Accuracy of axillary ultrasound after different neoadjuvant chemotherapy cycles in breast cancer patients

Abstract

BackgroundThis 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 MethodsFrom 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.ResultsIn 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).ConclusionPreoperative 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.

Assessment of response of neoadjuvant chemotherapy in carcinoma breast patients by high-frequency ultrasound

“…[ 23 ] in his study concluded that axillary ultrasound is recommended after NACT to guide axillary surgery. In a study by Ye et al ,[ 24 ] the result suggested that use of axillary ultrasound is a useful imaging technique to assess the response of axillary lymphnodes to NACT and is best depicted in patients who have finished 4 cycles of NACT, and as the number of NACT cycles increases to 6, the false negative rate increases. All these studies are in concordance with our studies, suggesting that axillary ultrasound can predict the response to NACT when compared to final histopathology.…”

Assessing the accuracy of conventional gadolinium‐enhanced breast MRI in measuring the nodal response to neoadjuvant chemotherapy (NAC) in breast cancer

“…While it has a high specificity at 82.76%, it has a low sensitivity at 33.93%. In terms of how this compares to other imaging modalities, one study assessing the use of axillary ultrasound (AUS) after NAC noted an overall sensitivity of 68.7%, a specificity of 67.1%, and an accuracy of 68.3% 22 . While we recorded a lower sensitivity rate, it would appear that MRI has a much higher specificity when compared to AUS.…”

“…In terms of how this compares to other imaging modalities, one study assessing the use of axillary ultrasound (AUS) after NAC noted an overall sensitivity of 68.7%, a specificity of 67.1%, and an accuracy of 68.3%. 22 While we recorded a lower sensitivity rate, it would appear that MRI has a much higher specificity when compared to AUS. MRI pre-treatment may help to identify more node-positive patients but it is not specific enough post-treatment to confirm treatment response.…”

The circRNA-0001361/miR-491/FGFR4 axis is associated with axillary response evaluated by ultrasound following NAC in subjects with breast cancer

“…In fact, > 70% BC patients might achieve a response after the treatment, with the rest presenting different levels of resistance [ 33 ]. Pre-NAC and post-NAC MRI values of tumor size have been linked to the level of axillary response, with the greatest diagnostic performance of an AUC of 0.760 [ 34 ]. Regarding the features of axillary LNs, the cortical thickness during and after NAC therapy are predictors for a higher OR [ 35 ].…”