Localization Techniques for Non-Palpable Breast Lesions : Current Status, Knowledge Gaps, and Rationale for the MELODY Study (EUBREAST-4/iBRA-NET, NCT 05559411)

Funding: The MELODY study will be financially supported by: Hologic, Merit Medical, Endomag and Sirius Medical.Peer reviewedPublisher PD

Surgical Management of the Axilla in Clinically Node-Positive Breast Cancer Patients Converting to Clinical Node Negativity through Neoadjuvant Chemotherapy : Current Status, Knowledge Gaps, and Rationale for the EUBREAST-03 AXSANA Study

In the last two decades, surgical methods for axillary staging in breast cancer patients have become less extensive, and full axillary lymph node dissection (ALND) is confined to selected patients. In initially node-positive patients undergoing neoadjuvant chemotherapy, however, the optimal management remains unclear. Current guidelines vary widely, endorsing different strategies. We performed a literature review on axillary staging strategies and their place in international recommendations. This overview defines knowledge gaps associated with specific procedures, summarizes currently ongoing clinical trials that address these unsolved issues, and provides the rationale for further research. While some guidelines have already implemented surgical de-escalation, replacing ALND with, e.g., sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD) in cN+ patients converting to clinical node negativity, others recommend ALND. Numerous techniques are in use for tagging lymph node metastasis, but many questions regarding the marking technique, i.e., the optimal time for marker placement and the number of marked nodes, remain unanswered. The optimal number of SLNs to be excised also remains a matter of debate. Data on oncological safety and quality of life following different staging procedures are lacking. These results provide the rationale for the multinational prospective cohort study AXSANA initiated by EUBREAST, which started enrollment in June 2020 and aims at recruiting 3000 patients in 20 countries (NCT04373655; Funded by AGO-B, Claudia von Schilling Foundation for Breast Cancer Research, AWOgyn, EndoMag, Mammotome, and MeritMedical)

Uncertainties and controversies in axillary management of patients with breast cancer

The aims of this Oncoplastic Breast Consortium and European Breast Cancer Research Association of Surgical Trialists initiative were to identify uncertainties and controversies in axillary management of early breast cancer and to recommend appropriate strategies to address them. By use of Delphi methods, 15 questions were prioritized by more than 250 breast surgeons, patient advocates and radiation oncologists from 60 countries. Subsequently, a global virtual consensus panel considered available data, ongoing studies and resource utilization. It agreed that research should no longer be prioritized for standardization of axillary imaging, de-escalation of axillary surgery in node-positive cancer and risk evaluation of modern surgery and radiotherapy. Instead, expert consensus recommendations for clinical practice should be based on current evidence and updated once results from ongoing studies become available. Research on de-escalation of radiotherapy and identification of the most relevant endpoints in axillary management should encompass a meta-analysis to identify knowledge gaps, followed by a Delphi process to prioritize and a consensus conference to refine recommendations for specific trial designs. Finally, treatment of residual nodal disease after surgery was recommended to be assessed in a prospective register

Priorities for Occupational Therapy Research in the United Kingdom: Executive Summary of the POTTER Project

The College of Occupational Therapists commissioned the POTTER project to inform its work and the work of its research foundation. The aim was to identify its members' views about the current national priorities for occupational therapy research in the United Kingdom. A five-stage study was conducted. The main method was a national survey of the professional body's membership (n = 7000); 2,661 completed questionnaires were returned (38% response rate) and the respondents represented the current membership. The main research priority was a need for research into the effectiveness of occupational therapy. The findings have implications for research capacity building and the commissioning of occupational therapy research

The nature and value of research priority setting in healthcare: Case study of the POTTER project

Health research provides new knowledge to improve the population's health. There are limited resources to fund this research so many organisations have developed research priorities to guide commissioning. These studies often involve the use of consensus methods. The POTTER project, commissioned by the College of Occupational Therapists, is used as a case study to explore the question, 'Does there need to be less emphasis on consensus in research priority setting to ensure better investment in health?' This is because the POTTER project identified the effectiveness of occupational therapy as the top research priority for UK-based occupational therapists. This result is too broad to be useful for commissioners because any topic could potentially attract funding under this heading. So, while consensus methods may promote ownership of results, criteria-based methods, ie demographic trends, burden of disease, potential benefits and policy, are likely to promote better investment in health. Managers have not traditionally played a role in research priority setting but they should be more involved. The nature of their involvement in service delivery inevitably requires them to have different concerns to clinicians and so they are not necessarily focused on specific interventions. Generally this means they consider the wider healthcare context when research priorities are being shaped