A Survey of Practice Patterns for Clinical Nodal Staging Prior to Neoadjuvant Chemotherapy in Breast Cancer

Han Byoel Lee, Kyung Hun Lee, Seok Hyun Song, Kyubo Kim, Hong Kyu Kim, Hyeong Gon Moon, Wonshik Han, Dae Won Lee, Seock Ah Im, Bum Sup Jang, Yong Bae Kim, Jonghan Yu, Jee Hyun Kim, Yeon Hee Park, Kyung Hwan Shin, Ji Hyun Chang

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)e1142-e1151
Issue number12
StatePublished - Dec 2023

Bibliographical note

Publisher Copyright:
© 2023 The Author(s). Published by Oxford University Press.


  • breast cancer
  • chemotherapy
  • neoadjuvant therapy
  • radiotherapy
  • staging
  • surgery


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