title: [Axillary management in breast cancer: The French practice versus recommendations in the post-2011 era].
abstract: OBJECTIVE
  Today, according to St-Gallen and ASCO clinical guidelines, axillary lymph node dissection (ALND) should be avoided in patients who meet the ACOSOG Z011 criteria. In French guidelines, ALND is still recommended in case of macrometastasis in sentinel lymph node (SLN) and in case of micrometastasis without systemic treatment. We performed a survey of the French practices in the management of the axilla.
  
  
  METHODS
  A questionnaire was sent to 454 breast surgeons between June 2014 and January 2015. Questionnaire included items about: indications of SLN biopsy, frequency of ALND in case of metastatic SLN and modality of radiotherapy in case of metastatic SLN without ALND.
  
  
  RESULTS
  A total of 169 surgeons (37%) answer the questionnaire. Twenty-one percent of surgeons avoid ALND in case of macrometastasis. Thirty-two percent do not perform extemporaneous examination of SLN. Only 8.4% of practionners performed a SLN biopsy after neoadjuvant chemotherapy. Fourteen percent performed a SLN biopsy in case of multicentric tumors, while it is not recommended. In case of positive SLN without ALND completion, radiotherapy does not change in 34% while irradiation fields are expanded in 44%.
  
  
  CONCLUSIONS
  Significant unconformities are observed towards national recommendations. The divergence between French and international guidelines leads to heterogeneous surgical practices.
authors.affiliation: Centre expert oncologie gynécologique et sénologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Clavier
authors.affiliation: Centre expert oncologie gynécologique et sénologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Cornou
authors.affiliation: Centre expert oncologie gynécologique et sénologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Capmas
authors.affiliation: Centre expert oncologie gynécologique et sénologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 45, rue des Saints-Pères, 75006 Paris, France; UMR S 747, faculté de médecine, université Paris Descartes, 45, rue des Saints-Pères, 75006 Paris, France.
authors.forename: A-S
authors.initials: AS
authors.lastname: Bats
authors.affiliation: Centre expert oncologie gynécologique et sénologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Bensaid
authors.affiliation: Centre expert oncologie gynécologique et sénologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Nos
authors.affiliation: Centre expert oncologie gynécologique et sénologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 45, rue des Saints-Pères, 75006 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Lécuru
authors.affiliation: Centre expert oncologie gynécologique et sénologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 45, rue des Saints-Pères, 75006 Paris, France. Electronic address: charlotte.ngo@egp.aphp.fr.
authors.forename: C
authors.initials: C
authors.lastname: Ngô
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005602:France; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D008207:Lymphatic Metastasis / Q000473:pathology; D020360:Neoadjuvant Therapy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D018714:Radiotherapy, Adjuvant; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data*; D066231:Surgeons; D011795:Surveys and Questionnaires
keywords: Axillary lymph node dissection; Breast cancer; Cancer du sein; Curage axillaire; Enquête de pratique; Ganglion sentinelle; Practice survey; Recommandations; Recommendations; Sentinel lymph node