High-resolution axillary ultrasound is a poor prognostic test for determining pathologic lymph node status in patients undergoing neoadjuvant chemotherapy for locally advanced breast cancer

Role of Ultrasound in the Diagnosis of Lymph Node Status in Axillary Lymph Node Metastases in Breast Cancer undergoing Neoadjuvant Chemotherapy

“…We need a method that can accurately evaluate the axillary status to guide the treatment after NAC.Herrada, J et al believed that ultrasound was the most accurate imaging examination method for the assessment of axillary status at present [7], while klauber-demore, N et al believed that ultrasound was not accurate enough for the assessment of axillary status after neoadjuvant chemotherapy for locally advanced breast cancer [8].Whether SLNB can replace ALND to evaluate the axillary status of patients with clinically negative ALNs is controversial [4,[9][10][11][12].ACOSOG Z1071 test and a number of studies have shown [5,[13][14][15][16]] that AUS combined with SLNB after NAC can reduce the FNR of axillary diagnosis and replace ALND to achieve the purpose of accurate assessment of axillary status.It has also been reported that [17] ultrasound and magnetic resonance imaging(MRI) have the same or more important value in accurately measuring the size of residual lesions of breast cancer after NAC.…”

“…The status of axillary lymph node (ALN) is one of the most importent prognostic factors in patients with breast cancer.Sentinel lymph node biopsy (SLNB) instead of axillary lymph node dissection (ALND) is widely used to evaluate ALN status in clinically node-negative patients with breast cancer, with less morbidity of surgical complications compared with ALND [1].And its security had been tested by many trails in early-stage breast cancer [2,3].However, whether it is applicable to the clinical evaluation of patients with negative ALNs after neoadjuvant chemotherapy(NAC) from locally advanced breast cancer with positive initial axillary lymph nodes remains controversial [4].In ACOSOG Z1071 trial, in patients with breast cancer with clinical N1 stage receiving NAC,the false-negative rate(FNR) of SLN biopsy (SLNB) was 12.6% [5].And the secondary endpoint of this trial was to evaluate the ALN status of patients after NAC by ultrasound.SLNB was performed in patients with negative axillary lymph nodes by ultrasound, and FNR was 9.8% [6].Ultrasound is one of the important basic methods to evaluate the axillary condition of breast cancer patients [7],it is an important means for evaluating the e cacy of chemotherapy [8].And it would be helpful for the reassessment of axillary lymph node status in these patients after NAC and guide the selection of their axillary surgical options.…”

Feasibility of Axillary Ultrasound in the Quality Assessment of Sentinel Node Biopsy in Breast Cancer Surgery

“…In all axillary enlarged nodes, approximately 65% arem alignant in breast cancer,t his can be confirmed with ultrasound-guided corebiopsy (17).The corebiopsy of axilla has proven to be asafe and reliable method in axilla (15). However,anegative postsurgical AU or physicalexamination does not always predict pathologic node status, and these tests may have limited value at least after neoadjuvant chemotherapy in locally advancedb reast cancer (23). As well postoperative adjuvant radiotherapy and chemotherapy may cause temporary disappearance of metastasis in axilla, thereforethe follow-up time has to be long enough to give acorrect diagnosis.…”

Imaging of the axilla before preoperative chemotherapy: Implications for postmastectomy radiation

“…34 Similarly, Klauber-Demore et al observed that the use of US after NAC had a PPV of 83% with an NPV of only 52%. 35 Finally, Vlastos et al studied US in patients with less advanced breast cancer (stage II) who received NAC 36 and observed that the PPV and NPV of US were both low at 67% and 49%, respectively, and the overall accuracy of US was 57% for correctly classifying ALN status. 36 In summary, those studies demonstrated that US imaging alone is not sufficient to accurately stage the axilla in the NAC setting.…”