (39.3%).

Conclusion: The indication of pre-NAC breast marking is consensual among Brazilian mastologists, although axillary nodal marking is not. There is a great divergence of attitudes among Brazilian surgeons in relation to the many issues related to pre-NAC breast and axilla marking.

Keywords: breast neoplasm; breast tumor markers; consensus development conferences; neoadjuvant therapy; sentinel lymph node.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Similar articles

See all similar articles

References

    1. Shah C, Hobbs BP, Vicini F, Al-Hilli Z, Manyam BV, Verma V, et al. . The diminishing impact of margin definitions and width on local recurrence rates following breast-conserving therapy for early-stage invasive cancer: A meta-analysis. Ann Surg Oncol. (2020) 27:4628–36. doi: 10.1245/s10434-020-08878-9 - DOI - PubMed
    1. Garzotto F, Comoretto RI, Michieletto S, Franzoso G, Lo Mele M, Gregori D, et al. . Preoperative non-palpable breast lesion localization, innovative techniques and clinical outcomes in surgical practice: A systematic review and meta-analysis. Breast. (2021) 58:93–105. doi: 10.1016/j.breast.2021.04.007 - DOI - PMC - PubMed
    1. El-Helou E, Eddy C, Picchia S, Van de Merckt C, Radermeker M, Moreau M, et al. . Effectiveness of carbon localization for invasive breast cancer: an institutional experience. Breast J. (2023) 2023:4082501. doi: 10.1155/2023/4082501 - DOI - PMC - PubMed
    1. Conti M, Morciano F, Bufi E, D'Angelo A, Panico C, Di Paola V, et al. . Surgical planning after neoadjuvant treatment in breast cancer: A multimodality imaging-based approach focused on MRI. Cancers (Basel). (2023) 15:1–18. doi: 10.3390/cancers15051439 - DOI - PMC - PubMed
    1. Haque W, Verma V, Hatch S, Suzanne Klimberg V, Brian Butler E, Teh BS. Response rates and pathologic complete response by breast cancer molecular subtype following neoadjuvant chemotherapy. Breast Cancer Res Treat. (2018) 170:559–67. doi: 10.1007/s10549-018-4801-3 - DOI - PubMed

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by BD. BD was not involved in the study design, in the collection, analysis, and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.

LinkOut - more resources