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Yu Y, Chen R, Yi J, Huang K, Yu X, Zhang J, Song C. Non-invasive prediction of axillary lymph node dissection exemption in breast cancer patients post-neoadjuvant therapy: A radiomics and deep learning analysis on longitudinal DCE-MRI data. Breast 2024; 77:103786. [PMID: 39137488 DOI: 10.1016/j.breast.2024.103786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/15/2024] [Accepted: 08/08/2024] [Indexed: 08/15/2024] Open
Abstract
PURPOSE In breast cancer (BC) patients with clinical axillary lymph node metastasis (cN+) undergoing neoadjuvant therapy (NAT), precise axillary lymph node (ALN) assessment dictates therapeutic strategy. There is a critical demand for a precise method to assess the axillary lymph node (ALN) status in these patients. MATERIALS AND METHODS A retrospective analysis was conducted on 160 BC patients undergoing NAT at Fujian Medical University Union Hospital. We analyzed baseline and two-cycle reassessment dynamic contrast-enhanced MRI (DCE-MRI) images, extracting 3668 radiomic and 4096 deep learning features, and computing 1834 delta-radiomic and 2048 delta-deep learning features. Light Gradient Boosting Machine (LightGBM), Support Vector Machine (SVM), RandomForest, and Multilayer Perceptron (MLP) algorithms were employed to develop risk models and were evaluated using 10-fold cross-validation. RESULTS Of the patients, 61 (38.13 %) achieved ypN0 status post-NAT. Univariate and multivariable logistic regression analyses revealed molecular subtypes and Ki67 as pivotal predictors of achieving ypN0 post-NAT. The SVM-based "Data Amalgamation" model that integrates radiomic, deep learning features, and clinical data, exhibited an outstanding AUC of 0.986 (95 % CI: 0.954-1.000), surpassing other models. CONCLUSION Our study illuminates the challenges and opportunities inherent in breast cancer management post-NAT. By introducing a sophisticated, SVM-based "Data Amalgamation" model, we propose a way towards accurate, dynamic ALN assessments, offering potential for personalized therapeutic strategies in BC.
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Affiliation(s)
- Yushuai Yu
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350001, China; Department of Breast Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, 350014, China
| | - Ruiliang Chen
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350001, China
| | - Jialu Yi
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350001, China
| | - Kaiyan Huang
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, 362000, China
| | - Xin Yu
- Department of Breast Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, 350014, China
| | - Jie Zhang
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350001, China.
| | - Chuangui Song
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350001, China; Department of Breast Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, 350014, China.
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Vaz SC, Woll JPP, Cardoso F, Groheux D, Cook GJR, Ulaner GA, Jacene H, Rubio IT, Schoones JW, Peeters MJV, Poortmans P, Mann RM, Graff SL, Dibble EH, de Geus-Oei LF. Joint EANM-SNMMI guideline on the role of 2-[ 18F]FDG PET/CT in no special type breast cancer : (endorsed by the ACR, ESSO, ESTRO, EUSOBI/ESR, and EUSOMA). Eur J Nucl Med Mol Imaging 2024; 51:2706-2732. [PMID: 38740576 PMCID: PMC11224102 DOI: 10.1007/s00259-024-06696-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/20/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION There is much literature about the role of 2-[18F]FDG PET/CT in patients with breast cancer (BC). However, there exists no international guideline with involvement of the nuclear medicine societies about this subject. PURPOSE To provide an organized, international, state-of-the-art, and multidisciplinary guideline, led by experts of two nuclear medicine societies (EANM and SNMMI) and representation of important societies in the field of BC (ACR, ESSO, ESTRO, EUSOBI/ESR, and EUSOMA). METHODS Literature review and expert discussion were performed with the aim of collecting updated information regarding the role of 2-[18F]FDG PET/CT in patients with no special type (NST) BC and summarizing its indications according to scientific evidence. Recommendations were scored according to the National Institute for Health and Care Excellence (NICE) criteria. RESULTS Quantitative PET features (SUV, MTV, TLG) are valuable prognostic parameters. In baseline staging, 2-[18F]FDG PET/CT plays a role from stage IIB through stage IV. When assessing response to therapy, 2-[18F]FDG PET/CT should be performed on certified scanners, and reported either according to PERCIST, EORTC PET, or EANM immunotherapy response criteria, as appropriate. 2-[18F]FDG PET/CT may be useful to assess early metabolic response, particularly in non-metastatic triple-negative and HER2+ tumours. 2-[18F]FDG PET/CT is useful to detect the site and extent of recurrence when conventional imaging methods are equivocal and when there is clinical and/or laboratorial suspicion of relapse. Recent developments are promising. CONCLUSION 2-[18F]FDG PET/CT is extremely useful in BC management, as supported by extensive evidence of its utility compared to other imaging modalities in several clinical scenarios.
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Affiliation(s)
- Sofia C Vaz
- Nuclear Medicine-Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal.
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | | | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - David Groheux
- Nuclear Medicine Department, Saint-Louis Hospital, Paris, France
- University Paris-Diderot, INSERM U976, Paris, France
- Centre d'Imagerie Radio-Isotopique (CIRI), La Rochelle, France
| | - Gary J R Cook
- Department of Cancer Imaging, King's College London, London, UK
- King's College London and Guy's & St Thomas' PET Centre, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Gary A Ulaner
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, CA, USA
- University of Southern California, Los Angeles, CA, USA
| | - Heather Jacene
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Cancer Center Clinica Universidad de Navarra, Navarra, Spain
| | - Jan W Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie-Jeanne Vrancken Peeters
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium
- University of Antwerp, Wilrijk, Antwerp, Belgium
| | - Ritse M Mann
- Radiology Department, RadboudUMC, Nijmegen, The Netherlands
| | - Stephanie L Graff
- Lifespan Cancer Institute, Providence, Rhode Island, USA
- Legorreta Cancer Center at Brown University, Providence, Rhode Island, USA
| | - Elizabeth H Dibble
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
- Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands.
- Department of Radiation Science & Technology, Technical University of Delft, Delft, The Netherlands.
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Leinert E, Lukac S, Schwentner L, Coenen A, Fink V, Veselinovic K, Dayan D, Janni W, Friedl TWP. The use of axillary ultrasound (AUS) to assess the nodal status after neoadjuvant chemotherapy (NACT) in primary breast cancer patients. Surg Oncol 2024; 52:102016. [PMID: 38056112 DOI: 10.1016/j.suronc.2023.102016] [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: 06/06/2023] [Revised: 11/02/2023] [Accepted: 11/18/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Axillary Ultrasound (AUS) is standard for pre-therapeutic axillary staging in early breast cancer patients. 35-75 % of the breast cancer (BC) patients with positive axillary lymph nodes receiving neoadjuvant chemotherapy (NACT) convert to pathological node negative. For those patients, axillary surgery after NACT could be de-escalated, if an accurate prediction of the pathologic nodal status following NACT was possible. This study aims to answer the question, whether AUS can be used as a reliable diagnostic tool for restaging of axillary nodal status after NACT. PATIENTS AND METHODS We collected data of 96 patients with nodal positive primary breast cancer who received NACT between 2009 and 2015 at the Breast Cancer Center of the University Hospital Ulm. Patients were classified as node negative or positive by AUS after NACT (ycN + or ycN0) and the results were compared to the pathological result obtained after axillary lymph node dissection (ypN + vs ypN0) in all patients. RESULTS 58.3 % of the patients had pathological complete remission of axillary lymph nodes after NACT (ypN0). The sensitivity and specificity of AUS were 57.5 % and 78.6 %, respectively. The FNR was 42.5 %. The Positive and Negative Predictive Values (PPV and NPV) were 65.7 % and 72.1 %, respectively. The accuracy of AUS was 69.8 % and not associated with any of the investigated clinico-pathological parameters. CONCLUSION AUS alone is not accurate enough to replace surgical restaging of the axilla after NACT in initially node positive breast cancer patients.
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Affiliation(s)
- Elena Leinert
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany.
| | - Stefan Lukac
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | - Lukas Schwentner
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | - Antonia Coenen
- Department of Internal Medicine, Krankenhaus der Augustinerinnen, Cologne, Germany
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | | | - Davut Dayan
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | - Thomas W P Friedl
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
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Li Z, Ma Q, Gao Y, Qu M, Li J, Lei J. Diagnostic performance of MRI for assessing axillary lymph node status after neoadjuvant chemotherapy in breast cancer: a systematic review and meta-analysis. Eur Radiol 2024; 34:930-942. [PMID: 37615764 DOI: 10.1007/s00330-023-10155-8] [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: 12/14/2022] [Revised: 06/09/2023] [Accepted: 07/08/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE This systematic review examined the diagnostic performance of magnetic resonance imaging (MRI) for assessing axillary lymph node status (ALNS) after neoadjuvant chemotherapy (NAC) in breast cancer patients. METHODS We searched PubMed, Embase, Cochrane Library, and Web of Science to identify relevant studies and used the QUADAS-2 tool to assess methodological quality of eligible studies. We used STATA version 12.0 to perform data pooling, heterogeneity testing, subgroup analysis, and sensitivity analysis. RESULTS For the 21 enrolled studies, including 2875 patients, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were respectively 0.63 (95% CI: 0.53-0.72), 0.75 (95% CI: 0.68-0.81), 2.52 (95% CI: 1.98-3.19), 0.50 (95% CI: 0.39-0.63), and 5.08 (95% CI: 3.38-7.63). The AUC was 0.76 (95% CI: 0.72-0.79). I2 values of sensitivity (I2 = 94.41%) and specificity (I2 = 88.97%) were both > 50%. For the initial positive ALN patients, the pooled sensitivity and specificity were 0.64 (95% CI: 0.53-0.75) and 0.74 (95% CI: 0.64-0.82), respectively. Sensitivity analyses by focusing on studies with MRI performed post-NAC, studies using DCE-MRI, or studies with low risk of bias showed similar results to the primary analyses. CONCLUSION MRI may have suboptimal diagnostic value in assessing ALNS after NAC for breast cancer patients. Due to the inconsistency of NAC regimens, the variability of axillary surgery, and the lack of time interval between MRI and surgery, further studies are needed to confirm our findings. CLINICAL RELEVANCE STATEMENT Our study provided the diagnostic value of MRI in assessing axillary lymph node status after neoadjuvant chemotherapy for breast cancer patients. KEY POINTS • MRI may have suboptimal diagnostic value in assessing axillary lymph node status after NAC for general breast cancer patients. • The initial axillary lymph node status has little impact on the diagnostic efficacy of MRI. • The substantial heterogeneity among studies highlights the need for further studies to provide more high-quality evidence in this field.
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Affiliation(s)
- Zhifan Li
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
| | - Qinqin Ma
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
| | - Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Mengmeng Qu
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
| | - Jinkui Li
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
- Department of Radiology, the First Hospital of Lanzhou University, Chengguan District, No. 1 Donggang West Road, Lanzhou, 730000, Gansu Province, China
| | - Junqiang Lei
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China.
- Department of Radiology, the First Hospital of Lanzhou University, Chengguan District, No. 1 Donggang West Road, Lanzhou, 730000, Gansu Province, China.
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van Hemert AKE, van Duijnhoven FH, Vrancken Peeters MJTFD. This house believes that: MARI/TAD is better than sentinel node biopsy after PST for cN+ patients. Breast 2023; 71:89-95. [PMID: 37562108 PMCID: PMC10432821 DOI: 10.1016/j.breast.2023.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/03/2023] [Accepted: 06/28/2023] [Indexed: 08/12/2023] Open
Abstract
The increasing use and effectiveness of primary systemic treatment (PST) enables tailored locoregional treatment. About one third of clinically node positive (cN+) breast cancer patients achieve pathologic complete response (pCR) of the axilla, with higher rates observed in Human Epidermal growth factor Receptor (HER)2-positive or triple negative (TN) breast cancer subtypes. Tailoring axillary treatment for patients with axillary pCR is necessary, as they are unlikely to benefit from axillary lymph node dissection (ALND), but may suffer complications and long-term morbidity such as lymphedema and impaired shoulder motion. By combining pre-PST and post-PST axillary staging techniques, ALND can be omitted in most cN + patients with pCR. Different post-PST staging techniques (MARI/TAD/SN) show low or ultra-low false negative rates for detection of residual disease. More importantly, trials using the MARI (Marking Axillary lymph nodes with Radioactive Iodine seeds) procedure or sentinel lymph node biopsy (SLNB) as axillary staging technique post-PST have already shown the safety of tailoring axillary treatment in patients with an excellent response. Tailored axillary treatment using the MARI procedure in stage I-III breast cancer resulted in 80% reduction of ALND and excellent five-year axillary recurrence free interval (aRFI) of 97%. Similar oncologic outcomes were seen for post-SLNB in stage I-II patients. The MARI technique requires only one invasive procedure pre-NST and a median of one node is removed post-PST, whereas for the SLNB and TAD techniques two to four nodes are removed. A disadvantage of the MARI technique is its use of radioactive iodine, which is subject to extensive regulations.
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Affiliation(s)
- Annemiek K E van Hemert
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands
| | - Frederieke H van Duijnhoven
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands
| | - Marie-Jeanne T F D Vrancken Peeters
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands; Department of Surgery, Amsterdam University Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
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Boersma LJ, Mjaaland I, van Duijnhoven F. Regional radiotherapy after primary systemic treatment for cN+ breast cancer patients. Breast 2023; 68:181-188. [PMID: 36805769 PMCID: PMC9975253 DOI: 10.1016/j.breast.2023.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/02/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
Pathologic complete response (pCR) after Primary Systemic Treatment (PST) for breast cancer is associated with excellent long-term outcomes. With increasing use of PST, the indication for regional nodal irradiation (RNI) has been challenged. The aim of this paper is to review the literature on de-escalation of RNI in patients treated with PST. We found no level 1 evidence on de-escalation of RNI after PST, but several randomized trials are ongoing. Consequently, current de-escalation strategies are based on cohort studies. These studies showed that in patients with low nodal tumour burden (LNTB) (≤3 suspicious nodes at imaging) prior to PST, and ypN0 based on Axillary Lymph Node Dissection (ALND), omission of RNI resulted in very low regional recurrences (RR) without compromising survival. In patients with LNTB and ypN0 based on Sentinel Lymph Node Biopsy (SLNB), omission of axillary treatment also resulted in low RR; the majority of these patients received local radiotherapy. Similarly, in patients with ypN1 (ALND) disease, omission of RNI resulted in low 5-year RR rates. Low RR-rates were also found in the few studies replacing ALND by RNI, in patients with ypN1 (SLNB) disease. In patients with high nodal tumour burden prior to PST and ypN0 (SLNB), replacing ALND by RNI also resulted in low RR. Due to the limited number of patients, these data should be interpreted with caution. We conclude that although level 1 evidence is lacking, de-escalation of RNI after PST can be considered in selected cases.
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Affiliation(s)
- Liesbeth J Boersma
- Dept. Radiation Oncology (Maastro), GROW-School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - Ingvil Mjaaland
- Division of Medicine, Stavanger University Hospital, Stavanger, Norway.
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Lan A, Chen J, Li C, Jin Y, Wu Y, Dai Y, Jiang L, Li H, Peng Y, Liu S. Development and Assessment of a Novel Core Biopsy-Based Prediction Model for Pathological Complete Response to Neoadjuvant Chemotherapy in Women with Breast Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1617. [PMID: 36674372 PMCID: PMC9867383 DOI: 10.3390/ijerph20021617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
Purpose: Pathological complete response (pCR), the goal of NAC, is considered a surrogate for favorable outcomes in breast cancer (BC) patients administrated neoadjuvant chemotherapy (NAC). This study aimed to develop and assess a novel nomogram model for predicting the probability of pCR based on the core biopsy. Methods: This was a retrospective study involving 920 BC patients administered NAC between January 2012 and December 2018. The patients were divided into a primary cohort (769 patients from January 2012 to December 2017) and a validation cohort (151 patients from January 2017 to December 2018). After converting continuous variables to categorical variables, variables entering the model were sequentially identified via univariate analysis, a multicollinearity test, and binary logistic regression analysis, and then, a nomogram model was developed. The performance of the model was assessed concerning its discrimination, accuracy, and clinical utility. Results: The optimal predictive threshold for estrogen receptor (ER), Ki67, and p53 were 22.5%, 32.5%, and 37.5%, respectively (all p < 0.001). Five variables were selected to develop the model: clinical T staging (cT), clinical nodal (cN) status, ER status, Ki67 status, and p53 status (all p ≤ 0.001). The nomogram showed good discrimination with the area under the curve (AUC) of 0.804 and 0.774 for the primary and validation cohorts, respectively, and good calibration. Decision curve analysis (DCA) showed that the model had practical clinical value. Conclusions: This study constructed a novel nomogram model based on cT, cN, ER status, Ki67 status, and p53 status, which could be applied to personalize the prediction of pCR in BC patients treated with NAC.
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Affiliation(s)
- Ailin Lan
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Junru Chen
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Chao Li
- Department of Vascular Surgery, Southwest Hospital, Army Medical University, 38 Main Street, Gaotanyan, Shapingba, Chongqing 400038, China
| | - Yudi Jin
- Department of Pathology, Chongqing University Cancer Hospital, No. 181, Hanyu Road, Shapingba District, Chongqing 400030, China
| | - Yinan Wu
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Yuran Dai
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Linshan Jiang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Han Li
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Yang Peng
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Shengchun Liu
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
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Koca B, Yildirim M, Ugurlu C, Bostan MS, Başak M, Dasıran MF, Özcan N. Factors Affecting Axillary Complete Response After Neoadjuvant Chemotherapy and the Importance of Ki-67 Level. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03633-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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9
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Le-Petross HT, Slanetz PJ, Lewin AA, Bao J, Dibble EH, Golshan M, Hayward JH, Kubicky CD, Leitch AM, Newell MS, Prifti C, Sanford MF, Scheel JR, Sharpe RE, Weinstein SP, Moy L. ACR Appropriateness Criteria® Imaging of the Axilla. J Am Coll Radiol 2022; 19:S87-S113. [PMID: 35550807 DOI: 10.1016/j.jacr.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 11/26/2022]
Abstract
This publication reviews the current evidence supporting the imaging approach of the axilla in various scenarios with broad differential diagnosis ranging from inflammatory to malignant etiologies. Controversies on the management of axillary adenopathy results in disagreement on the appropriate axillary imaging tests. Ultrasound is often the appropriate initial imaging test in several clinical scenarios. Clinical information (such as age, physical examinations, risk factors) and concurrent complete breast evaluation with mammogram, tomosynthesis, or MRI impact the type of initial imaging test for the axilla. Several impactful clinical trials demonstrated that selected patient's population can received sentinel lymph node biopsy instead of axillary lymph node dissection with similar overall survival, and axillary lymph node dissection is a safe alternative as the nodal staging procedure for clinically node negative patients or even for some node positive patients with limited nodal tumor burden. This approach is not universally accepted, which adversely affect the type of imaging tests considered appropriate for axilla. This document is focused on the initial imaging of the axilla in various scenarios, with the understanding that concurrent or subsequent additional tests may also be performed for the breast. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Huong T Le-Petross
- The University of Texas MD Anderson Cancer Center, Houston, Texas; Director of Breast MRI.
| | - Priscilla J Slanetz
- Panel Chair, Boston University School of Medicine, Boston, Massachusetts; Vice Chair of Academic Affairs, Department of Radiology, Boston Medical Center; Associate Program Director, Diagnostic Radiology Residency, Boston Medical Center; Program Director, Early Career Faculty Development Program, Boston University Medical Campus; Co-Director, Academic Writing Program, Boston University Medical Group; President, Massachusetts Radiological Society; Vice President, Association of University Radiologists
| | - Alana A Lewin
- Panel Vice-Chair, New York University School of Medicine, New York, New York; Associate Program Director, Breast Imaging Fellowship, NYU Langone Medical Center
| | - Jean Bao
- Stanford University Medical Center, Stanford, California; Society of Surgical Oncology
| | | | - Mehra Golshan
- Smilow Cancer Hospital, Yale Cancer Center, New Haven, Connecticut; American College of Surgeons; Deputy CMO for Surgical Services and Breast Program Director, Smilow Cancer Hospital at Yale; Executive Vice Chair for Surgery, Yale School of Medicine
| | - Jessica H Hayward
- University of California San Francisco, San Francisco, California; Co-Fellowship Direction, Breast Imaging Fellowship
| | | | - A Marilyn Leitch
- UT Southwestern Medical Center, Dallas, Texas; American Society of Clinical Oncology
| | - Mary S Newell
- Emory University Hospital, Atlanta, Georgia; Interim Director, Division of Breast Imaging at Emory; ACR: Chair of BI-RADS; Chair of PP/TS
| | - Christine Prifti
- Boston Medical Center, Boston, Massachusetts, Primary care physician
| | | | | | | | - Susan P Weinstein
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania; Associate Chief of Radiology, San Francisco VA Health Systems
| | - Linda Moy
- Specialty Chair, NYU Clinical Cancer Center, New York, New York; Chair of ACR Practice Parameter for Breast Imaging, Chair ACR NMD
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Yirgin IK, Engin G, Yildiz Ş, Aydin EC, Karanlik H, Cabioglu N, Tukenmez M, Emiroglu S, Semen Onder SO, Yildiz SO, Yavuz E, Saip P, Aydiner A, Igci A, Muslumanoglu M. Abbreviated and Standard Breast MRI in Neoadjuvant Chemotherapy Response Evaluation: A Comparative Study. Curr Med Imaging 2022; 18:1052-1060. [PMID: 35209823 DOI: 10.2174/1573405618666220223142009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/04/2021] [Accepted: 12/22/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To investigate the efficacy of abbreviated breast magnetic resonance imaging (MRI) in neoadjuvant chemotherapy (NAC) response evaluation. METHODS MR images of 50 locally advanced breast cancer patients who underwent standard protocol (SP) breast MRI before and after NAC, were re-evaluated retrospectively. Abbreviated protocol (AP) was obtained by extracting images from SP and then evaluating them in a separate session. Protocols were compared with the histological findings after surgery as the reference standard. RESULTS A statistically significant difference was found between two protocols in response evaluation by the McNemar test (p=0.018). But, the Kappa value was 0.62 (p<0.001) which indicates substantial agreement. No statistically significant differences were found between the two protocols (AP and SP) and pathological results in the McNemar test (p=0.12, p=0.60, respectively). Kappa values were 0.48 (p<0.001), 0.60 (p<0.001), respectively which indicates moderate agreement for both protocols with higher values by SP evaluation. The residual maximum median diameters were smaller than the pathology, with both protocols (p<0.001). CONCLUSION Although statistical difference, there was a substantial correlation between the two protocols in response evaluation. Both protocols were moderately correlated with pathological results with slightly higher in SP. However, the residual maximum median diameters were smaller than the pathology, with both protocols. These results may limit the use of AP in evaluating the local extent of the tumor, especially in patients who will undergo breast-conserving surgery.
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Affiliation(s)
- Inci Kizildag Yirgin
- Department of Radiology. Oncology Institute, Istanbul University, Istanbul, 34390, Capa, Turkey
| | - Gulgun Engin
- Department of Radiology. Oncology Institute, Istanbul University, Istanbul,Turkey
| | - Şeyma Yildiz
- Department of Medical Oncology. Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Esra Cureoglu Aydin
- Department of General Surgery. Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Hasan Karanlik
- Department of General Surgery. Istanbul faculty of medicine. Istanbul University, Istanbul, Turkey
| | - Neslihan Cabioglu
- Department of General Surgery. Istanbul faculty of medicine. Istanbul University, Istanbul, Turkey
| | - Mustafa Tukenmez
- Department of General Surgery. Istanbul faculty of medicine. Istanbul University, Istanbul,Turkey
| | - Selman Emiroglu
- Department of General Surgery. Istanbul faculty of medicine. Istanbul University, Istanbul,Turkey
| | - Semen Onder Semen Onder
- Department of Pathology. Istanbul faculty of medicine. Istanbul University, Istanbul, Turkey
| | - Sevda Ozel Yildiz
- Department of of Biostatistics, Istanbul University, Istanbul, Turkey
| | - Ekrem Yavuz
- Department of Pathology. Istanbul faculty of medicine. Istanbul University, Istanbul, Turkey
| | - Pınar Saip
- Department of Medical Oncology. Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Adnan Aydiner
- Department of Medical Oncology. Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Abdullah Igci
- Department of General Surgery. Istanbul Faculty of Medicine. Istanbul University, Istanbul, Turkey
| | - Mahmut Muslumanoglu
- Department of General Surgery. Istanbul Faculty of Medicine. Istanbul University, Istanbul,Turkey
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11
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Graña-López L, Pérez-Ramos T, Maciñeira FA, Villares Á, Vázquez-Caruncho M. Predicting axillary response to neoadjuvant chemotherapy: the role of diffusion weighted imaging. Br J Radiol 2022; 95:20210511. [PMID: 34757835 PMCID: PMC8822565 DOI: 10.1259/bjr.20210511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE The aim of this study is to investigate whether the primary tumour response to neoadjuvant chemotherapy (NAC), based on the increase in the ADC-values (apparent diffusion coefficient) within the breast lesion, could help to predict axillary complete response. METHODS We retrospectively included 74 patients who were treated with NAC followed by surgery at Lucus Augusti Hospital between January 2015 and September 2020. Simple logistic regression was used to evaluate the factors associated with axillary pathological complete response, including the changes in breast tumour ADC-values due to the treatment. RESULTS Axillary complete response was correlated with negative oestrogen receptor status, Her2 positivity and response of primary tumour. It was achieved in 31% of the patients. In addition, the increase in the tumour ADC-values with NAC was higher for responders. Among the tumours that demonstrated an increase in ADC-value >0.92 ×10-3 mm2/s, 42.8% (15/35) showed axillary complete response. Eight (20.5%) breast cancers with an increase in ADC below the cut-off value were found to have no metastatic nodes after treatment (p = 0.038). CONCLUSION Our results suggest that the performance of models predicting axillary response to NAC can be improved by adding the tumour response determined also using diffusion-weighted imaging. ADVANCES IN KNOWLEDGE For the fist time, we investigate the relation between tumour response to NAC, assessed using diffusion-weighted imaging, and axillary pathologic complete response.
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Affiliation(s)
| | - Tania Pérez-Ramos
- Department of Radiology, Hospital Lucus Augusti Lugo. Ulises Romero 1, Lugo, Spain
| | - Fiz Andrés Maciñeira
- Department of Radiology, Hospital Lucus Augusti Lugo. Ulises Romero 1, Lugo, Spain
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12
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Turan U, Aygun M, Duman BB, Kelle AP, Cavus Y, Tas ZA, Dirim AB, Irkorucu O. Efficacy of US, MRI, and F-18 FDG-PET/CT for Detecting Axillary Lymph Node Metastasis after Neoadjuvant Chemotherapy in Breast Cancer Patients. Diagnostics (Basel) 2021; 11:diagnostics11122361. [PMID: 34943597 PMCID: PMC8700016 DOI: 10.3390/diagnostics11122361] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The aim of this study was to investigate the efficacy of post-neoadjuvant chemotherapy (NAC) ultrasound (US), magnetic resonance imaging (MRI), and F-18fluorodeoxyglucose positron emission tomography (F-18 FDG-PET/CT) for detecting post-NAC axillary lymph node(ALN) metastasis in patients who had ALN metastasis at the time of diagnosis. Methods: This study included all breast cancer patients who received NAC for ALN metastasis; underwent axillary assessment with US, MRI, or F18FDG-PET/CT; and then were operated on in the General Surgery Clinic, Adana City Research and Training Hospital, Turkey. Patients’ data were recorded, including demographic data, clinicopathological parameters, NAC regimens, and operation types. The axillary response to chemotherapy on post-NAC US, MRI, and F-18 FDG-PET/CT was compared with the postoperative histopathological result of the ALN. Results: The study included a total of 171 female patients. The mean age of the patients was 53.28 ± 10.62 years. The post-NAC assessment revealed that the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of US for detecting ALN metastasis were 59.42%, 82.35%, 82.00%, and 60.00%, respectively, while the same measures regarding MRI for detecting ALN metastasis were 36.67%, 77.78%, 73.33%, and 42.42%, respectively. The sensitivity, specificity, PPV, and NPV of F-18FDG-PET/CT were 47.50%, 76.67%, 73.08%, and 52.27%, respectively. The evaluation of dual combinations of these three imaging techniques showed that the specificity and PPV of the combined use of US and F-18FDG-PET/CT was 100%. Conclusions: The results showed that US has the highest sensitivity and specificity for detecting ALN metastasis after NAC. Furthermore, ALND may be preferred for these patients instead of SLNB if both examinations simultaneously indicate lymph node metastasis in the post-NAC assessment with US and F-18 FDG-PET/CT. SLNB may be preferred if these two examinations simultaneously show a complete response.
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Affiliation(s)
- Umit Turan
- Adana City Research and Training Center, Department of General Surgery, Saglik Bilimleri University, Adana 01230, Turkey; (M.A.); (A.B.D.)
- Correspondence: ; Tel.: +90-505-360-4067
| | - Murat Aygun
- Adana City Research and Training Center, Department of General Surgery, Saglik Bilimleri University, Adana 01230, Turkey; (M.A.); (A.B.D.)
| | - Berna Bozkurt Duman
- Adana City Research and Training Center, Department of Medical Oncology, Saglik Bilimleri University, Adana 01230, Turkey;
| | - Aygül Polat Kelle
- Adana City Research and Training Center, Department of Nuclear Medicine and Molecular Imaging, Saglik Bilimleri University, Adana 01230, Turkey;
| | - Yeliz Cavus
- Adana City Research and Training Center, Department of Radiology, Saglik Bilimleri University, Adana 01230, Turkey;
| | - Zeynel Abidin Tas
- Adana City Research and Training Center, Department of Pathology, Saglik Bilimleri University, Adana 01230, Turkey;
| | - Ahmet Baris Dirim
- Adana City Research and Training Center, Department of General Surgery, Saglik Bilimleri University, Adana 01230, Turkey; (M.A.); (A.B.D.)
| | - Oktay Irkorucu
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates;
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13
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Murphy LC, Quinn EM, Razzaq Z, Brady C, Livingstone V, Duddy L, Barry J, Redmond HP, Corrigan MA. Assessing the accuracy of conventional gadolinium-enhanced breast MRI in measuring the nodal response to neoadjuvant chemotherapy (NAC) in breast cancer. Breast J 2020; 26:2151-2156. [PMID: 33176396 DOI: 10.1111/tbj.14065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 11/30/2022]
Abstract
Management of the axilla in the era of neoadjuvant chemotherapy for breast cancer is evolving. The aim of this study is to determine if conventional gadolinium-enhanced breast MRI can aid in evaluation of the response to neoadjuvant chemotherapy in the axilla. A retrospective review of a prospectively maintained database of patients undergoing neoadjuvant chemotherapy for breast cancer was performed. Pre and post-neoadjuvant chemotherapy MRI reports for node-positive patients were examined in conjunction with demographic data, treatment type, and final histopathology reports. One-hundred and fourteen patients with breast cancer undergoing neoadjuvant chemotherapy were included in the study. The sensitivity of magnetic resonance imaging in detecting nodal response post-neoadjuvant chemotherapy was 33.93% and the specificity was 82.76%. Magnetic resonance imaging had a positive predictive value of 65.52% and a negative predictive value of 56.47%. MRI was found to be most specific in the detection of triple-negative cancer response. Specificity was 100% in this group and sensitivity was 75%. Magnetic resonance imaging has a relatively high specificity in detecting nodal response post-neoadjuvant chemotherapy but has a low sensitivity. Alone it cannot be relied upon to identify active axillary malignancy post-neoadjuvant chemotherapy. However, given its increased specificity among certain subgroups, it may have a role in super-selecting patients suitable for sentinel lymph node biopsy post-neoadjuvant chemotherapy.
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Affiliation(s)
| | - Edel Marie Quinn
- Cork Breast Research Centre, University College Cork, Cork, Ireland
| | - Zeeshan Razzaq
- Cork Breast Research Centre, University College Cork, Cork, Ireland
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14
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Combined positive axillary lymph node marking with iodine-125 seeds and sentinel lymph node biopsy in breast cancer patients treated with neoadjuvant chemotherapy. Rev Esp Med Nucl Imagen Mol 2020. [DOI: 10.1016/j.remnie.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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Affiliation(s)
- Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eric P. Winer
- Department of Medical Oncology, Dana-Farber Cancer Center, Harvard Medical School, Boston, Massachusetts
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16
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Simons J, Maaskant-Braat A, Luiten E, Leidenius M, van Nijnatten T, Boelens P, Koppert L, van der Pol C, van de Velde C, Audisio R, Smidt M. Patterns of axillary staging and management in clinically node positive breast cancer patients treated with neoadjuvant systemic therapy: Results of a survey amongst breast cancer specialists. Eur J Surg Oncol 2020; 46:53-58. [DOI: 10.1016/j.ejso.2019.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/03/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022] Open
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17
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Al-Hattali S, Vinnicombe SJ, Gowdh NM, Evans A, Armstrong S, Adamson D, Purdie CA, Macaskill EJ. Breast MRI and tumour biology predict axillary lymph node response to neoadjuvant chemotherapy for breast cancer. Cancer Imaging 2019; 19:91. [PMID: 31878958 PMCID: PMC6933687 DOI: 10.1186/s40644-019-0279-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/12/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In patients who have had axillary nodal metastasis diagnosed prior to neoadjuvant chemotherapy for breast cancer, there is little consensus on how to manage the axilla subsequently. The aim of this study was to explore whether a combination of breast magnetic resonance imaging (MRI) assessed response and primary tumour pathology factors could identify a subset of patients that might be spared axillary node clearance. METHODS A retrospective data analysis was performed of patients with core biopsy-proven axillary nodal metastasis prior to commencement of neoadjuvant chemotherapy (NAC) who had subsequent axillary node clearance (ANC) at definitive breast surgery. Breast tumour and axillary response at MRI before, during and on completion of NAC, core biopsy tumour grade, tumour type and immunophenotype were correlated with pathological response in the breast and the number of metastatic nodes in the ANC specimens. RESULTS Of 87 consecutive patients with MRI at baseline, interim and after neoadjuvant chemotherapy who underwent ANC at time of breast surgery, 33 (38%) had no residual macrometastatic axillary disease, 28 (32%) had 1-2 metastatic nodes and 26 (30%) had more than 2 metastatic nodes. Factors that predicted axillary nodal complete response were MRI complete response in the breast (p < 0.0001), HER2 positivity (p = 0.02) and non-lobular tumour type (p = 0.015). CONCLUSION MRI assessment of breast tumour response to NAC and core biopsy factors are predictive of response in axillary nodes, and can be used to guide decision making regarding appropriate axillary surgery.
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Affiliation(s)
- Samia Al-Hattali
- Department of Breast Surgery, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Sarah J Vinnicombe
- Thirlestaine Breast Centre, Cheltenham, UK.,Ninewells Hospital and Medical School, Dundee, UK
| | | | - Andrew Evans
- Department of Breast Radiology, Ninewells Hospital and Medical School, Dundee, UK
| | - Sharon Armstrong
- Department of Clinical Oncology, Ninewells Hospital and Medical School, Dundee, UK
| | - Douglas Adamson
- Department of Clinical Oncology, Ninewells Hospital and Medical School, Dundee, UK
| | - Colin A Purdie
- Department of Breast Pathology, Ninewells Hospital and Medical School, Dundee, UK
| | - E Jane Macaskill
- Department of Breast Surgery, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
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18
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Prediction of axillary response by monitoring with ultrasound and MRI during and after neoadjuvant chemotherapy in breast cancer patients. Eur Radiol 2019; 30:1460-1469. [DOI: 10.1007/s00330-019-06539-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/11/2019] [Accepted: 10/23/2019] [Indexed: 12/15/2022]
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19
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Custodio Rebollo Aguirre A, Sánchez Sánchez R, González Jiménez AD, Culiañez Casas M, Mendoza Arnau I, Rashki M, Rudolphi Solero T, Martínez Meca S. Combined procedure of marking axillary positive node with iodine-125 seed and sentinel lymph node biopsy in breast cancer patients treated with neoadjuvant chemotherapy. Rev Esp Med Nucl Imagen Mol 2019; 39:75-83. [PMID: 31759957 DOI: 10.1016/j.remn.2019.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To present our initial experience in the combined procedure of intraoperative detection of axillary positive node marked with 125I seed (ML) and sentinel node biopsy (SLN) after neoadjuvant chemotherapy (NACT), in breast cancer patients. MATERIAL AND METHODS Prospective study, January 2017 - March 2019, 16 breast cancer patients T1-3N1. TNM stage: IIA: 3, IIB: 10, IIIA: 3. Histological type ductal invasive: 14. Molecular subtype: luminal A: 3, luminal B: 9, HER2: 3, basal like: 1. The ML was marked 227±36 days before neoadjuvant chemotherapy (n: 10), or 1-6 days before surgery, on previously identified node by ultrasound visibility marker, hydrogel (n: 3) or three dimensional-3D (n: 3). Axillary lymphadenectomy was undertaken in 10 patients. RESULTS ML and SLN were identified in the surgery in 93.7% (15/16) of the cases, in 33.3% (5/15) ML was not among SLN, and in only one patient (1/5) was there a discrepancy between the result of ML and SLN (macrometastases vs. negative 0/2). Median number of lymph nodes SLN: 2.2±0.9 (range 1-3) and AD: 13.5±5.2 (range 7-23). In all cases, histopathological analysis of ML, 125I seed and/or marker within, correctly predicted axillary status after neoadjuvant chemotherapy. In all patients the 125I radioactive seed was recovered. CONCLUSIONS Placing of 125I seeds is a feasible technique for intraoperative location of axillary positive node combined with SLN. The histopathological result of ML allows the axillary status to be determined after neoadjuvant chemotherapy.
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Affiliation(s)
| | - R Sánchez Sánchez
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España
| | - A D González Jiménez
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España
| | - M Culiañez Casas
- Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, España
| | - I Mendoza Arnau
- Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, España
| | - M Rashki
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España
| | - T Rudolphi Solero
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España
| | - S Martínez Meca
- Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, España
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20
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Cattell RF, Kang JJ, Ren T, Huang PB, Muttreja A, Dacosta S, Li H, Baer L, Clouston S, Palermo R, Fisher P, Bernstein C, Cohen JA, Duong TQ. MRI Volume Changes of Axillary Lymph Nodes as Predictor of Pathologic Complete Responses to Neoadjuvant Chemotherapy in Breast Cancer. Clin Breast Cancer 2019; 20:68-79.e1. [PMID: 31327729 DOI: 10.1016/j.clbc.2019.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/24/2019] [Accepted: 06/13/2019] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Longitudinal monitoring of breast tumor volume over the course of chemotherapy is informative of pathologic response. This study aims to determine whether axillary lymph node (aLN) volume by magnetic resonance imaging (MRI) could augment the prediction accuracy of treatment response to neoadjuvant chemotherapy (NAC). MATERIALS AND METHODS Level-2a curated data from the I-SPY-1 TRIAL (2002-2006) were used. Patients had stage 2 or 3 breast cancer. MRI was acquired pre-, during, and post-NAC. A subset with visible aLNs on MRI was identified (N = 132). Prediction of pathologic complete response (PCR) was made using breast tumor volume changes, nodal volume changes, and combined breast tumor and nodal volume changes with sub-stratification with and without large lymph nodes (3 mL or ∼1.79 cm diameter cutoff). Receiver operating characteristic curve analysis was used to quantify prediction performance. RESULTS The rate of change of aLN and breast tumor volume were informative of pathologic response, with prediction being most informative early in treatment (area under the curve (AUC), 0.57-0.87) compared with later in treatment (AUC, 0.50-0.75). Larger aLN volume was associated with hormone receptor negativity, with the largest nodal volume for triple negative subtypes. Sub-stratification by node size improved predictive performance, with the best predictive model for large nodes having AUC of 0.87. CONCLUSION aLN MRI offers clinically relevant information and has the potential to predict treatment response to NAC in patients with breast cancer.
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Affiliation(s)
- Renee F Cattell
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, NY; Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY
| | - James J Kang
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, NY
| | - Thomas Ren
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, NY
| | - Pauline B Huang
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, NY
| | - Ashima Muttreja
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, NY
| | - Sarah Dacosta
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, NY
| | - Haifang Li
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, NY
| | - Lea Baer
- Department of Medical Oncology, Stony Brook University, Stony Brook, NY
| | - Sean Clouston
- Department of Preventive Medicine and Population Health, Stony Brook University, Stony Brook, NY
| | - Roxanne Palermo
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, NY
| | - Paul Fisher
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, NY
| | - Cliff Bernstein
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, NY
| | - Jules A Cohen
- Department of Medical Oncology, Stony Brook University, Stony Brook, NY
| | - Tim Q Duong
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, NY.
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21
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Di Micco R, Zuber V, Fiacco E, Carriero F, Gattuso MI, Nazzaro L, Panizza P, Gianolli L, Canevari C, Di Muzio N, Pasetti M, Sassi I, Zambetti M, Gentilini OD. Sentinel node biopsy after primary systemic therapy in node positive breast cancer patients: Time trend, imaging staging power and nodal downstaging according to molecular subtype. Eur J Surg Oncol 2019; 45:969-975. [PMID: 30744944 DOI: 10.1016/j.ejso.2019.01.219] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/20/2019] [Accepted: 01/29/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The management of axilla after Primary Systemic Therapy (PST) for breast cancer is a highly debated field. Despite the proven axillary downstaging occurring after PST, there is still some degree of reluctance in applying sentinel node biopsy (SNB) in the neoadjuvant setting. PATIENTS AND METHODS We performed a retrospective analysis on 181 PST patients with axillary positive nodes at presentation treated between 2005 and 2017 at San Raffaele Hospital in Milan. The aim was to observe the application time trend of SNB, to determine the imaging staging power and the axillary downstaging according to molecular subtypes. RESULTS Median follow-up after surgery was 32.5(IQR: 12-59) months. After PST, 119 (65.7%) patients had no clinically palpable nodes, 72 (39.7%) converted to N0 on final imaging and 34 (18.8%) underwent SNB with an increasing application trend. Axillary-US showed the highest accuracy (69.3%) in re-staging axilla after PST. Staging power of preoperative testing varied with tumour biology: Positive Predictive Value was higher in Luminal A (80% for clinical examination and 100% for axillary-US) and Luminal B (72% and 70.5%) tumours, whilst Negative Predictive Value was higher in HER2 positive (100% and 93.3%), and triple negative (71.4% and 93.3%) tumours. Ninety five (52.5%) patients experienced axillary downstaging after PST, by molecular subtype 15% (3/20) in Luminal A, 46.4% (45/97) in Luminal B, 90.9% (20/22) in HER2+ and 70.3% (26/37) in triple negative breast tumours. CONCLUSION SNB application after PST for breast cancer in node positive patients at presentation is increasing. Pre-operative axillary imaging and tumour biology help identify patients who might be candidates for SNB as a single staging procedure.
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Affiliation(s)
- Rosa Di Micco
- Breast Surgery Unit, San Raffaele Hospital, Milan, Italy; Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Veronica Zuber
- Breast Surgery Unit, San Raffaele Hospital, Milan, Italy
| | - Enrico Fiacco
- Breast Surgery Unit, San Raffaele Hospital, Milan, Italy
| | | | | | | | - Pietro Panizza
- Breast Radiology Unit, San Raffaele Hospital, Milan, Italy
| | - Luigi Gianolli
- Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy
| | - Carla Canevari
- Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy
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22
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Quelle est la valeur prédictive de l’imagerie pour évaluer la réponse axillaire après chimiothérapie néoadjuvante des cancers mammaires avec envahissement axillaire. IMAGERIE DE LA FEMME 2018. [DOI: 10.1016/j.femme.2018.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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23
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Du L, Li X, Zhen L, Chen W, Mu L, Zhang Y, Song A. Everolimus inhibits breast cancer cell growth through PI3K/AKT/mTOR signaling pathway. Mol Med Rep 2018; 17:7163-7169. [PMID: 29568883 PMCID: PMC5928673 DOI: 10.3892/mmr.2018.8769] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 10/30/2017] [Indexed: 01/14/2023] Open
Abstract
Breast cancer is one of the most prevalent malignancies and the leading cause of cancer‑associated mortality in women worldwide and in China. Everolimus (C53H83NO14) is an efficient anti-cancer drug for breast cancer which targets mammalian target of rapamycin (mTOR). The present study investigated the inhibitory effects of everolimus on breast cancer cells and an MCF‑7‑bearing mouse model. The potential mechanism of the everolimus‑mediated decrease in growth and aggressiveness of breast cancer cells was reported. Results demonstrated that everolimus significantly inhibited breast cancer cell growth, migration and invasion. It was demonstrated that everolimus induced apoptosis through decreasing B cell lymphoma (Bcl)‑2 and Bcl‑w and increasing caspase‑3 and caspase‑8 expression levels in breast cancer cells. It was observed that everolimus decreased phosphoinositide 3‑kinase (PI3K), protein kinase B (AKT) and mTOR expression levels in breast cancer cells. Results additionally demonstrated that PI3 K overexpression prevented that everolimus‑mediated inhibition of growth and aggressiveness in MCF‑7 cells. In vivo assays demonstrated that everolimus treatment markedly inhibited tumor growth in the MCF‑7 bearing mouse model. Overall, these data indicate that everolimus inhibits growth and aggressiveness of breast cancer cells through the PI3K/AKT/mTOR signaling pathways, suggesting the PI3K/AKT/mTOR signaling pathway may act as a therapeutic target for the treatment of human cancer.
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Affiliation(s)
- Liyan Du
- Department of Breast Surgery, Xingtai First Hospital, Xingtai, Hebei 054001, P.R. China
| | - Xiaomei Li
- Department of Breast Surgery, Xingtai First Hospital, Xingtai, Hebei 054001, P.R. China
| | - Linhong Zhen
- Department of Breast Surgery, Xingtai First Hospital, Xingtai, Hebei 054001, P.R. China
| | - Weiling Chen
- Department of Breast Surgery, Xingtai First Hospital, Xingtai, Hebei 054001, P.R. China
| | - Lingguang Mu
- Department of Breast Surgery, Xingtai First Hospital, Xingtai, Hebei 054001, P.R. China
| | - Yang Zhang
- Department of Breast Surgery, Xingtai First Hospital, Xingtai, Hebei 054001, P.R. China
| | - Ailin Song
- Department of Breast Surgery, Xingtai First Hospital, Xingtai, Hebei 054001, P.R. China
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van der Noordaa MEM, van Duijnhoven FH, Straver ME, Groen EJ, Stokkel M, Loo CE, Elkhuizen PHM, Russell NS, Vrancken Peeters MTFD. Major Reduction in Axillary Lymph Node Dissections After Neoadjuvant Systemic Therapy for Node-Positive Breast Cancer by combining PET/CT and the MARI Procedure. Ann Surg Oncol 2018; 25:1512-1520. [DOI: 10.1245/s10434-018-6404-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Indexed: 12/12/2022]
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25
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Ruano Pérez R, Rebollo Aguirre A, García-Talavera San Miguel P, Díaz Expósito R, Vidal-Sicart S, Cordero García J, Carrera Salazar D, Rioja Martín M. Review of the role of the sentinel node biopsy in neoadjuvant chemotherapy in women with breast cancer and negative or positive axillary node at diagnosis. Rev Esp Med Nucl Imagen Mol 2018. [DOI: 10.1016/j.remnie.2017.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Schwentner L, Dayan D, Wöckel A, Janni W, Kreienberg R, Blettner M, Wollschläger D. Is extracapsular nodal extension in sentinel nodes a predictor for nonsentinel metastasis and is there an impact on survival parameters?-A retrospective single center cohort study with 324 patients. Breast J 2017; 24:480-486. [PMID: 29265572 DOI: 10.1111/tbj.12983] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 08/23/2017] [Accepted: 08/25/2017] [Indexed: 01/05/2023]
Abstract
The Z0011 trial has fundamentally changed axillary management in breast cancer patients. However, some important questions remain, like the role of extracapsular nodal extension (ENE) in positive sentinel nodes and the need for further axillary treatment. In this retrospective cohort study, we reviewed and analyzed data from 342 clinically node negative (cN0) breast cancer patients with a positive sentinel node and subsequent axillary lymph node dissection (ALND) from the BRENDA data base. The 104 (30.4%) ENE positive patients had a significantly higher proportion of ≥3 positive axillary lymph nodes (65.0%) compared to ENE negative patients with a positive sentinel node (21.4%). Likewise, ENE positive patients had significantly more often lymph node metastasis size >2 mm (96.2%) than ENE negative patients (72.7%). T1 status was observed significantly more often in ENE negative patients (53.2%) than in ENE positive patients (24.0%). While ENE was linked to worse overall survival in univariate analysis, this effect disappeared when adjusting for nodal status, age, and comorbidities in multivariate analysis. ENE of the sentinel node is an important predictor for nonsentinel lymph node involvement. We suggest that ENE influences survival only via a higher number of positive nodes - one of the most predictive parameters for survival outcome in breast cancer.
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Affiliation(s)
- Lukas Schwentner
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Davut Dayan
- Department of Gynecology and Obstetrics, Kliniken Landkreis Heidenheim gGmbH, Heidenheim, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Kliniken Landkreis Heidenheim gGmbH, Heidenheim, Germany
| | - Rolf Kreienberg
- Department of Gynecology and Obstetrics, Kliniken Landkreis Heidenheim gGmbH, Heidenheim, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
| | - Daniel Wollschläger
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
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Ha SM, Cha JH, Kim HH, Shin HJ, Chae EY, Choi WJ. Diagnostic performance of breast ultrasonography and MRI in the prediction of lymph node status after neoadjuvant chemotherapy for breast cancer. Acta Radiol 2017; 58:1198-1205. [PMID: 28350255 DOI: 10.1177/0284185117690421] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Neoadjuvant chemotherapy (NAC) is widely used to treat breast cancer. Sentinel lymph node biopsy has replaced axillary lymph node dissection in patients who convert to node-negative status after NAC. However, few studies have evaluated the diagnostic performance of ultrasonography and magnetic resonance imaging (MRI) in determining axillary lymph node status after NAC. Purpose To evaluate the diagnostic performance of breast ultrasonography and MRI in determining residual metastatic axillary lymph node status after NAC for breast cancer and to identify histopathological factors affecting radiological performance. Material and Methods This study included 157 patients who underwent initial and follow-up preoperative breast ultrasonography and MRI before NAC between January and December 2010. The sensitivity, specificity, negative and positive predictive values, and accuracy of ultrasonography, MRI, and their combinations were evaluated. Results The sensitivity of ultrasonography, MRI, and their combination in post-NAC axillary imaging was 60.00%, 57.33%, and 65.33%, respectively; the specificity was 60.47%, 72.09%, and 60.47%, respectively. The positive predictive value was highest with MRI (78.18%). On univariate analysis, positive estrogen receptor status was associated with misdiagnosis by ultrasonography ( P = 0.002), MRI ( P = 0.002), and their combination ( P = 0.001). When residual metastatic lymph nodes were present, lymph nodes with macrometastasis (>2.0 mm) were associated with correct ultrasonography-based diagnosis ( P = 0.0027). Conclusion Imaging assists in predicting axillary lymph node status in patients undergoing NAC; however, is imprudent to omit sentinel lymph node biopsy or axillary lymph node dissection for staging in women determined to be node-positive.
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Affiliation(s)
- Su Min Ha
- Department of Radiology, Research Institute of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Joo Hee Cha
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hak Hee Kim
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee Jung Shin
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Young Chae
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo Jung Choi
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Weber JJ, Jochelson MS, Eaton A, Zabor EC, Barrio AV, Gemignani ML, Pilewskie M, Van Zee KJ, Morrow M, El-Tamer M. MRI and Prediction of Pathologic Complete Response in the Breast and Axilla after Neoadjuvant Chemotherapy for Breast Cancer. J Am Coll Surg 2017; 225:740-746. [PMID: 28919579 DOI: 10.1016/j.jamcollsurg.2017.08.027] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND In the setting where determining extent of residual disease is key for surgical planning after neoadjuvant chemotherapy (NAC), we evaluate the reliability of MRI in predicting pathologic complete response (pCR) of the breast primary and axillary nodes after NAC. STUDY DESIGN Patients who had MRI before and after NAC between June 2014 and August 2015 were identified in a prospective database after IRB approval. Post-NAC MRI of the breast and axillary nodes was correlated with residual disease on final pathology. Pathologic complete response was defined as absence of invasive and in situ disease. RESULTS We analyzed 129 breast cancers. Median patient age was 50.8 years (range 27.2 to 80.6 years). Tumors were human epidermal growth factor receptor 2 amplified in 52 of 129 (40%), estrogen receptor-positive/human epidermal growth factor receptor 2-negative in 45 of 129 (35%), and triple negative in 32 of 129 (25%), with respective pCR rates of 50%, 9%, and 31%. Median tumor size pre- and post-NAC MRI were 4.1 cm and 1.45 cm, respectively. Magnetic resonance imaging had a positive predictive value of 63.4% (26 of 41) and negative predictive value of 84.1% (74 of 88) for in-breast pCR. Axillary nodes were abnormal on pre-NAC MRI in 97 patients; 65 had biopsy-confirmed metastases. The nodes normalized on post-NAC MRI in 33 of 65 (51%); axillary pCR was present in 22 of 33 (67%). In 32 patients with proven nodal metastases and abnormal nodes on post-NAC MRI, 11 achieved axillary pCR. In 32 patients with normal nodes on pre- and post-NAC MRI, 6 (19%) had metastasis on final pathology. CONCLUSIONS Radiologic complete response by MRI does not predict pCR with adequate accuracy to replace pathologic evaluation of the breast tumor and axillary nodes.
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Affiliation(s)
- Joseph J Weber
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anne Eaton
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Emily C Zabor
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrea V Barrio
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Melissa Pilewskie
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kimberly J Van Zee
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mahmoud El-Tamer
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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Review of the role of the sentinel node biopsy in neoadjuvant chemotherapy in women with breast cancer and negative or positive axillary node at diagnosis. Rev Esp Med Nucl Imagen Mol 2017; 37:63-70. [PMID: 28869178 DOI: 10.1016/j.remn.2017.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/04/2017] [Accepted: 06/29/2017] [Indexed: 02/06/2023]
Abstract
The role of the selective sentinel node biopsy (SNB) is increasing in relevance in breast cancer women with indication of neoadjuvant chemotherapy (NAC). The Radiosurgery Working Group of the SEMNIM is aware of the necessity of establishing the need for SNB before or after NAC, and also how to manage patients with axillary node-negative or node-positive. There is sufficient data to assess that the SNB with radioisotope techniques are feasible and safe in all these scenarios. An adequate axilla evaluation prior to surgery and the possibility of marking prior to NAC the nodes infiltrated must be the two main pillars to guarantee the success of the SNB. It has been shown that to incorporate the SNB in breast cancer women with indication of NAC increases the rate of a conservative treatment of the axilla that will be a clear benefit for these patients.
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30
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Ye BB, Zhao HM, Yu Y, Ge J, Wang X, Cao XC. Accuracy of axillary ultrasound after different neoadjuvant chemotherapy cycles in breast cancer patients. Oncotarget 2017; 8:36696-36706. [PMID: 27852041 PMCID: PMC5482689 DOI: 10.18632/oncotarget.13313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 10/28/2016] [Indexed: 12/29/2022] Open
Abstract
Background This study determined whether axillary ultrasound (AUS) accurately predicted the status of axillary lymph nodes of patients who received different number of cycles of neoadjuvant chemotherapy (NAC). Materials and Methods From 2008 to 2015, 656 cases of patients with breast cancers who received NAC and had subsequent axillary lymph node dissection were included in this study. The findings of preoperative AUS were tested by pathological examination. We evaluated the sensitivity, specificity and accuracy of AUS for patients who received two-, four-, and six-cycle NAC. Results In the two-cycle subgroup, the sensitivity (Sn), specificity (Sp) and diagnostic odds ratio (DOR) were 80.2% (95% CI: 74.3%-86.2%), 61.4% (95% CI: 48.8%-74.0%) and 6.64 (95% CI: 3.36-12.4) respectively. In the four-cycle subgroup, the Sn, Sp and DOR were 69.7% (95% CI: 62.2%-77.1%), 66.1% (95% CI: 53.7%-78.5%) and 4.47 (95% CI: 2.32-8.62), respectively. In the six-cycle subgroup, the Sn, Sp and DOR were 56.7% (95% CI: 49.5%-64.0%), 74.5% (95% CI: 62.8%-87.2%) and 3.83 (95% CI: 1.863-7.86), respectively. Furthermore, the patients with normal AUS findings after six cycles of NAC have few positive nodes than patients with suspicious findings (p < 0.001). Conclusion Preoperative AUS is a potentially useful imaging modality to predict the pathologic status of the axillary within four cycles of NAC. Although the accuracy is lower for patients who completed six cycles of NAC than that who received four- and two- cycles, the number of positive lymph nodes for patients with normal findings on AUS is low.
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Affiliation(s)
- Bei-Bei Ye
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Hong-Meng Zhao
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Yue Yu
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Jie Ge
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Xin Wang
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Xu-Chen Cao
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
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31
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Koolen BB, Donker M, Straver ME, van der Noordaa MEM, Rutgers EJT, Valdés Olmos RA, Vrancken Peeters MJTFD. Combined PET-CT and axillary lymph node marking with radioactive iodine seeds (MARI procedure) for tailored axillary treatment in node-positive breast cancer after neoadjuvant therapy. Br J Surg 2017; 104:1188-1196. [PMID: 28524246 DOI: 10.1002/bjs.10555] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/04/2016] [Accepted: 03/06/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND The treatment of axillary lymph node metastases after neoadjuvant systemic therapy (NST) remains debatable and axillary lymph node dissection (ALND) is still the standard of care. Marking axillary lymph nodes with radioactive iodine seeds (MARI procedure) is accurate in restaging the axilla after NST (false-negative rate 7 per cent). Here, the potential of tailored axillary treatment, determined by combining the results of PET-CT before NST with those of the MARI procedure after NST, was analysed. METHODS A cohort of axillary node-positive patients was used to construct a hypothetical treatment algorithm based on a combination of PET-CT and the MARI procedure. In the algorithm, the number of fluorodeoxyglucose (FDG)-avid axillary lymph nodes (1-3 versus 4 or more) before NST and the tumour status of the MARI node (positive versus negative) after NST were used to tailor axillary treatment. All patients in the cohort underwent ALND, allowing estimation of potential overtreatment and undertreatment. RESULTS A total of 93 patients were included in the study. Between one and three FDG-avid axillary lymph nodes were observed in 59 patients, and four or more in 34 patients. The MARI node was tumour-negative in 32 patients and showed residual disease in 61. Treatment according to the constructed algorithm would have resulted in 74 per cent of patients avoiding an ALND, with potential undertreatment in three patients (3 per cent) and overtreatment in 16 (17 per cent). CONCLUSION Tailored axillary treatment after NST in node-positive patients, by combining PET-CT before NST and the MARI procedure after NST, has the potential for ALND to be avoided in 74 per cent of patients.
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Affiliation(s)
- B B Koolen
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - M Donker
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - M E Straver
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - M E M van der Noordaa
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - E J T Rutgers
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - R A Valdés Olmos
- Department of Nuclear Medicine, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - M J T F D Vrancken Peeters
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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32
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van Ramshorst MS, Loo CE, Groen EJ, Winter-Warnars GH, Wesseling J, van Duijnhoven F, Peeters MJTV, Sonke GS. MRI predicts pathologic complete response in HER2-positive breast cancer after neoadjuvant chemotherapy. Breast Cancer Res Treat 2017; 164:99-106. [PMID: 28432515 DOI: 10.1007/s10549-017-4254-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 04/17/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Neoadjuvant treatment of HER2-positive breast cancer frequently leads to a pathologic complete response (pCR), which is associated with favourable long-term outcome. Treatment regimens typically consist of 6-9 cycles of trastuzumab-based chemotherapy, although many patients achieve early radiologic complete response (rCR). If rCR accurately predicts pCR, the number of chemotherapy cycles can possibly be reduced. METHODS We performed a diagnostic accuracy study to determine the association between rCR and pCR in patients with stage II-III HER2-positive breast cancer treated with neoadjuvant trastuzumab-based chemotherapy at the Netherlands Cancer Institute. RCR was defined as the disappearance of pathologic contrast enhancement in the original tumour region on repeated magnetic resonance imaging (MRI). PCR was defined as the absence of invasive tumour cells in the resected breast specimen (ypT0/is). Diagnostic accuracy was estimated in the overall population and in subgroups based on hormone receptor (HR) status. The prognostic value of rCR for recurrence-free interval was evaluated as an exploratory analysis. RESULTS We identified 296 eligible patients with 297 HER2-positive tumours (154 HR-negative and 143 HR-positive) treated with neoadjuvant trastuzumab-based chemotherapy between 2004 and 2016. Overall, the rCR rate was 69% (206/297) and the pCR rate was 61% (181/297). Among 206 patients with rCR, 150 also had pCR (negative predictive value [NPV] = 150/206 = 73%). Among 91 patients without rCR, 60 had residual tumour at pathology (positive predictive value [PPV] = 60/91 = 66%). The NPV was better in HR-negative compared to HR-positive tumours (88 vs. 57%), while the PPV was better in HR-positive tumours (50 vs. 78%). Achieving rCR was associated with a 5-year recurrence-free interval of 88% compared to 68% without rCR (hazard ratio 0.34, 95% confidence interval 0.17-0.65, P = 0.001). CONCLUSION Achieving rCR corresponds well with pCR in HER2-positive breast cancer, particularly in the HR-negative subgroup. RCR is also associated with improved long-term outcome.
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Affiliation(s)
- Mette S van Ramshorst
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Claudette E Loo
- Department of Radiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Emilie J Groen
- Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Gonneke H Winter-Warnars
- Department of Radiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Jelle Wesseling
- Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Frederieke van Duijnhoven
- Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | | | - Gabe S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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Candelaria RP, Bassett RL, Symmans WF, Ramineni M, Moulder SL, Kuerer HM, Thompson AM, Yang WT. Performance of Mid-Treatment Breast Ultrasound and Axillary Ultrasound in Predicting Response to Neoadjuvant Chemotherapy by Breast Cancer Subtype. Oncologist 2017; 22:394-401. [PMID: 28314842 DOI: 10.1634/theoncologist.2016-0307] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 12/02/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The primary objective was to determine whether mid-treatment ultrasound measurements of index breast tumors and index axillary nodes of different cancer subtypes associate with residual cancer burden (RCB). METHODS Patients with invasive breast cancer who underwent neoadjuvant chemotherapy and had pre-treatment and mid-treatment breast and axillary ultrasound were included in this single-institution, retrospective cohort study. Linear regression analysis assessed associations between RCB with (a) change in index breast tumor size, (b) change in index node size, and (c) absolute number of abnormal nodes at mid-treatment. Multivariate linear regression was used to calculate best-fit models for RCB. RESULTS One hundred fifty-nine patients (68 triple negative breast cancer [TNBC], 45 hormone receptor [HR]+/human epidermal growth factor receptor 2 [HER2]-, and 46 HR-/HER2+) were included. Median age at diagnosis was 50 years, range 30-76. Median tumor size was 3.4 cm, range 0.9-10.4. Pathological complete response/RCB-I rates were 36.8% (25/68) for TNBC patients, 24.4% (11/45) for HR+/HER2- patients, and 71.7% (33/46) for HR-/HER2+ patients. Linear regression analyses demonstrated associations between percent change in tumor ultrasound measurements at mid-treatment with RCB index score in TNBC and HR+/HER2- (p < .05) but not in HR-/HER2+ (p > .05) tumors and an association between axillary ultrasound assessment of number of abnormal nodes at mid-treatment with RCB index score across all subtypes (p < .05). CONCLUSION Performance characteristics of breast ultrasound associated with RCB vary by cancer subtype, whereas the performance characteristics of axillary ultrasound associated with RCB are consistent across cancer subtype. Breast and axillary ultrasound may be valuable in monitoring response to neoadjuvant therapy. The Oncologist 2017;22:394-401 IMPLICATIONS FOR PRACTICE: The differential performance characteristics of breast ultrasound by molecular subtype and the consistent performance characteristics of axillary ultrasound across molecular subtypes can have clinical utility in monitoring response to neoadjuvant therapy.
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Affiliation(s)
| | | | | | | | | | - Henry M Kuerer
- Department of Breast Surgical Oncology, Unit 1434, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alastair M Thompson
- Department of Breast Surgical Oncology, Unit 1434, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Schwentner L, Helms G, Nekljudova V, Ataseven B, Bauerfeind I, Ditsch N, Fehm T, Fleige B, Hauschild M, Heil J, Kümmel S, Lebeau A, Schmatloch S, Schrenk P, Staebler A, Loibl S, Untch M, Von Minckwitz G, Liedtke C, Kühn T. Using ultrasound and palpation for predicting axillary lymph node status following neoadjuvant chemotherapy – Results from the multi-center SENTINA trial. Breast 2017; 31:202-207. [DOI: 10.1016/j.breast.2016.11.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 11/10/2016] [Accepted: 11/11/2016] [Indexed: 10/20/2022] Open
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35
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Ollila DW, Cirrincione CT, Berry DA, Carey LA, Sikov WM, Hudis CA, Winer EP, Golshan M. Axillary Management of Stage II/III Breast Cancer in Patients Treated with Neoadjuvant Systemic Therapy: Results of CALGB 40601 (HER2-Positive) and CALGB 40603 (Triple-Negative). J Am Coll Surg 2017; 224:688-694. [PMID: 28089784 DOI: 10.1016/j.jamcollsurg.2016.12.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Management of the axilla in stage II/III breast cancer undergoing neoadjuvant systemic therapy (NST) is controversial. To understand current patterns of care, we collected axillary data from 2 NST trials: HER2-positive (Cancer and Leukemia Group B [CALGB] 40601) and triple-negative (CALGB 40603). STUDY DESIGN Axillary evaluation pre- and post-NST was per the treating surgeon and could include sentinel node biopsy. Post-NST, node-positive patients were recommended to undergo axillary lymph node dissection (ALND). We report pre-NST histopathologic nodal evaluation and post-NST axillary surgical procedures with correlation to clinical and pathologic nodal status. RESULTS Seven hundred and forty-two patients were treated, 704 had complete nodal data pre-NST and post-NST. Pre-NST, 422 (60%) of 704 patients underwent at least 1 procedure for axillary node evaluation (total of 468 procedures): fine needle aspiration (n = 234; 74% positive), core needle biopsy (n = 138; 72% positive), and sentinel node biopsy (n = 96; 33% positive). Pre-NST, 304 patients were considered node-positive. Post-NST, 304 of 704 patients (43%) underwent sentinel node biopsy; 44 were positive and 259 were negative (29 and 36 patients, respectively, had subsequent ALND). Three hundred and ninety-one (56%) patients went directly to post-NST ALND and 9 (1%) pre-NST node-positive patients had no post-NST axillary procedure. Post-NST, 170 (24%) of the 704 patients had residual axillary disease. Agreement between post-NST clinical and radiologic staging and post-NST histologic staging was strongest for node-negative (81%) and weaker for node-positive (N1 31%, N2 29%), with more than half of the clinically node-positive patients found to be pathologic negative (p < 0.001). CONCLUSIONS Our results suggest there is no widely accepted standard for axillary nodal evaluation pre-NST. Post-NST staging was highly concordant in patients with N0 disease, but poorly so in node-positive disease. Accurate methods are needed to identify post-NST patients without residual axillary disease to potentially spare ALND.
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Affiliation(s)
- David W Ollila
- Department of Surgery, University of North Carolina, at Chapel Hill, Chapel Hill, NC.
| | | | - Donald A Berry
- Alliance Statistics and Data Center, MD Anderson Cancer Center, Houston, TX
| | - Lisa A Carey
- Department of Medical Oncology, University of North Carolina, at Chapel Hill, Chapel Hill, NC
| | - William M Sikov
- Program in Women's Oncology, Women and Infants Hospital of Rhode Island, Providence, RI; Alpert Medical School of Brown University, Providence, RI
| | - Clifford A Hudis
- Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Eric P Winer
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA
| | - Mehra Golshan
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
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Prognostic Role of Early and End-of-Neoadjuvant Treatment 18F-FDG PET/CT in Patients With Breast Cancer. Clin Nucl Med 2016; 41:e313-22. [DOI: 10.1097/rlu.0000000000001191] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Kim TH, Kang DK, Kim JY, Han S, Jung Y. Histologic Grade and Decrease in Tumor Dimensions Affect Axillary Lymph Node Status after Neoadjuvant Chemotherapy in Breast Cancer Patients. J Breast Cancer 2015; 18:394-9. [PMID: 26770247 PMCID: PMC4705092 DOI: 10.4048/jbc.2015.18.4.394] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/04/2015] [Indexed: 12/31/2022] Open
Abstract
Purpose The purposes our study was to find out any histologic factors associated with negative conversion of axillary lymph node (ALN) after neoadjuvant chemotherapy (NAC). We also evaluated the association between the decrease in size of primary breast tumor and negative conversion of ALN. Methods From January 2012 to November 2014, we included 133 breast cancer patients who underwent NAC and who had ALN metastases which were confirmed on fine-needle aspiration or core needle biopsy at initial diagnosis. All 133 patients underwent initial magnetic resonance imaging (MRI) at the time of diagnosis and preoperative MRI after completion of NAC. We measured the longest dimension of primary breast cancer on MRI. Results Of 133 patients, 39 patients (29%) showed negative conversion of ALN and of these 39 patients, 25 patients (64%) showed pathologic complete remission of primary breast. On univariate analysis, mean percent decrease in longest dimension, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 status and histologic grade were significantly associated with the ALN status after NAC (p<0.001, p=0.001, p< 0.001, p=0.001, p=0.002, respectively). On multivariate logistic regression analysis, percent decrease in longest dimension (odds ratio, 1.026; 95% confidence interval [CI], 1.009-1.044) and histologic grade (odds ratio, 3.964; 95% CI, 1.151-13.657) were identified as being independently associated with the ALN status after NAC. The area under the receiver operating characteristic curve was 0.835 with the best cutoff value of 80% decrease in longest dimension. Combination of high histologic grade and more than 80% decrease in longest dimension showed 64% sensitivity and 92% specificity. Conclusion High histologic grade and more than 80% decrease in primary tumor dimension were associated with negative conversion of ALN after NAC.
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Affiliation(s)
- Tae Hee Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Doo Kyoung Kang
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Ji Young Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Sehwan Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Yongsik Jung
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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You S, Kang DK, Jung YS, An YS, Jeon GS, Kim TH. Evaluation of lymph node status after neoadjuvant chemotherapy in breast cancer patients: comparison of diagnostic performance of ultrasound, MRI and ¹⁸F-FDG PET/CT. Br J Radiol 2015; 88:20150143. [PMID: 26110204 PMCID: PMC4651396 DOI: 10.1259/bjr.20150143] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective: To evaluate the diagnostic performance of ultrasound, MRI and fluorine-18 fludeoxyglucose positron emission tomography (18F-FDG PET)/CT for the diagnosis of metastatic axillary lymph node (ALN) after neoadjuvant chemotherapy (NAC) and to find out histopathological factors affecting the diagnostic performance of these imaging modalities. Methods: From January 2012 to November 2014, 191 consecutive patients with breast cancer who underwent NAC before surgery were retrospectively reviewed. We included 139 patients with ALN metastasis that was confirmed on fine needle aspiration or core needle biopsy at initial diagnosis. Results: After NAC, 39 (28%) patients showed negative conversion of ALN on surgical specimens of sentinel lymph node (LN) or ALN. The sensitivity of ultrasound, MRI and PET/CT was 50% (48/96), 72% (70/97) and 22% (16/73), respectively. The specificity of ultrasound, MRI and PET/CT was 77% (30/39), 54% (21/39) and 85% (22/26), respectively. The Az value of combination of ultrasound and PET/CT was the highest (0.634) followed by ultrasound (0.626) and combination of ultrasound, MRI and PET/CT (0.617). The size of tumour deposit in LN and oestrogen receptor was significantly associated with the diagnostic performance of ultrasound (p < 0.001 and p = 0.009, respectively) and MRI (p = 0.045 and p = 0.036, respectively). The percentage diameter decrease, size of tumour deposit in LN, progesterone receptor, HER2 and histological grade were significantly associated with the diagnostic performance of PET/CT (p = 0.023, p = 0.002, p = 0.036, p = 0.044 and p = 0.008, respectively). On multivariate logistic regression analysis, size of tumour deposit within LN was identified as being independently associated with diagnostic performance of ultrasound [odds ratio, 13.07; 95% confidence interval (CI), 2.95–57.96] and PET/CT (odds ratio, 6.47; 95% CI, 1.407–29.737). Conclusion: Combination of three imaging modalities showed the highest sensitivity, and PET/CT showed the highest specificity for the evaluation of ALN metastasis after NAC. Ultrasound alone or combination of ultrasound and PET/CT showed the highest positive-predictive value. The size of tumour deposit within ALN was significantly associated with diagnostic performance of ultrasound and PET/CT. Advances in knowledge: This study is about the diagnostic performance of ultrasound, MRI, PET/CT and combination of each imaging modality for the evaluation of metastatic ALN after NAC. Of many histopathological factors, only the size of tumour deposit within ALN was an independent factor associated with the diagnostic performance of ultrasound and PET/CT.
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Affiliation(s)
- S You
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - D K Kang
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Y S Jung
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Y-S An
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - G S Jeon
- Department of Radiology, CHA Bundang Medical Center, CHA University, College of Medicine, Seongnam, Republic of Korea
| | - T H Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
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