Diagnostic Performance of Noninvasive Imaging for Assessment of Axillary Response After Neoadjuvant Systemic Therapy in Clinically Node-positive Breast Cancer

Abstract

Objective: The purpose of this study was to perform a systematic review and meta-analysis to determine the diagnostic performance of current noninvasive imaging modalities for assessment of axillary response after neoadjuvant systemic therapy (NST) in clinically node-positive breast cancer patients. Summary of Background Data: NST can lead to downstaging of axillary lymph node disease. Imaging can potentially provide information about the axillary response to NST and, consequently, tailor the surgical management. Methods: PubMed and Embase were searched for studies that compared noninvasive imaging after NST with axillary surgery outcome to identify axillary response in patients with initial pathologically proven axillary lymph node metastasis. Two reviewers independently screened the studies and extracted the data. A meta-analysis was performed by computing the pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: Thirteen studies describing 2380 patients were included for final analysis. Of these patients, 1322 had undergone axillary ultrasound, 849 breast MRI, and 209 whole-body 18F-FDG PET-CT. The overall axillary pathologic complete response rate was 39.5% (941/2380). For axillary ultrasound, the pooled sensitivity, specificity, PPV, and NPV were 65%, 69%, 77%, 50%, respectively. For breast MRI, the pooled sensitivity, specificity, PPV, and NPV were 60%, 76%, 78%, 58%, respectively. For whole-body 18F-FDG PET-CT, the pooled sensitivity, specificity, PPV, and NPV were 38%, 86%, 78%, 49%, respectively. Conclusions: The diagnostic performance of current noninvasive imaging modalities is limited to accurately assess axillary response after NST in clinically node-positive breast cancer patients.

Axillary surgery in node-positive breast cancer

“…The use of non-invasive imaging after NACT cannot replace axillary surgery. In a meta-analysis looking at how reliable imaging is in determining nodal pathological complete response (pCR), the outcome of 2380 patients in 13 studies with non-invasive imaging after NACT was compared with axillary surgery [ 19 ]. The study showed an axillary pCR of 39.5% (941/2380).…”

Magnetic resonance imaging radiomics predicts preoperative axillary lymph node metastasis to support surgical decisions and is associated with tumor microenvironment in invasive breast cancer: A machine learning, multicenter study

“…The diagnostic performance of current non-invasive imaging modalities to assess ALN status, including magnetic resonance imaging (MRI) and axillary ultrasound, are limited by their high false-negative rates [7]. Nowadays, the development of radiomics in the aspects of tumor diagnosis, treatment decisions, and prognosis prediction is encouraging, and breast cancer is one of the focal areas in the exploration [8À10].…”

De-Escalation of Breast Cancer Surgery Following Neoadjuvant Systemic Therapy

“…Moreover, the diagnostic performance of non-invasive imaging, including PET and magnetic resonance imaging (MRI), for assessment of axillary response after NST in clinically node-positive breast cancer was the focus of a recent systematic review and meta-analysis. The authors concluded that the diagnostic performance of current noninvasive imaging modalities was too limited to accurately assess axillary response after NST in clinically node-positive breast cancer patients (13).…”