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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.

그림 설명: 같은 환자 case 에서도 각 과 별로 다양하게 nodal staging을 평가하는 양상을 보여주는 그래프.

Affiliations

Han-Byoel Lee 1 2 3, Kyung-Hun Lee 3 4 5, Seok Hyun Song 6, Kyubo Kim 7, Hong Kyu Kim 1 2 3, Hyeong-Gon Moon 1 2 3, Wonshik Han 1 2 3, Dae-Won Lee 4 5, Seock-Ah Im 3 4 5, Bum-Sup Jang 8 9, Yong Bae Kim 10, Jonghan Yu 11, Jee Hyun Kim 12, Yeon Hee Park 13, Kyung Hwan Shin 8 9, Ji Hyun Chang 8 9
1Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
2Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
3Cancer Research Institute, Seoul National University, Seoul, Republic of Korea.
4Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
5Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
6Seoul National University College of Medicine, Seoul, Republic of Korea.
7Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea.
8Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
9Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.
10Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
11Division of Breast, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
12Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
13Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.