1Jiri Gatek, 1Ratajsky M, 1Duben J, 1Dudesek B, 2Frydrych B, 2Opelova P, 3Vazan P and 4Zabojnikova M
1University Tomas Bata in Zlin, Czech Republic
2Atlas Hospital Zlin, Czech Republic
3Bioptic and cytology laboratory Zlin CGB, Czech Republic
4Radiology Bata Hospital Zlin, Czech Republic
Aim: Contemporary oncosurgery including surgery of breast cancer seeks to decrease extent of procedures but with preservation full oncological safety. Neoadjuvant chemotherapy increase number of operable tumors, which were originally inoperative and allows greater number of conservative procedures. In axilla we can see tendency to avoid axillary dissection by implementation sentinel node biopsy and now this technic is used after neoadjuvant chemotherapy when malignant nodes are converted to benign. Aim of our study is to evaluate extent procedures in axilla after neoadjuvant chemotherapy in our department.
Method: In retrospective study we assessed extent of procedures in axilla at Department of Surgery Atlas Hospital in Zlin from 2010 to 2017 and influence of neoadjuvant chemotherapy on axillary nodes. All patients were discussed in multidisciplinary board (radiologist, oncologist, surgeon and pathologist). Tumors in breast were marked with the clips before therapy. Biopsy were done in all suspected axillary nodes before chemotherapy. Response on therapy were followed by sonography and with mammography during and after therapy. In multidisciplinary board definitive extend of procedure was set after therapy.
Results: There were 75 patients and size of the tumor was: ypT0 26x, ypT2a 2x, ypT1b 2x, ypT1c 13x, ypT2 26x, ypT3 6x. Mastectomy were performed 41x and 34x conservative surgery. Primary axillary dissection was done in 39x patients and sentinel node biopsy 33x. In three cases we did not excised nodes. Negative sentinel nodes were diagnosed 20x and average number of excised sentinel nodes were five. There were no false negative sentinel nodes. In cases with axillary dissection negative axilla was 11x. Number of patients with all negative axillary nodes after neoadjuvant chemotherapy was thirty-one, that means 41%.
Conclusion: After implementation modern drugs in neoadjuvant chemotherapy in the breast cancer therapy number of complete pathologic response increased and also appeared higher number of node negative patients. That means, the selected part of patient after neoadjuvant chemotherapy could be saved from axillary dissection. In our file it was 41% of the patients.
Jiri Gatek works as the Head of the Department of Surgery at Atlas Hospital in Zlin, is chairman of the mammology department of the Czech Surgical Society, lectures at Masaryk University in Brno at the Faculty of Medicine.