AGO Recommendations for the Surgical Therapy of Breast Cancer: Update 2022

TY - JOUR

T1 - AGO Recommendations for the Surgical Therapy of Breast Cancer: Update 2022

AU - Banys-Paluchowski, Maggie

AU - Thill, Marc

AU - Kühn, Thorsten

AU - Ditsch, Nina

AU - Heil, Jörg

AU - Wöckel, Achim

AU - Fallenberg, Eva

AU - Friedrich, Michael

AU - Kümmel, Sherko

AU - Müller, Volkmar

AU - Janni, Wolfgang

AU - Albert, Ute-Susann

AU - Bauerfeind, Ingo

AU - Blohmer, Jens-Uwe

AU - Budach, Wilfried

AU - Dall, Peter

AU - Fasching, Peter

AU - Fehm, Tanja

AU - Gluz, Oleg

AU - Harbeck, Nadia

AU - Huober, Jens

AU - Jackisch, Christian

AU - Kolberg-Liedtke, Cornelia

AU - Kreipe, Hans H

AU - Krug, David

AU - Loibl, Sibylle

AU - Lüftner, Diana

AU - Lux, Michael Patrick

AU - Maass, Nicolai

AU - Mundhenke, Christoph

AU - Nitz, Ulrike

AU - Park-Simon, Tjoung Won

AU - Reimer, Toralf

AU - Rhiem, Kerstin

AU - Rody, Achim

AU - Schmidt, Marcus

AU - Schneeweiss, Andreas

AU - Schütz, Florian

AU - Sinn, H Peter

AU - Solbach, Christine

AU - Solomayer, Erich-Franz

AU - Stickeler, Elmar

AU - Thomssen, Christoph

AU - Untch, Michael

AU - Witzel, Isabell

AU - Gerber, Bernd

N1 - The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).

PY - 2022/10

Y1 - 2022/10

N2 - The recommendations of the AGO Breast Committee on the surgical therapy of breast cancer were last updated in March 2022 (www.ago-online.de). Since surgical therapy is one of several partial steps in the treatment of breast cancer, extensive diagnostic and oncological expertise of a breast surgeon and good interdisciplinary cooperation with diagnostic radiologists is of great importance. The most important changes concern localization techniques, resection margins, axillary management in the neoadjuvant setting and the evaluation of the meshes in reconstructive surgery. Based on meta-analyses of randomized studies, the level of recommendation of an intraoperative breast ultrasound for the localization of non-palpable lesions was elevated to "++". Thus, the technique is considered to be equivalent to wire localization, provided that it is a lesion which can be well represented by sonography, the surgeon has extensive experience in breast ultrasound and has access to a suitable ultrasound device during the operation. In invasive breast cancer, the aim is to reach negative resection margins ("no tumor on ink"), regardless of whether an extensive intraductal component is present or not. Oncoplastic operations can also replace a mastectomy in selected cases due to the large number of existing techniques, and are equivalent to segmental resection in terms of oncological safety at comparable rates of complications. Sentinel node excision is recommended for patients with cN0 status receiving neoadjuvant chemotherapy after completion of chemotherapy. Minimally invasive biopsy is recommended for initially suspect lymph nodes. After neoadjuvant chemotherapy, patients with initially 1 - 3 suspicious lymph nodes and a good response (ycN0) can receive the targeted axillary dissection and the axillary dissection as equivalent options.

AB - The recommendations of the AGO Breast Committee on the surgical therapy of breast cancer were last updated in March 2022 (www.ago-online.de). Since surgical therapy is one of several partial steps in the treatment of breast cancer, extensive diagnostic and oncological expertise of a breast surgeon and good interdisciplinary cooperation with diagnostic radiologists is of great importance. The most important changes concern localization techniques, resection margins, axillary management in the neoadjuvant setting and the evaluation of the meshes in reconstructive surgery. Based on meta-analyses of randomized studies, the level of recommendation of an intraoperative breast ultrasound for the localization of non-palpable lesions was elevated to "++". Thus, the technique is considered to be equivalent to wire localization, provided that it is a lesion which can be well represented by sonography, the surgeon has extensive experience in breast ultrasound and has access to a suitable ultrasound device during the operation. In invasive breast cancer, the aim is to reach negative resection margins ("no tumor on ink"), regardless of whether an extensive intraductal component is present or not. Oncoplastic operations can also replace a mastectomy in selected cases due to the large number of existing techniques, and are equivalent to segmental resection in terms of oncological safety at comparable rates of complications. Sentinel node excision is recommended for patients with cN0 status receiving neoadjuvant chemotherapy after completion of chemotherapy. Minimally invasive biopsy is recommended for initially suspect lymph nodes. After neoadjuvant chemotherapy, patients with initially 1 - 3 suspicious lymph nodes and a good response (ycN0) can receive the targeted axillary dissection and the axillary dissection as equivalent options.

U2 - 10.1055/a-1904-6231

DO - 10.1055/a-1904-6231

M3 - SCORING: Journal article

C2 - 36186147

VL - 82

SP - 1031

EP - 1043

JO - GEBURTSH FRAUENHEILK

JF - GEBURTSH FRAUENHEILK

SN - 0016-5751

IS - 10

ER -