Abstract
We have prepared the Japanese Breast Cancer Society clinical practice guidelines (CPGs) for surgical treatment of breast cancer, 2018 update after a systematic review (SR) of the literature based upon the Medical Information Network Distribution Service (Minds) procedure. The CPG committee for surgical treatment of breast cancer, composed of breast surgeons and plastic surgeons treating breast cancer, has developed the CPGs. Eight clinical questions (CQs) were selected and divided roughly into the following five categories: (1) breast surgery in initial therapy (CQs 1–3); (2) axillary surgery in initial therapy (CQs 4–5); (3) breast reconstruction in initial therapy (CQ 6); (4) surgical treatment for recurrent and metastatic breast cancer (CQs 7–8); and (5) others. Recommendations for these CQs were decided by the GRADE grid method. In addition, 4 outlines, 14 background questions (BQs), and 12 future research questions (FQs) were also selected. Statements for these BQs and FQs are provided. We developed the updated CPGs for surgical treatment of breast cancer, 2018, which include 8 CQs and recommendations. As a decision-making tool for the understanding and treatment of breast cancer, these guidelines will help surgical oncologists dealing with breast cancer, medical staff, and patients, along with their family members.
Highlights
In the Breast Cancer Practice Guidelines, 2018 edition, guidelines were developed while weighing the balance of benefits and harms, and the Medical Information Network Distribution Service (Minds) Handbook for Clinical Practice
We introduce the contents of the clinical questions (CQs) and background questions (BQs)
BQ3: Is breast-conserving therapy (BCT) recommended for invasive breast cancer patients responding to neoadjuvant chemotherapy (NAC)?
Summary
In the Breast Cancer Practice Guidelines, 2018 edition, guidelines were developed while weighing the balance of benefits and harms, and the Medical Information Network Distribution Service (Minds) Handbook for Clinical Practice. (SoR: 1, SoE: moderate) CQ4b: In cases of macrometastases CQ4b-1: Breast-conserving therapy (Recommendation) Is no further axillary surgery is weakly recommended. (SoR: 2, SoE: moderate) CQ4b-2: Total mastectomy (without radiation therapy) (Recommendation) Further axillary surgery is strongly recommended. (SoR: 4, SoE: very weak) CQ4b-3: Total mastectomy (with radiation therapy) (Recommendation) Is no further axillary surgery is weakly recommended. (SoR: 2, SoE: weak) CQ5b: Is SLNB recommended, if an ipsilateral axillary lymph node is initially positive, and it is clinically negative after NAC? CQ6: Is immediate breast reconstruction recommended after total mastectomy for clinically node-positive breast cancer patients who desire breast reconstruction?. (Recommendation) Immediate breast reconstruction after total mastectomy is weakly recommended for breast cancer patients with node-positive breast cancer who desire breast reconstruction. CQ8a: For ipsilateral axillary lymph node recurrence after ALND (Recommendation) Surgical resection is weakly recommended. CQ8b: For ipsilateral supraclavicular lymph node recurrence (Recommendation) It is weakly recommended not to perform surgical resection. (SoR: 3, SoE: very weak)
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