title: Trends in axillary treatment for breast cancer patients undergoing sentinel lymph node biopsy as determined by a questionnaire from the Japanese Breast Cancer Society.
abstract: BACKGROUND
  Sentinel lymph node biopsy (SLNB) alone has been compared with SLNB followed by axillary lymph node dissection (ALND) in sentinel lymph node (SLN)-positive breast cancer patients in randomized phase III trials: the addition of ALND did not further improve the patient's outcome. However, there is still some controversy, regarding the clinical application of SLNB alone. To identify the optimal axillary treatment in the era of SLNB, the Japanese Breast Cancer Society conducted a group study of SLNB in 2014.
  
  
  METHODS
  A questionnaire on axillary surgery and radiation therapy was sent to 432 Japanese institutes in December 2014, and 309 (72 %) completed the questionnaire.
  
  
  RESULTS
  SLNB was performed at 98 % of the institutes, and 77 % offered irradiation for cancer treatment. Regarding breast-conserving surgery (BCS), SLNB alone was indicated at 41 % of the institutes in the cases of SLN with micrometastases. However, in the cases of SLN with macrometastases, ALND was performed at 64 %. The proportion of ALND seemed to be higher in total mastectomy than in BCS regardless of the SLN-positive status. In the cases of SLN with micrometastases, the radiation field was localized in the conserved breast at about half of the institutes. On the other hand, in the cases of SLN with macrometastases, it was extended to axillary and/or supraclavicular lesions beyond the conserved breast at about 70 % of the institutes.
  
  
  CONCLUSIONS
  Japanese breast physicians were conservative with respect to the omission of ALND in SLN-positive breast cancer, especially in the cases of SLN with macrometastases.
authors.affiliation: Department of Breast Surgery, School of Medicine, Kyorin University, 6-20-2, Shinkawa, Mitaka, 181-8611, Japan. simoto@ks.kyorin-u.ac.jp.
authors.forename: Shigeru
authors.identifier: http://orcid.org/0000-0002-0878-7851
authors.initials: S
authors.lastname: Imoto
authors.affiliation: Department of Radiation Oncology, Shiga Medical Center for Adults, 5-4-30, Moriyama, Moriyama, Shiga, 524-8524, Japan.
authors.forename: Chikako
authors.initials: C
authors.lastname: Yamauchi
authors.affiliation: Department of Surgery, Kinki University Faculty of Medicine, Osaka-sayama, Osaka, 589-8511, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Komoike
authors.affiliation: Division of Breast and Endocrine Surgery, Department of Surgery, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Tsugawa
authors.affiliation: Department of Breast Surgery, Sagara Hospital, 3-31, Matsubara, Kagoshima, Kagoshima, 892-0833, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yotsumoto
authors.affiliation: Department of Surgery, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Wada
authors.affiliation: Department of Breast Surgery, School of Medicine, Kyorin University, 6-20-2, Shinkawa, Mitaka, 181-8611, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ueno
authors.affiliation: Department of Medical Statistics, Toho University, 5-21-16, Ohmori-Nishi, Ota, Tokyo, 143-8540, Japan.
authors.forename: Mari S
authors.initials: MS
authors.lastname: Oba
authors.affiliation: Department of Breast and Endocrine Surgery, Okayama University Hospital, 2-5-1, Shikata, Kita, Okayama, Okayama, 700-8558, Japan.
authors.forename: Tadahiko
authors.initials: T
authors.lastname: Shien
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
authors.forename: Sadatoshi
authors.initials: S
authors.lastname: Sugae
authors.affiliation: Department of Basic Pathology, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tsuda
authors.affiliation: Department of Breast Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
authors.forename: Kimiyasu
authors.initials: K
authors.lastname: Yoneyama
mesh_terms: D001365:Axilla / Q000473:pathology / Q000528:radiation effects / Q000601:surgery*; D001943:Breast Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006801:Humans; D007564:Japan; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data; D061206:Neoplasm Micrometastasis / Q000473:pathology; D021701:Sentinel Lymph Node Biopsy / Q000379:methods* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
keywords: Axillary lymph node dissection; Breast-conserving surgery; Micrometastases; Regional node irradiation; Sentinel lymph node biopsy