# AGO Recommendations for the Surgical Therapy of Breast Cancer: Update 2022.

**Organizacion:** AGO
**Autores:** Banys-Paluchowski M, Thill M, K&#xfc;hn T et al.
**Revista:** Geburtshilfe Frauenheilkd (2022)
**PMID:** 36186147 | **PMCID:** PMC9525149
**DOI:** [10.1055/a-1904-6231](https://doi.org/10.1055/a-1904-6231)
**Fuente:** PubMed Central (open access)

## Relevancia
Recomendaciones anuales del grupo aleman de oncologia ginecologica (Arbeitsgemeinschaft Gynaekologische Onkologie). Cubren extensamente el manejo quirurgico axilar en cN+ post-NAC, incluyendo diseccion axilar dirigida (TAD), marcaje de ganglios y tecnicas de localizacion; con nivel de evidencia AGO (+ / ++ / +++).

## Recomendaciones clave (resumen)
- TAD (Targeted Axillary Dissection) recomendada para cN+ -> ycN0 (AGO ++).
- Marcaje del ganglio positivo confirmado por biopsia es mandatorio antes de NAC.
- BSGC sola post-NAC en cN1 inicial: aceptable si se utiliza doble trazador y se extraen >=3 ganglios centinela.
- Si TAD/BSGC es ypN0 -> omision de ALND aceptable.
- ALND axilar completa sigue indicada en caso de no respuesta o ypN+ macrometastatico.

## Abstract
The recommendations of the AGO Breast Committee on the surgical therapy of breast cancer were last updated in March 2022 (www.ago-online.de). Since surgical therapy is one of several partial steps in the treatment of breast cancer, extensive diagnostic and oncological expertise of a breast surgeon and good interdisciplinary cooperation with diagnostic radiologists is of great importance. The most important changes concern localization techniques, resection margins, axillary management in the neoadjuvant setting and the evaluation of the meshes in reconstructive surgery. Based on meta-analyses of randomized studies, the level of recommendation of an intraoperative breast ultrasound for the localization of non-palpable lesions was elevated to "++". Thus, the technique is considered to be equivalent to wire localization, provided that it is a lesion which can be well represented by sonography, the surgeon has extensive experience in breast ultrasound and has access to a suitable ultrasound device during the operation. In invasive breast cancer, the aim is to reach negative resection margins ("no tumor on ink"), regardless of whether an extensive intraductal component is present or not. Oncoplastic operations can also replace a mastectomy in selected cases due to the large number of existing techniques, and are equivalent to segmental resection in terms of oncological safety at comparable rates of complications. Sentinel node excision is recommended for patients with cN0 status receiving neoadjuvant chemotherapy after completion of chemotherapy. Minimally invasive biopsy is recommended for initially suspect lymph nodes. After neoadjuvant chemotherapy, patients with initially 1 - 3 suspicious lymph nodes and a good response (ycN0) can receive the targeted axillary dissection and the axillary dissection as equivalent options.

## Acceso
Disponible en PMC: https://pmc.ncbi.nlm.nih.gov/articles/PMC9525149/

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*Datos de PubMed. Citar: doi 10.1055/a-1904-6231*
