Imaging and pathology features to predict axillary tumor load in breast cancer

Bosch-Nicolau, Pau; Gamero, Rocío; Rodríguez-Arana, Ana; Plancarte, F.; Alcántara, Rodrigo; Carreras, Ramón; Sabadell, Dolors; Vernet-Tomas, M.

doi:10.1111/jog.13490

Cited by 4 publications

(1 citation statement)

References 21 publications

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“…This suggests that the SN technique is even less reliable in patients with axillary lymph node involvement and a more proliferative breast cancer, which is therefore more aggressive. Future trials should analyze all the techniques available to quantify axillary tumor load considering the histopathological, immunohistochemical and molecular characteristics of the tumors, given that it has been proven that these features influence the axillary tumor load (24,25) and the accuracy of diagnostic tests (26,27) An obvious limitation of this initial phase of the MUTAS trial is the very small number of patients analyzed that did not reach the predefined estimated sample size. The reason for the low recruitment was the outbreak of the COVID 2019 (COVID-19) pandemic a few months after the start of the study, 2.5 years ago.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of sentinel node mapping in patients with biopsy-proven metastatic axillary lymph nodes and upfront surgery: preliminary results of the Multimodal Targeted Axillary Surgery (MUTAS) trial

Vernet-Tomas¹,

Argudo²,

Jimenez³

et al. 2023

Gland Surg

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Background: Some studies suggested that the patients included in the Z0011 trial may represent patients with ultrasound-negative axillary nodes and axillary invasion diagnosed by sentinel node (SN) biopsy.Nevertheless, the National Comprehensive Cancer Network (NCCN) guidelines recommend SN mapping if 1 or 2 suspicious lymph nodes are identified on axillary ultrasound (AU). The aim of this preliminary phase of the Multimodal Targeted Axillary Surgery (MUTAS) trial was to establish the accuracy of SN mapping in patients with axillary involvement undergoing upfront surgery.Methods: Between September 2019 and March 2022, we recruited patients with biopsy-proven metastatic axillary nodes and upfront surgery from a single center. We performed SN mapping in these patients before the surgical intervention, which included axillary lymph node dissection. The biopsy-proven metastatic node, SNs and the remaining axillary nodes were excised separately. SN status was considered representative of the status of the remaining axillary nodes. We calculated the sensitivity, specificity, negative predictive value and positive predictive value of the SN, overall and in patients with palpable nodes, in those with non-palpable nodes and an AU leading to diagnosis of axillary involvement, in those with 1 or 2 suspicious nodes on AU, and in patients with a single suspicious node on AU. We evaluated clinical, imaging and pathology features as predictors of the status of the remaining axillary nodes, false-negatives, and false-positives. Results:We included 25 patients in this phase. The false-negative rate of SN mapping was 28% overall, 21.42% for patients with palpable nodes, 36.36% for patients with non-palpable nodes and an AU diagnosis of axillary involvement, 28.75% for those with 1 or 2 suspicious nodes on AU, and 15.38% in patients with a single suspicious node on AU. The negative predictive value was highest in patients with a single suspicious node on AU (75%). The only significant predictive factor was that FN showed a higher Ki67 index score.Conclusions: In this study, SN mapping was not reliable in patients with biopsy-proven metastatic axillary

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