Axillary Pathologic Complete Response After Neoadjuvant Systemic Therapy by Breast Cancer Subtype in Patients With Initially Clinically Node-Positive Disease

Samiei, Sanaz; Simons, Janine M.; Engelen, Sanne; Beets‐Tan, Regina G. H.; Classe, Jean‐Marc; Smidt, Marjolein L.

doi:10.1001/jamasurg.2021.0891

Cited by 104 publications

(84 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a pooled analysis with 57,531 unique patients, pCR-LN rates were reported in 60% of hormone receptor-negative/HER2-positive, 48% of TNBC, 45% of hormone receptor-positive/HER2-positive, 35% of luminal B, 18% of hormone receptor-positive/HER2-negative, and 13% of luminal A breast cancer. The pCR rates were independent of clinically or pathologically proven node status [16].…”

Section: Discussionmentioning

confidence: 80%

“…A similar relation between response and tumor subtype was reported from Barron et al with pCR-B rates of 43.3% in HER2positive, 37.7% in TNBC, and 12.7% in luminal HER2-negative disease [15]. In a pooled analysis of 33 studies with 57,531 clinically node-positive patients before NAST axillary pCR according to subtypes were reported in 60% (hormone receptor-negative/HER2-positive), 59% (HER2-positive/hormone receptor-negative or positive), 48% TNBC, 45% (hormone receptor-positive/HER2-positive), 35% (luminal B), 18% (hormone receptor-positive/HER2negative), and 13% (luminal A) breast cancer [16]. The difference in magnitude of the effect of NAST on pCR rates may be explained by a modern dose-dense intensified schedule as used in the GeparOcto trial.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Pathological Response in the Breast and Axillary Lymph Nodes after Neoadjuvant Systemic Treatment in Patients with Initially Node-Positive Breast Cancer Correlates with Disease Free Survival: An Exploratory Analysis of the GeparOcto Trial

Gerber

Schneeweiß

Möbus

et al. 2022

Cancers

View full text Add to dashboard Cite

Background: The conversion of initially histologically confirmed axillary lymph node-positive (pN+) to ypN0 after neoadjuvant systemic treatment (NAST) is an important prognostic factor in breast cancer (BC) patients and may influence surgical de-escalation strategies. We aimed to determine pCR rates in lymph nodes (pCR-LN), the breast (pCR-B), and both (tpCR) in women who present with pN+ BC, to assess predictors for response and the impact of pCR-LN, pCR-B, and tpCR on invasive disease-free survival (iDFS). Methods: Retrospective, exploratory analysis of 242 patients with pN+ at diagnosis from the multicentric, randomized GeparOcto trial. Results: Of 242 patients with initially pN+ disease, 134 (55.4%) had a pCR-LN, and 109 (45.0%) a pCR-B. Of the 109 pCR-B patients, 9 (8.3%) patients had involved LN, and 100 (41.3%) patients had tpCR. Those with involved LN still had a bad prognosis. As expected, pCR-B and intrinsic subtypes (TNBC and HER2+) were identified as independent predictors of pCR-LN. pCR-LN (ypN0; hazard ratio 0.42; 95%, CI 0.23–0.75; p = 0.0028 for iDFS) was the strongest independent prognostic factor. Conclusions: In initially pN+ patients undergoing NAST, the conversion to ypN0 is of high prognostic value. Surgical axillary staging after NAST is still essential in these patients to offer tailored treatment.

show abstract

Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Pathological Response in the Breast and Axillary Lymph Nodes after Neoadjuvant Systemic Treatment in Patients with Initially Node-Positive Breast Cancer Correlates with Disease Free Survival: An Exploratory Analysis of the GeparOcto Trial

Gerber

Schneeweiß

Möbus

et al. 2022

Cancers

View full text Add to dashboard Cite

show abstract

“…In initially clinically node-positive (cN +) breast cancer, conversion to pathological node negativity (ypN0) through neoadjuvant systemic therapy (NST) occurs in 13–60% depending on breast cancer subtype [ 1 ]. Since the proportion of ypN0 patients, i.e.…”

Section: Introductionmentioning

confidence: 99%

False-negative rate in the extended prospective TATTOO trial evaluating targeted axillary dissection by carbon tattooing in clinically node-positive breast cancer patients receiving neoadjuvant systemic therapy

Boniface

Frisell

Kühn

et al. 2022

Breast Cancer Res Treat

View full text Add to dashboard Cite

Purpose In clinically node-positive breast cancer patients receiving neoadjuvant systemic therapy (NST), nodal metastases can be initially marked and then removed during surgical axillary staging. Marking methods vary significantly in terms of feasibility and cost. The purpose of the extended TATTOO trial was to report on the false-negative rate (FNR) of the low-cost method carbon tattooing. Methods The international prospective single-arm TATTOO trial included clinically node-positive breast cancer patients planned for NST from November 2017 to January 2021. For the present analysis, patients who received both the targeted procedure with or without an additional sentinel lymph node (SLN) biopsy and a completion axillary lymph node dissection (ALND) were selected. Primary endpoint was the FNR. Results Out of 172 included patients, 149 had undergone a completion ALND. The detection rate for the tattooed node was 94.6% (141 out of 149). SLN biopsy was attempted in 132 out of 149 patients with a detection rate of 91.7% (121 out of 132). SLN and tattooed node were identical in 58 out of 121 individuals (47.9%). The combined procedure, i.e. targeted axillary dissection (TAD) was successful in 147 of 149 cases (98.7%). Four out of 65 patients with a clinically node-negative status after NST had a negative TAD but metastases on ALND, corresponding to a FNR of 6.2%. All false-negative TAD procedures were performed in the first 2 years of the trial (2018–2019, p = 0.022). Conclusion Carbon tattooing is a feasible marking method for TAD with a high detection rate and an acceptably low FNR. The TATTOO trial was preregistered as prospective trial before initiation at the University of Rostock, Germany (DRKS00013169).

show abstract

“…The combination of SLNB and target lymph node biopsy (TLNB) is referred to as targeted axillary dissection (TAD) and was first described by Caudle et al in 2016 6 . TAD could avoid the more radical axillary lymphadenectomy (ALND) in up to 60% of patients who no longer have tumor cells in their lymph nodes after NACT despite initial lymph node metastasis 9 .…”

Section: Introductionmentioning

confidence: 99%

Axillary Staging after Neoadjuvant Chemotherapy for Initially Node-Positive Breast Carcinoma in Germany

Hartmann

Kühn

Hauptmann

et al. 2022

Geburtshilfe Frauenheilkd

View full text Add to dashboard Cite

Introduction To date, the optimal axillary staging procedure for initially node-positive breast carcinoma patients after neoadjuvant chemotherapy (NACT) has been unclear. The aim of the AXSANA study is to prospectively compare different surgical staging techniques with respect to the oncological outcome and quality of life for the patients. Little is known about current clinical practice in Germany. Material and Methods In this paper we analyzed data from patients enrolled in the AXSANA study at German study sites from June 2020 to March 2022. Results During the period under investigation, 1135 patients were recruited at 143 study sites. More than three suspicious lymph nodes were initially found in 22% of patients. The target lymph node (TLN) was marked in 64% of cases. This was done with clips/coils in 83% of patients, with magnetic seeds or carbon suspension in 8% each, and with a radar marker in 1% of patients. After NACT, targeted axillary dissection (TAD) or axillary lymphadenectomy (ALND) were each planned in 48% of patients, and sentinel lymph node biopsy alone (SLNB) in 2%. Clinically, the nodal status after NACT was found to be unremarkable in 65% of cases. Histological lymph node status was correctly assessed by palpation in 65% of patients and by sonography in 69% of patients. Conclusion At the German AXSANA study sites, TAD and ALND are currently used as the most common surgical staging procedures after NACT in initially node-positive breast cancer patients. The TLN is marked with various markers prior to NACT. Given the inadequate accuracy of clinical assessment of axillary lymph node status after NACT, it should be questioned whether axillary dissection after NACT should be performed based on clinical assessment of nodal status alone.

show abstract

Axillary Pathologic Complete Response After Neoadjuvant Systemic Therapy by Breast Cancer Subtype in Patients With Initially Clinically Node-Positive Disease

Cited by 104 publications

References 63 publications

Pathological Response in the Breast and Axillary Lymph Nodes after Neoadjuvant Systemic Treatment in Patients with Initially Node-Positive Breast Cancer Correlates with Disease Free Survival: An Exploratory Analysis of the GeparOcto Trial

Pathological Response in the Breast and Axillary Lymph Nodes after Neoadjuvant Systemic Treatment in Patients with Initially Node-Positive Breast Cancer Correlates with Disease Free Survival: An Exploratory Analysis of the GeparOcto Trial

False-negative rate in the extended prospective TATTOO trial evaluating targeted axillary dissection by carbon tattooing in clinically node-positive breast cancer patients receiving neoadjuvant systemic therapy

Axillary Staging after Neoadjuvant Chemotherapy for Initially Node-Positive Breast Carcinoma in Germany

Contact Info

Product

Resources

About