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Sun P, Han J, Li M, Wang Z, Guo R, Zhang Y, Qian L, Ma J, Hu X. Ultrasound Spectral Combined With Clinical Pathological Parameters in Prediction of Axillary Lymph Node Metastatic in Breast Cancer. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 39230251 DOI: 10.1002/jum.16564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/26/2024] [Accepted: 08/17/2024] [Indexed: 09/05/2024]
Abstract
OBJECTIVES To explore the clinical value of the nomogram based on ultrasound spectral combined with clinical pathological parameter in predicting axillary lymph node metastasis in breast cancer. METHODS We prospectively gathered clinicopathologic and ultrasonic data from 240 patients confirmed breast cancer. The risk factors of axillary lymph node metastasis were analyzed by univariate and multivariate logistic regression, and the prediction model was established. The model calibration, predictive ability, and diagnostic efficiency in the training set and the testing set were analyzed by receiver operating characteristic curve and calibration curve analysis, respectively. RESULTS Univariate analysis showed that lymph node metastasis was related with tumor size, Ki-67, axillary ultrasound, ultrasound spectral quantitative parameter, internal echo, and calcification (P < .05). Multivariate logistic regression analysis showed that the Ki-67, axillary ultrasound, quantitative parameter (the mean of the mid-band fit in tumor and posterior tumor) were independent risk factors of axillary lymph node metastasis (P < .05). The models developed using Ki-67, axillary ultrasound, and quantitative parameters for predicting axillary lymph node metastasis demonstrated an area under the receiver operating characteristic curve of 0.83. Additionally, the prediction model exhibited outstanding predictability for axillary lymph node metastasis, as evidenced by a Harrell C-index of 0.83 (95% confidence interval 0.73-0.93). CONCLUSION Axillary ultrasound combined with Ki-67 and ultrasound spectral parameters has the potential to predict axillary lymph node metastasis in breast cancer, which is superior to axillary ultrasound alone.
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Affiliation(s)
- Pengfei Sun
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiaqi Han
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China
| | - Min Li
- Clinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University, Beijing Clinical Research Institute, Beijing, China
| | - Zhixiang Wang
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ruifang Guo
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yanning Zhang
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jianguo Ma
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China
| | - Xiangdong Hu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Bi Z, Li L, Chen P, Li ZD, Qiu PF, Wang YS. Optimal management of breast cancer with physical exam negative/radiological abnormal axilla. Sci Rep 2024; 14:20504. [PMID: 39227511 PMCID: PMC11372074 DOI: 10.1038/s41598-024-70874-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 08/22/2024] [Indexed: 09/05/2024] Open
Abstract
For breast cancer patients with physical exam node negative but radiological finding node abnormal (cN0/rNa), the NCCN and ASCO guidelines recommend sentinel lymph node biopsy (SLNB) as the first-line axillary staging. However, patients who undergo surgery firstly may be upstaged to pathological II-III status, and these patients happen to be the adaptive population of neoadjuvant therapy (NAT). There is no consensus on the optimal management of cN0/rNa patients. The aim is to explore the optimal management strategy of these patients. We performed a retrospective real-world study of 1414 cN0/rNa patients from June 2014 to October 2022. There were 1003 patients underwent surgery first and 411 patients underwent surgery after NAT. We analyzed the real-world conditions of these patients, compared axilla tumor burden between these two groups. In addition, we compared benefit ratio of axillary surgery and regional nodal irradiation (RNI) de-escalation under the two strategies. Among 1003 patients underwent surgery first, the positive and negative rates of fine needle aspiration (FNA) were 18.5% and 81.5%, respectively. There were 66.1% had ≤ 2 lymph nodes+. There were 40.8% of FNA+ patients could be exempted from ALND underwent surgery first. In 411 patients underwent surgery after NAT, the FNA positive and negative rates were 60.8% and 49.2%, respectively. There were 54.4% of FNA+ patients achieved axilla pathologic complete response (apCR) and could omit ALND after NAT. The apCR was 67.3% in HER2+/TNBC subtypes. According to the NSABP-B51 trial, there were 0 and 54.4% of FNA+ patients could omit RNI among surgery first and after NAT, respectively. Among 1-2 sentinel lymph node (SLN)-positive patients underwent surgery first, with a median follow-up 49 months, there was no difference of survival benefit between SLNB-only and SLNB-ALND. Compared with 1-2 SLN+ patients without RNI, RNI could bring better invasive disease-free survival (97.38% vs. 89.36%, P = 0.046) and breast cancer special survival (100% vs. 94.68%, P = 0.020). It is safe to perform SLNB omitting ALND when detected 1-2 positive SLNs in cN0/rNa patients. Patients with HER2+/TNBC subtypes underwent surgery after NAT had more chance to benefit from dual de-escalation, including axillary surgery and RNI de-escalation.
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Affiliation(s)
- Zhao Bi
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Ji Yan Road 440, Jinan, 250000, Shandong, People's Republic of China
| | - Lei Li
- The 970th Hospital of the Chinese People's Liberation Army, Wehai, 264200, Shandong, People's Republic of China
| | - Peng Chen
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Ji Yan Road 440, Jinan, 250000, Shandong, People's Republic of China
| | - Zhe-Dong Li
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Ji Yan Road 440, Jinan, 250000, Shandong, People's Republic of China
| | - Peng-Fei Qiu
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Ji Yan Road 440, Jinan, 250000, Shandong, People's Republic of China.
| | - Yong-Sheng Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Ji Yan Road 440, Jinan, 250000, Shandong, People's Republic of China.
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Song Y, Liu J, Jin C, Zheng Y, Zhao Y, Zhang K, Zhou M, Zhao D, Hou L, Dong F. Value of Contrast-Enhanced Ultrasound Combined with Immune-Inflammatory Markers in Predicting Axillary Lymph Node Metastasis of Breast Cancer. Acad Radiol 2024; 31:3535-3545. [PMID: 38918153 DOI: 10.1016/j.acra.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/16/2024] [Accepted: 06/06/2024] [Indexed: 06/27/2024]
Abstract
RATIONALE AND OBJECTIVES To evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) combined with immune-inflammatory markers in predicting axillary lymph node metastasis (ALNM) in breast cancer patients. METHODS From January 2020 to June 2023, the clinicopathological data and ultrasound features of 401 breast cancer patients who underwent biopsy or surgery were recorded. Patients were randomly divided into a training set (321 patients) and a validation set (80 patients). The risk factors for ALNM were determined using univariate, least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analysis, and prediction models were constructed. Receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were used to assess their diagnostic performance. RESULTS Logistic regression analysis demonstrated that systemic immunoinflammatory index (SII), CA125, Ki67, pathological type, lesion size, enhancement pattern and Breast Imaging Reporting and Data System (BI-RADS) category were significant risk factors for ALNM. Three different models were constructed, and the combined model yielded an AUC of 0.903, which was superior to the clinical model (AUC=0.790) and ultrasound model (AUC=0.781). A nomogram was constructed based on the combined model, calibration curves and DCA demonstrated its satisfactory performance in predicting ALNM. CONCLUSION The nomogram combining ultrasound features and immune-inflammatory markers could serve as a valuable instrument for predicting ALNM in breast cancer patients. DATA AVAILABILITY STATEMENT The original contributions presented in the study are included in the article. Further inquiries can be directed to the corresponding authors.
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Affiliation(s)
- Ying Song
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, China
| | - Jinjin Liu
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, China
| | - Chenyang Jin
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, China
| | - Yan Zheng
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, China
| | - Yingying Zhao
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, China
| | - Kairen Zhang
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, China
| | - Mengqi Zhou
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, China
| | - Dan Zhao
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, China
| | - Lizhu Hou
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, China
| | - Fenglin Dong
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, China.
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Boland MR. Modern management of the axilla. J Surg Oncol 2024; 130:23-28. [PMID: 38643485 DOI: 10.1002/jso.27649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/11/2024] [Indexed: 04/23/2024]
Abstract
Surgical management of the axilla has evolved considerably in recent years, with a strong focus on de-escalation to minimise morbidity whilst maintaining oncological outcomes. Current trials will focus on the omission of Sentinel node biopsy in select groups of patients, while axillary lymph node dissection will be reserved for those with more aggressive disease.
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Affiliation(s)
- Michael R Boland
- Department of Breast Surgery, St Vincent's University Hospital, Dublin, Ireland
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Jiang K, Ma C, Yang Y, McKevitt E, Pao JS, Warburton R, Dingee C, Bremang JN, Deban M, Bazzarelli A. Axillary ultrasonography for early-stage invasive breast cancer. Am J Surg 2024; 231:86-90. [PMID: 38490879 DOI: 10.1016/j.amjsurg.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/13/2024] [Accepted: 03/07/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Among women with early invasive breast cancer and 1-2 positive sentinel nodes, sentinel lymph node biopsy (SLNB) is non-inferior to axillary lymph node dissection (ALND).1-3 However, preoperative axillary ultrasonography (AxUS) may not be sensitive enough to discriminate burden of nodal metastasis in these patients, potentially leading to overtreatment.4-6 This study compares axillary operation rates in patients who did and did not receive preoperative AxUS, assessing its utility and risks for overtreatment. METHODS This is a retrospective cohort study of patients with clinical T1/T2 breast tumors who were clinically node negative and underwent an axillary operation. RESULTS Patients who had preoperative AxUS received more ALND compared to patients who did not (5.6% vs. 1.4%, p < 0.001). There was no significant difference in the number of additional axillary operations following SLNB (2.1% vs. 2.3%, p = 0.77). CONCLUSION Eliminating preoperative AxUS is associated with fewer invasive ALND procedures, without increased rate of axillary reoperations.
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Affiliation(s)
- Karen Jiang
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Crystal Ma
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Yuwei Yang
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Elaine McKevitt
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Jin-Si Pao
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Rebecca Warburton
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Carol Dingee
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Jieun Newman- Bremang
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Melina Deban
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Amy Bazzarelli
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
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Rocco N, Ghilli M, Curcio A, Bortul M, Burlizzi S, Cabula C, Cabula R, Ferrari A, Folli S, Fortunato L, Frittelli P, Gentilini O, Grendele S, Grassi MM, Grossi S, Magnoni F, Murgo R, Palli D, Rovera F, Sanguinetti A, Taffurelli M, Tazzioli G, Terribile DA, Caruso F, Galimberti V. Is routine axillary lymph node dissection needed to tailor systemic treatments for breast cancer patients in the era of molecular oncology? A position paper of the Italian National Association of Breast Surgeons (ANISC). EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107954. [PMID: 38217946 DOI: 10.1016/j.ejso.2024.107954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/17/2023] [Accepted: 01/05/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND De-escalation of axillary surgery in breast cancer (BC) management began when sentinel lymph node biopsy (SLNB) replaced axillary lymph node dissection (ALND) as standard of care in patients with node-negative BC. The second step consolidated ALND omission in selected subgroups of BC patients with up to two macrometastases and recognized BC molecular and genomic implication in predicting prognosis and planning adjuvant treatment. Outcomes from the recent RxPONDER and monarchE trials have come to challenge the previous cut-off of two SLN in order to inform decisions on systemic therapies for hormone receptor-positive (HR+), human epidermal growth factor receptor type-2 (HER2) negative BC, as the criteria included a cut-off of respectively three and four SLNs. In view of the controversy that this may lift in surgical practice, the Italian National Association of Breast Surgeons (Associazione Nazionale Italiana Senologi Chirurghi, ANISC) reviewed data regarding the latest trials on this topic and proposes an implementation in clinical practice. MATERIAL AND METHODS We reviewed the available literature offering data on the pathological nodal status of cN0 breast cancer patients. RESULTS The rates of pN2 status in cN0 patients ranges from 3.5 % to 16 %; pre-surgical diagnostic definition of axillary lymph node status in cN0 patients by ultrasound could be useful to inform about a possible involvement of ≥4 lymph nodes in this specific sub-groups of women. CONCLUSIONS The Italian National Association of Breast Surgeons (ANISC) considers that for HR + HER2-/cN0-pN1(sn) BC patients undergoing breast conserving treatment the preoperative workup should be optimized for a more detailed assessment of the axilla and the technique of SLNB should be optimized, if considered appropriate by the surgeon, not considering routine ALND always indicated to determine treatment recommendations according to criteria of eligibility to RxPONDER and monarch-E trials.
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Affiliation(s)
- Nicola Rocco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Matteo Ghilli
- Breast Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Marina Bortul
- SSD Chirurgia Senologica e Breast Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy Naples, Italy
| | - Stefano Burlizzi
- UOSD Chirurgia Senologica, Ospedale "A. Perrino", Brindisi, Italy
| | - Carlo Cabula
- Chirurgia Senologica Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Roberta Cabula
- Cagliari University Hospital, Surgery Unit, Cagliari, Italy
| | - Alberta Ferrari
- SSD Chirurgia Tumori eredo-famigliari, SC Chirurgia Generale 3, Senologia, Fondazione IRCCS Policlinico san Matteo, Pavia, Italy
| | - Secondo Folli
- SC di Chirurgia Oncologica-Senologia, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Lucio Fortunato
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Patrizia Frittelli
- UOC Chirurgia senologica, Ospedale Isola Tiberina Gemelli Isola, Rome, Italy
| | - Oreste Gentilini
- Breast Unit, IRCCS Ospedale San Raffaele di Milano, Milan, Italy
| | - Sara Grendele
- Breast Surgery, Department of Functional Oncology, Alto Vicentino Hospital, Santorso, Vicenza, Italy
| | | | | | - Francesca Magnoni
- Division of Senology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Roberto Murgo
- Chirurgia Senologica, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Dante Palli
- UOC di Chirurgia Generale ad Indirizzo Senologico-Breast Unit AUSL Piacenza, Italy
| | - Francesca Rovera
- S.S.D. Breast Unit - Ospedale Universitario, Varese, Italy; Dipartimento di Medicina e Innovazione Tecnologica, Università degli Studi dell'Insubria, Varese, Italy
| | - Alessandro Sanguinetti
- SSD Chirurgia della Mammella - Dipartimento di Chirurgia, Azienda Ospedaliera "S.Maria", Terni, Italy
| | - Mario Taffurelli
- Breast Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | | | | | - Francesco Caruso
- Breast Unit, Humanitas Istituto Clinico Catanese, Misterbianco, (CT), Italy; National Association of Breast Surgeons (ANISC), Italy
| | - Viviana Galimberti
- Division of Senology, European Institute of Oncology, IRCCS, Milan, Italy
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Sae-Lim C, Wu WP, Chang MC, Lai HW, Chen ST, Chou CT, Liao CY, Huang HI, Chen ST, Chen DR, Hung CL. Reliability of predicting low-burden (≤ 2) positive axillary lymph nodes indicating sentinel lymph node biopsy in primary operable breast cancer - a retrospective comparative study with PET/CT and breast MRI. World J Surg Oncol 2024; 22:12. [PMID: 38183069 PMCID: PMC10770957 DOI: 10.1186/s12957-023-03297-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/26/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is the standard of care for axillary staging in early breast cancer patients with low-burden axillary metastasis (≤ 2 positive nodes). This study aimed to determine the diagnostic performances of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and breast magnetic resonance imaging in detecting axillary lymph node (ALN) metastases and the reliability to predict ALN burden. METHODS A total of 275 patients with primary operable breast cancer receiving preoperative PET/CT and upfront surgery from January 2001 to December 2022 in a single institution were enrolled. A total of 244 (88.7%) of them also received breast MRI. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT and breast MRI were assessed. The predictive values to determine ALN burden were evaluated using radio-histopathological concordance. RESULTS PET/CT demonstrated a sensitivity of 53.4%, specificity of 82.1%, PPV of 65.5%, NPV of 73.5%, and accuracy of 70.9% for detecting ALN metastasis, and the corresponding values for MRI were 71.8%, 67.8%, 56%, 80.8%, and 69.2%, respectively. Combining PET/CT and MRI showed a significantly higher PPV than MRI (72.7% vs 56% for MRI alone, p = 0.037) and a significantly higher NPV than PET/CT (84% vs 73.5% for PET/CT alone, p = 0.041). For predicting low-burden axillary metastasis (1-2 positive nodes), the PPVs were 35.9% for PET/CT, 36.7% for MRI, and 55% for combined PET/CT and MRI. Regarding patients with 0-2 positive ALNs in imaging, who were indicated for SLNB, the predictive correctness was 96.1% for combined PET/CT and MRI, 95.7% for MRI alone, and 88.6% for PET/CT alone. CONCLUSIONS PET/CT and breast MRI exhibit high predictive values for identifying low-burden axillary metastasis in patients with operable breast cancer with ≦ 2 positive ALNs on imaging.
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Affiliation(s)
- Chayanee Sae-Lim
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Wen-Pei Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan
- Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Che Chang
- Department of Nuclear Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Hung-Wen Lai
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
- Endoscopic and Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.
- Minimally Invasive Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan.
- Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan.
- Kaohsiung Medical University, Kaohsiung, Taiwan.
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
- Department of Surgery, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Shu-Tian Chen
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan
| | - Chen-Te Chou
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan
- Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chiung-Ying Liao
- Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsin-I Huang
- Department of Information Management, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Shou-Tung Chen
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Dar-Ren Chen
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Che-Lun Hung
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan
- Department of Computer Science and Communication Engineering, Providence University, Taichung, Taiwan
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8
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Duijm LEM, Strobbe LJA, van Breest Smallenburg V, Op de Coul-Froger CL, Setz-Pels W, Vreuls W, van Beek HC, van Bommel RMG, Voogd AC. Trends in the pre-operative diagnosis and surgical management of axillary lymph node metastases in women with screen-detected breast cancer. Breast 2023; 72:103593. [PMID: 37890215 PMCID: PMC10624574 DOI: 10.1016/j.breast.2023.103593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
AIM The aim of the current study was to investigate time-trends in pre-operative diagnosis and surgical treatment of axillary lymph node metastases in breast cancers detected at screening mammography. METHODS We included all women who underwent screening mammography in the South of the Netherlands between 2005 and 2020. During a follow-up period of at least two years, data on clinical radiological examinations, biopsy procedures and surgical interventions were obtained. The 15 years of inclusion were divided into five cohorts of three years each. RESULTS Of the 4049 women with invasive breast cancer, 22.1 % (896/4049) had axillary lymph node metastasis at pathology (ALN+). Percutaneous axillary biopsy was performed in 39.6 % (355/896) of these women, with the proportions of fine needle aspiration biopsy (FNAB) decreasing from 97.6 % (40/41) in 2005-2007 to 41.6 % (37/89) in 2017-2019 and core needle biopsy (CNB) rising from 2.4 % (1/41) in 2005-2007 to 58.4 % (52/89) in 2017-2019 (P < 0.001). Sensitivity of FNAB and CNB was comparable (77.4 % (188/243, 95%CI = 71%-82 %) versus 82.4 % (103/125), 95%CI = 74%-88 %) (P = 0.26). Pre-operative confirmation of ALN + by percutaneous biopsy ranged from 27.3 % (56/205) in 2011-2013 to 39.0 % (80/205) in 2017-2019, with no significant trend changes over time (P = 0.103). The proportion of ALN + women who underwent axillary lymph node dissection (ALND) decreased from 96.0 % (97/101) in 2005-2007 to 16.6 % (34/205) in 2017-2019 (P < 0.001). CONCLUSION Pre-operative confirmation of axillary lymph node metastasis by ultrasound-guided biopsy did not rise despite the increased use of CNB at the expense of less invasive FNAB. A significant reduction in ALND was observed through the years.
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Affiliation(s)
- Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532, SZ, Nijmegen, the Netherlands
| | - Luc J A Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532, SZ, Nijmegen, the Netherlands
| | | | | | - Wikke Setz-Pels
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623, EJ, Eindhoven, the Netherlands
| | - Willem Vreuls
- Department of Pathology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532, SZ, Nijmegen, the Netherlands
| | - Hermen C van Beek
- Department of Radiology, Maxima Medical Center, De Run 4600, 5504, DB Veldhoven, the Netherlands
| | - Rob M G van Bommel
- Department of Radiology, St Anna Hospital, Bogardeind 2, 5664, EH, Geldrop, the Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands.
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Pislar N, Gasljevic G, Music MM, Borstnar S, Zgajnar J, Perhavec A. Axillary ultrasound for predicting response to neoadjuvant treatment in breast cancer patients-a single institution experience. World J Surg Oncol 2023; 21:292. [PMID: 37715188 PMCID: PMC10504742 DOI: 10.1186/s12957-023-03174-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/09/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND In node-positive breast cancer patients at diagnosis (cN +) that render node-negative after neoadjuvant systemic treatment (NAST), axillary lymph node dissection (ALND) can be avoided in selected cases. Axillary ultrasound (AUS) is most often used for re-staging after NAST. We aimed to determine sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of AUS after NAST for predicting nodal response at the Institute of Oncology, Ljubljana. METHODS Biopsy-confirmed cN + patients consecutively diagnosed at our institution between 2008 and 2021, who received NAST, followed by surgery were identified retrospectively. Only patients that underwent AUS after NAST were included. AUS results were compared to definite nodal histopathology results. We calculated sensitivity, specificity, PPV and NPV of AUS. We also calculated the proportion of patients with false-positive AUS that results in surgical overtreatment (unnecessary ALND). RESULTS We identified 437 cN + patients. In 244 (55.8%) AUS after NAST was performed. Among those, 42/244 (17.2%) were triple negative (TN), 78/244 (32.0%) Her-2 positive (Her-2 +), and 124/244 (50,8%) luminal Her-2 negative cancers. AUS was negative in 179/244 (73.4%), suspicious/positive in 65/244 (26.6%) (11/42 (26.2%) TN, 19/78 (24.4%) Her-2 + , and 35/124 (28.2%) luminal Her-2 negative cancers). On definite histopathology, nodal complete response (pCR) was observed in 89/244 (36.5%) (19/42 (45.2%) TN, 55/78 (70.5%) Her-2 + , and 15/124 (12.1%) luminal Her-2 negative cancers). Among patients with suspicious/positive AUS, pCR was observed in 20/65 (30.8%) (6/11 (54.5%) TN, 13/19 (68.4%) Her-2 + and 1/35 (2.9%) luminal Her-2 negative cancers). Sensitivity was 29.0%, specificity 77,5%, PPV 69.2%, NPV 38.5%. Specificity and PPV in TN was 68.4% and 45.4%, in Her-2 + 76.4% and 31.6%, in luminal Her-2 negative 93,3% and 97,1%, respectively. CONCLUSION In approximately half of the patients, AUS falsely predicts nodal response after NAST and may lead to overtreatment in 30% of the cases (ALND). However, AUS has to be interpreted in context with tumor subtype. In luminal Her-2 negative cancers, it has a high PPV and is therefore useful.
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Affiliation(s)
- Nina Pislar
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Zaloska cesta 2, 1000, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Gorana Gasljevic
- Department of Pathology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Maja Marolt Music
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
- Department of Radiology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Simona Borstnar
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Janez Zgajnar
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Zaloska cesta 2, 1000, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Andraz Perhavec
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Zaloska cesta 2, 1000, Ljubljana, Slovenia.
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
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