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Special Issue Editor

Prof. Dr. Masakuni Noguchi

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Guest Editor

Faculty of Breast and Endocrine Surgery, Kanazawa Medical University, Kahoku 920-0293, Japan
Interests: surgical oncology of breast cancer; sentinel lymph node biopsy; conservative axillary surgery; axillary reverse mapping; oncoplastic breast conserving surgery

Special Issue Information

Dear Colleagues,

Axillary lymph node dissection (ALND) has been the standard axillary treatment for breast cancer for a long time. However, ALND is associated with postoperative morbidities, most notably arm lymphedema. Recently, it has been shown that ALND can be avoided not only in clinically node-negative patients with negative sentinel lymph nodes (SLNs), but also in patients with less than three positive SLNs. Nevertheless, ALND is still required in a select group of patients. A variety of conservative approaches to ALND have been developed to spare arm lymphatics in order to minimize arm lymphedema. These conservative procedures seem to decrease the incidence of lymphedema without increasing axillary recurrence. Full conventional ALND removing all microscopic axillary disease may now be unnecessary in the era of effective multimodality therapy.

Prof. Dr. Masakuni Noguchi
Guest Editor

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Keywords

breast cancer
axillary lymph node dissection
axillary reverse mapping
breast cancer
conserva-tive axillary dissection
partial axillary dissection
tailored axillary surgery

Published Papers (2 papers)

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Research

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9 pages, 632 KiB

Open AccessArticle

Axillary Reverse Mapping in Clinically Node-Positive Breast Cancer Patients

by Masakuni Noguchi, Masafumi Inokuchi, Miki Yokoi-Noguchi, Emi Morioka, Yusuke Haba, Tomoko Takahashi, Akihiro Shioya and Sohsuke Yamada

Cancers 2023, 15(21), 5302; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15215302 - 6 Nov 2023

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Abstract

Background: Axillary reverse mapping (ARM) nodes are involved in a significant proportion of clinically node-positive (cN+) breast cancer patients. However, neoadjuvant chemotherapy (NAC) is effective at decreasing the incidence of nodal metastases in cN+ patients. Patients and methods: One hundred forty-five cN+ patients with confirmed nodal involvement on ultrasound-guided fine needle aspiration cytology were enrolled in this study: one group underwent axillary lymph node dissection (ALND) without NAC (upfront surgery group), and the other group underwent ALND following NAC (NAC group). The patients underwent ¹⁸F-FDG-positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT) before surgery, as well as an ARM procedure during ALND. Results: the rates of involvement of ARM nodes in the NAC group were significantly lower than those of the upfront surgery group (36.6% vs. 62.2%, p < 0.01). Notably, involvement was significantly decreased after NAC in non-luminal-type tumors as compared to the luminal-type (18.4% vs. 48.5%: p < 0.01). Moreover, there was a significant difference in ARM node involvement after NAC between patients with or without axillary uptake of ¹⁸F-FDG (61.5% vs. 32.5%: p < 0.01). Conclusions: NAC significantly decreased the risk of ARM node metastases in cN+ patients, but ¹⁸F-FDG-PET/CT was not suitable to detect residual metastatic disease of the axilla after NAC. Full article

(This article belongs to the Special Issue Conservative Axillary Surgery for Breast Cancer)

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Review

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11 pages, 605 KiB

Open AccessReview

Conservative Axillary Surgery May Prevent Arm Lymphedema without Increasing Axillary Recurrence in the Surgical Management of Breast Cancer

by Masakuni Noguchi, Masafumi Inokuchi, Miki Yokoi-Noguchi, Emi Morioka and Yusuke Haba

Cancers 2023, 15(22), 5353; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15225353 - 9 Nov 2023

Viewed by 975

Abstract

Axillary lymph node dissection (ALND) has been associated with postoperative morbidities, including arm lymphedema, shoulder dysfunction, and paresthesia. Sentinel lymph node (SLN) biopsy emerged as a method to assess axillary nodal status and possibly obviate the need for ALND in patients with clinically node-negative (cN0) breast cancer. The majority of breast cancer patients are eligible for SLN biopsy only, so ALND can be avoided. However, there are subsets of patients in whom ALND cannot be eliminated. ALND is still needed in patients with three or more positive SLNs or those with gross extranodal or matted nodal disease. Moreover, ALND has conventionally been performed to establish local control in clinically node-positive (cN+) patients with a heavy axillary tumor burden. The sole method to avoid ALND is through neoadjuvant chemotherapy (NAC). Recently, various forms of conservative axillary surgery have been developed in order to minimize arm lymphedema without increasing axillary recurrence. In the era of effective multimodality therapy, conventional ALND may not be necessary in either cN0 or cN+ patients. Further studies with a longer follow-up period are needed to determine the safety of conservative axillary surgery. Full article

(This article belongs to the Special Issue Conservative Axillary Surgery for Breast Cancer)

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