Accuracy of ultrasound-guided targeted fine-needle aspiration in assessing nodal response in node-positive breast cancer after neoadjuvant chemotherapy: prospective feasibility study

Wu, Siyu; Li, Jian Wei; Wu, Huai Liang; Shao, Zhi Ming; Liu, Guang Yu; Hu, Na

doi:10.1093/bjs/znac277

Cited by 4 publications

(6 citation statements)

References 16 publications

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“…This study also found that 50% of patients with ultrasound results suggestive of LN metastasis (ycN+) actually had ypN0. [17] Similar results were found during our study, wherein 9 of 21 patients with ycN+ according to the ultrasound assessment had achieved pCR. Following the current guidelines indicating that ALND is mandatory for ycN+ cases will result in a signi cant proportion of patients with axillary pCR to undergo unnecessary ALND.…”

Section: Discussionsupporting

confidence: 89%

“…[12] It is dif cult to accurately de ne ycN0 after NAC, and ultrasound, magnetic resonance imaging, positron emission tomography/computed tomography, or even ultrasound-guided ne-needle aspiration to assess the axillary LN status after NAC have yielded inaccurate results. [16,17] Because there are still many problems and controversies regarding the screening of pre-NAC cN1 and post-NAC ycN0 patients, we conducted a single-center prospective trial. This single-arm, prospective trial aimed to evaluate the ef cacy and accuracy of performing TAD after NAC in rigorously de ned pre-NAC cN1 patients and determine the need for clinical assessment of post-NAC axillary staging.…”

Section: Introductionmentioning

confidence: 99%

“…[ 12 ] It is difficult to accurately define ycN0 after NAC, and ultrasound, magnetic resonance imaging, positron emission tomography/computed tomography, or even ultrasound-guided fine-needle aspiration to assess the axillary LN status after NAC have yielded inaccurate results. [ 16 , 17 ]…”

Section: Introductionmentioning

confidence: 99%

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Targeted axillary dissection after neoadjuvant chemotherapy for highly selective patients with initial cN1 breast cancer: A single-center prospective trial

Chen,

Lu,

Wang

et al. 2024

Chinese Medical Journal

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Background: Sentinel lymph node (SLN) biopsy is gradually accepted as the standard of care in breast cancer patients with down-staged axillary disease after neoadjuvant chemotherapy (NAC). However, it is still difficult to precisely define pre-NAC clinical node-positive (cN1) and post-NAC clinical node-negative (ycN0). This prospective single-center trial was designed to evaluate the feasibility and accuracy of standard targeted axillary dissection (TAD) after NAC in highly selective pre-NAC cN1 patients (not considering ultrasound-based axillary ycN staging). Methods: This prospective trial included patients with initial pre-NAC cT1–3N1M0 invasive breast cancer but with a rigorous definition of cN1 from the Affiliated Cancer Hospital of Zhengzhou University. When NAC was effective (including complete and partial responses) and preoperative axillary palpation was negative, preoperative ultrasound-based axillary staging was not considered, and all patients underwent TAD followed by axillary lymph node (LN) dissection. The detection rate (DR) and false-negative rate (FNR) of TAD were calculated. Results: A total of 82 patients were included, and 77 of them were eligible for data analysis. The DR for TAD was 94.8% (73/77). There were 26 patients with one abnormal LN at the time of diagnosis based on ultrasound, 45 patients with two, and 2 patients with three. One patient had one TAD LN, four patients had two TAD LNs, and 68 patients had three or more TAD LNs. Preoperative axillary palpation yielded negative results for all 73 patients who successfully underwent TAD. Preoperative ultrasound-based ycN0 and ycN+ conditions were detected for 52 and 21 cases, respectively. The FNR was 7.4% (2/27) for standard TAD (≥3 SLNs), which was lower than that of all successful TAD (≥1 SLN; 10.0%, 3/30). Conclusions: In rigorously defined pre-NAC cN1 breast cancer patients, standard TAD is feasible for those with negative axillary palpation after NAC, and FNR is also less than 10%. Registration: chictr.org.cn, ChiCTR2100049093

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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Targeted axillary dissection after neoadjuvant chemotherapy for highly selective patients with initial cN1 breast cancer: A single-center prospective trial

Chen,

Lu,

Wang

et al. 2024

Chinese Medical Journal

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“…Rather than clinical trials, in our practice, for patients with clip placement in our centre, TAD is selectively attempted, and the decision to perform TAD is comprehensively determined by preoperative evaluation of treatment response as well as breast cancer subtypes. Based on a series of previous studies by our group, we demonstrated serial 18 F-FDG PET/computed tomography, second CNB in breast, or preoperative targeted FNA of CLN could serve as diverse accurate modalities to predict response of NACT and thus distinguish good responders who are unlikely candidates of less-invasive TAD or poor responders suitable to directly proceed to ALND 24 – 26 .…”

Section: Discussionmentioning

confidence: 99%

“…Commonly, TAD, which included the excision of both SLNs and CLN, was suggested but not mandatory. Instead of attempting TAD, breast surgeons had the option to directly perform ALND, mainly based on imaging- and biopsy-related results indicating a low possibility to achieve pCR, which included serial 18 F-FDG PET/computed tomography, second CNB in breast, or preoperative targeted FNA of CLN 24 – 26 . Notably, clinically positive nodal status after NACT (ypN+) was not deemed as a contraindication of TAD in our centre.…”

Section: Methodsmentioning

confidence: 99%

Clinical feasibility and oncological safety of non-radioactive targeted axillary dissection after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: a prospective diagnostic and prognostic study

Wang

et al. 2023

International Journal of Surgery

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Background: Targeted axillary dissection (TAD) includes biopsy of clipped lymph node and sentinel lymph nodes. However, clinical evidence regarding clinical feasibility and oncological safety of non-radioactive TAD in a real-world cohort remains limited. Methods: In this prospective registry study, patients routinely underwent clip insertion into biopsy-confirmed lymph node. Eligible patients received neoadjuvant chemotherapy followed by axillary surgery. Main endpoints included the false-negative rate (FNR) of TAD and nodal recurrence rate. Results: Data from 353 eligible patients were analyzed. After completion of neoadjuvant chemotherapy, 85 patients directly proceeded to axillary lymph node dissection (ALND), furthermore, TAD with or without ALND was performed in 152 and 85 patients, respectively. Overall detection rate of clipped node was 94.9% (95% CI, 91.3–97.4%) and FNR of TAD was 12.2% (95% CI, 6.0–21.3%) in our study, with FNR decreasing to 6.0% (95% CI, 1.7–14.6%) in initially cN1 patients. During a median follow-up of 36.6 months, 3 nodal recurrences occurred (3/237 with ALND; 0/85 with TAD alone), with a 3-year freedom-from-nodal-recurrence rate of 100.0% among the TAD-only patients and 98.7% among the ALND patients with axillary pathologic complete response ( P =0.29). Conclusions: TAD is feasible in initially cN1 breast cancer patients with biopsy-confirmed nodal metastases. ALND can safely be foregone in patients with negativity or a low volume of nodal positivity on TAD, with a low nodal failure rate and no compromise of 3-year recurrence-free survival.

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Repeated core needle biopsy and targeted fine-needle aspiration to optimize axillary surgery after neoadjuvant chemotherapy in node-positive breast cancer: prospective clinical study

Zhang

et al. 2023

British Journal of Surgery

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Accuracy of ultrasound-guided targeted fine-needle aspiration in assessing nodal response in node-positive breast cancer after neoadjuvant chemotherapy: prospective feasibility study

Cited by 4 publications

References 16 publications

Targeted axillary dissection after neoadjuvant chemotherapy for highly selective patients with initial cN1 breast cancer: A single-center prospective trial

Targeted axillary dissection after neoadjuvant chemotherapy for highly selective patients with initial cN1 breast cancer: A single-center prospective trial

Clinical feasibility and oncological safety of non-radioactive targeted axillary dissection after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: a prospective diagnostic and prognostic study

Repeated core needle biopsy and targeted fine-needle aspiration to optimize axillary surgery after neoadjuvant chemotherapy in node-positive breast cancer: prospective clinical study

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