Comment: Artificial Intelligence and surgical management of Axilla

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Published: 31 Jan 2023
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Prof Mehra Golshan - Yale School of Medicine, New Haven, USA

Prof Mehra Golshan comments on Dr Maria João Cardoso talk on Artificial Intelligence. Her talk highlights the use of AI technologies being used to support health professionals’ skills.

Prof Golshan also comments on Prof Terry Mamounas talk on the surgical management of Axilla.

Breast cancer patients with lymph node metastasis have been treated with a full axillary lymph node dissection, even if they converted to clinical node negativity. However, the removal of a large number of lymph nodes during the procedure can increase arm morbidity and impact quality of life. 

Prof Golshan explores several studies investigating less radical surgical strategies in this setting, such as sentinel lymph node biopsy or targeted axillary dissection.

He finishes by summarising the future of surgical management of Axilla.

Dr Cardoso from Portugal spent a lot of time talking about the use of artificial intelligence and how that can help in terms of not only detecting breast cancer earlier, being able to not replace the eye of the radiologist but complement the eye of a radiologist in finding a cancer in a mammogram, but also using artificial intelligence in terms of being able to look at the position of the tumour using 3D glasses and being able to target your surgery appropriately, which I thought was really fascinating.

Yesterday there was also an interesting talk by Dr Terry Mamounas from Orlando who spent some time talking about some of the advances in terms of lymph node surgery. We used to remove all the lymph nodes with a woman with breast cancer; now we can remove just a few lymph nodes and if they’re clear not remove any more. If the lymph node has cancer we often give chemotherapy and if we can make the cancer disappear in the lymph nodes then maybe just remove that previously cancered lymph node and no other nodes to be able to do then either radiation or no therapy. Then, pushing the envelope even further, potentially you had cancer in the lymph nodes, you give them chemotherapy and maybe there’s a subset of women who don’t need further surgery or any form of treatment. That’s where the future is in terms of de-escalating therapy.