Stepping forward in personalizing breast cancer management Added value of diagnostic assets

Breast cancer has become the leading cause of cancer for women worldwide. Treatment nowadays is multidisciplinary and the surgical management of breast cancer has transformed from a radical mutilating procedure to a less invasive and oncologic safe operation. In this era of de-escalation, it is important to select those patients where a ‘less is more’ approach is oncologic save while keeping in mind that breast cancer is a very heterogeneous disease.
First we focused on the triple negative breast cancer patients and found tumour-stroma ratio to be a strong independent prognostic variables. Another group of breast cancer patients who lack optimal therapy guidelines, are the so-called special types. Submitting them all to the same treatment may lead to both over- and under-treatment. We need to form and analyse large databases in the near future by combining (inter)national data.
Secondly we focused on the de-escalation of axillary surgery and studied the utility and diagnostic accuracy of axillary US and US with FNAC in detecting axillary lymph node metastases. Knowledge of the axillary status pre-operatively with the use of ultrasonography makes a more personalized treatment possible. However we had to conclude it was too difficult to identify a clinically relevant proportion of woman in whom we could safely omit the SLNB based on clinicopathological variables. A number of ongoing large prospective trials evaluating the outcome of omitting SLNB have to be awaited. In the meanwhile, our nomogram may be used as a tool for individual decision-making.