Axillary Pathologic Complete Response to Neoadjuvant Chemotherapy in Clinically Node-Positive Breast Cancer Patients: A Predictive Model Integrating the Imaging Characteristics of Ultrasound Restaging with Known Clinicopathologic Characteristics

Kim, Won Hwa; Kim, Hye Jung; Park, Ho Yong; Park, Ji Young; Chae, Yee Soo; Lee, So Mi; Cho, Seung-Hyun; Shin, Kyung Min; Lee, Sang Yub

doi:10.1016/j.ultrasmedbio.2018.10.026

Cited by 25 publications

(22 citation statements)

References 26 publications

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“…Although they cannot replace current decision paradigms, they nevertheless allow a more individualized assessment of axillary pCR. There have been many efforts to develop nomograms, or scoring systems to predict axillary pCR, and some of those study results are summarized in Table 4 (108)(109)(110)(111)(112)(113)(114)(115)(116)(117)(118). Negative hormone receptor and positive HER2 receptor status, lower clinical T and N stages, high histologic and nuclear grade, and breast tumor response to NAC were the common predictors of axillary pCR.…”

Section: Axillary Nodal Evaluation Following Nacmentioning

confidence: 99%

“…Negative hormone receptor and positive HER2 receptor status, lower clinical T and N stages, high histologic and nuclear grade, and breast tumor response to NAC were the common predictors of axillary pCR. Interestingly, imaging findings such as tumor size change at MRI or nodal status at axillary US before or after treatment were also found to be the important predictors in many models (Fig 10) (109,111,112,(115)(116)(117)(118). According to the American College of Radiology Appropriateness Criteria, the most accurate imaging modality in the assessment of residual disease before and after NAC is MRI for primary breast cancer and US for axillary LN (119).…”

Section: Axillary Nodal Evaluation Following Nacmentioning

confidence: 99%

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Axillary Nodal Evaluation in Breast Cancer: State of the Art

Leung²,

et al. 2020

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Axillary lymph node (LN) metastasis is the most important predictor of overall recurrence and survival in patients with breast cancer, and accurate assessment of axillary LN involvement is an essential component in staging breast cancer. Axillary management in patients with breast cancer has become much less invasive and individualized with the introduction of sentinel LN biopsy (SLNB). Emerging evidence indicates that axillary LN dissection may be avoided in selected patients with node-positive as well as nodenegative cancer. Thus, assessment of nodal disease burden to guide multidisciplinary treatment decision making is now considered to be a critical role of axillary imaging and can be achieved with axillary US, MRI, and US-guided biopsy. For the node-positive patients treated with neoadjuvant chemotherapy, restaging of the axilla with US and MRI and targeted axillary dissection in addition to SLNB is highly recommended to minimize the false-negative rate of SLNB. Efforts continue to develop prediction models that incorporate imaging features to predict nodal disease burden and to select proper candidates for SLNB. As methods of axillary nodal evaluation evolve, breast radiologists and surgeons must work closely to maximize the potential role of imaging and to provide the most optimized treatment for patients.

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Section: Axillary Nodal Evaluation Following Nacmentioning

confidence: 99%

Section: Axillary Nodal Evaluation Following Nacmentioning

confidence: 99%

Axillary Nodal Evaluation in Breast Cancer: State of the Art

Leung²,

et al. 2020

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“…36 However, even with the combined model constructed in previous studies through integration of imaging and clinicopathologic characteristics, the sensitivity and specificity for predicting axillary pathological response to NACT are moderate, 67.9%, and 73.6%, respectively. 13 In contrast, we created an accurate nomogram by combining the results of clinicopathologic factors, imaging indicators, and serological tumor indicators. These variables are the most common clinical indicators and are therefore very easy to acquire.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple models have been published predicting axillary pathological response after NACT in varying cohorts. [10][11][12][13][14][15][16][17][18][19][20][21][22][23] Some baseline clinicopathological features and genotyping can predict the curative effect of NACT for breast cancer and further reflect the satisfied prognosis. However, the high costs associated with these genetic and molecular tests limit their utility in regular clinical practice.…”

Section: Introductionmentioning

confidence: 99%

A Practical Predictive Model Based on Ultrasound Imaging and Clinical Indices for Estimation of Response to Neoadjuvant Chemotherapy in Patients with Breast Cancer

Duan

Zhao

et al. 2021

CMAR

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Purpose: Clinical responses of neoadjuvant chemotherapy (NACT) are associated with prognosis in patients with breast cancer. The selection of suitable variables for the prediction of clinical responses remains controversial. Herein, we developed a predictive model based on ultrasound imaging and clinical indices to identify patients most likely to benefit from NACT. Patients and Methods: We recruited a total of 225 consecutive patients who underwent NACT followed by surgery and axillary lymph node dissection at the Sixth Hospital of Ning Bo City of Zhe Jiang Province between January 1, 2018, and March 31, 2021. All patients had been diagnosed with breast cancer following the clinical examination. First, we created a training cohort of patients who underwent NACT+surgery (N=180) to develop a nomogram. We then validated the performance of the nomogram in a validation cohort of patients who underwent NACT+ surgery (N=45). Multivariate logistic regression was then used to identify independent risk factors that were associated with the response to NACT; these were then incorporated into the nomogram. Results: Multivariate logistic regression analysis identified several significant differences as to clinical responses of NACT, including neutrophil-lymphocyte ratio (NLR), body mass index (BMI), pulsatility index (PI), resistance index (RI), blood flow, Ki67, histological type, molecular subtyping, and tumor size. The performance of the nomogram score exhibited a robust C-index of 0.89 (95% confidence interval [CI]: 0.83 to 0.95) in the training cohort and a high C-index of 0.87 (95% CI: 0.81 to 0.93) in the validation cohort. Clinical impact curves showed that the nomogram had a good predictive ability. Conclusion:We successfully established an accurate and optimized nomogram incorporated ultrasound imaging and clinical indices that could be used preoperatively to predict clinical responses of NACT. This model can be used to evaluate the risk of clinical responses to NACT and therefore facilitate the choice of personalized therapy.

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“…Therefore, restaging may play a role in predicting nodal status. Imaging (usually US) has been recommended for guiding axillary surgery in previous studies, despite the moderate sensitivity of this approach [13, 27, 28].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided dual-localization for axillary nodes before and after neoadjuvant chemotherapy with clip and activated charcoal in breast cancer patients: a feasibility study

Kim

et al. 2019

BMC Cancer

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Background We report on our experience of ultrasound (US)-guided dual-localization for axillary nodes before and after neoadjuvant chemotherapy (NAC) with clip and activated charcoal to guide axillary surgery in breast cancer patients. Methods Between November 2017 and May 2018, a dual-localization procedure was performed under US guidance for the most suspicious axillary nodes noted at initial staging (before NAC, with clip) and restaging (after NAC, with activated charcoal) in 28 cytologically proven node-positive breast cancer patients. Patients underwent axillary sampling or dissection, which involved removing not only the sentinel nodes (SNs), but also clipped nodes (CNs) and tattooed nodes (TNs). Success (or failure) rates of biopsies of SNs, CNs, and TNs and inter-nodal concordance rates were determined. Sensitivities for the individual and combined biopsies were calculated. Results SN biopsy failed in four patients (14%), whereas the CN biopsy failed in one patient (4%). All TNs were identified in the surgical field. Concordance rates were 79% for CNs–TNs, 63% for CNs–SNs, and 58% for TNs–SNs. Sensitivity for SN, CN, and TN biopsy was 73%, 67%, and 67%, respectively. Sensitivity was 80% for any combination of biopsies (SN plus CN, SN plus TN, SN plus CN plus TN). Conclusions US-guided dual-localization of axillary nodes before and after NAC with clip and activated charcoal was a feasible approach that might facilitate more reliable nodal staging with less-invasive strategies in node-positive breast cancer patients.

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Axillary Pathologic Complete Response to Neoadjuvant Chemotherapy in Clinically Node-Positive Breast Cancer Patients: A Predictive Model Integrating the Imaging Characteristics of Ultrasound Restaging with Known Clinicopathologic Characteristics

Cited by 25 publications

References 26 publications

Axillary Nodal Evaluation in Breast Cancer: State of the Art

Axillary Nodal Evaluation in Breast Cancer: State of the Art

A Practical Predictive Model Based on Ultrasound Imaging and Clinical Indices for Estimation of Response to Neoadjuvant Chemotherapy in Patients with Breast Cancer

Ultrasound-guided dual-localization for axillary nodes before and after neoadjuvant chemotherapy with clip and activated charcoal in breast cancer patients: a feasibility study

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