A Survey of Practice Patterns for Clinical Nodal Staging Prior to Neoadjuvant Chemotherapy in Breast Cancer

Author:

Lee Han-Byoel123,Lee Kyung-Hun345ORCID,Song Seok Hyun6,Kim Kyubo7,Kim Hong Kyu123,Moon Hyeong-Gon123,Han Wonshik123,Lee Dae-Won45,Im Seock-Ah345,Jang Bum-Sup89,Kim Yong Bae10,Yu Jonghan11,Kim Jee Hyun12,Park Yeon Hee13,Shin Kyung Hwan89,Chang Ji Hyun89ORCID

Affiliation:

1. Department of Surgery, Seoul National University College of Medicine , Seoul , Republic of Korea

2. Biomedical Research Institute, Seoul National University Hospital , Seoul , Republic of Korea

3. Cancer Research Institute, Seoul National University , Seoul , Republic of Korea

4. Department of Internal Medicine, Seoul National University College of Medicine , Seoul , Republic of Korea

5. Department of Internal Medicine, Seoul National University Hospital , Seoul , Republic of Korea

6. Seoul National University College of Medicine , Seoul , Republic of Korea

7. Department of Radiation Oncology, Ewha Womans University College of Medicine , Seoul , Republic of Korea

8. Department of Radiation Oncology, Seoul National University College of Medicine , Seoul , Republic of Korea

9. Department of Radiation Oncology, Seoul National University Hospital , Seoul , Republic of Korea

10. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine , Seoul , Republic of Korea

11. Division of Breast, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea

12. Department of Internal Medicine, Seoul National University Bundang Hospital , Seoul National University College of Medicine, Seongnam , Republic of Korea

13. Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea

Abstract

Abstract Background The importance of clinical staging in breast cancer has increased owing to the wide use of neoadjuvant systemic therapy (NST). This study aimed to investigate the current practice patterns regarding clinical nodal staging in breast cancer in real-world settings. Materials and Methods A web-based survey was administered to board-certified oncologists in Korea, including breast surgical, medical, and radiation oncologists, from January to April 2022. The survey included 19 general questions and 4 case-based questions. Results In total, 122 oncologists (45 radiation, 44 surgical, and 33 medical oncologists) completed the survey. Among them, 108 (88%) responded that clinical staging before NST was primarily performed by breast surgeons. All the respondents referred to imaging studies during nodal staging. Overall, 64 (52.5%) responders determined the stage strictly based on the radiology reports, whereas 58 (47.5%) made their own decision while noting radiology reports. Of those who made their own decisions, 88% referred to the number or size of the suspicious node. Of the 75 respondents involved in prescribing regimens for neoadjuvant chemotherapy, 58 (77.3%) responded that the reimbursement regulations in the selection of NST regimens affected nodal staging in clinical practice. In the case-based questions, high variability was observed among the clinicians in the same cases. Conclusions Diverse assessments by specialists owing to the lack of a clear, harmonized staging system for the clinical nodal staging of breast cancer can lead to diverse practice patterns. Thus, practical, harmonized, and objective methods for clinical nodal staging and for the outcomes of post-NST response are warranted for appropriate treatment decisions and accurate outcome evaluation.

Funder

Ministry of Health and Welfare

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Oncology

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