Management of the Axilla in the Era of Breast Cancer Heterogeneity

Bellefon, M. de Méric de; Lemanski, C.; Ducteil, A.; Fenoglietto, P.; Azria, D.; Bourgier, C.

doi:10.3389/fonc.2018.00084

Cited by 10 publications

(9 citation statements)

References 55 publications

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“…Non-invasive prediction of lymph node status for patients with early-stage invasive breast cancer based on a morphological feature from ultrasound images for local disease control. In the past few years, sentinel node biopsy (SNB) has developed as an alternative to ALND and has become the regular treatment for axillary evaluation in clinically negative patients (4)(5)(6). The SNB is a minimally invasive method and has a significantly lower incidence rate of complications such as lymphedema, numbness, pain, and shoulder impairment than ALND (7,8).…”

Section: Original Articlementioning

confidence: 99%

Non-invasive prediction of lymph node status for patients with early-stage invasive breast cancer based on a morphological feature from ultrasound images

Jiang¹,

Su²,

Zhao³

et al. 2021

Quant Imaging Med Surg

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Background: This study aimed to estimate the value of a morphological feature on ultrasound (US) for preoperative diagnosis of axillary lymph node (ALN) status in patients with early-stage invasive breast cancer (ESIBC).Methods: In this retrospective work, a total of 239 ESIBC patients, were recruited, and their preoperative US images and postoperative pathology results were collected. The relationship between US images based on morphological features and ALN metastasis was investigated. The tumor circularity and US-reported ALN status were developed as a nomogram to predict the ALN status.Results: Among the 239 participants, 82 (34.31%) had ALN metastasis, and 157 (65.69%) did not. There was a statistically significant difference in tumors between participants diagnosed with and without ALN metastasis. The median value was 0.47 vs. 0.62 (P<0.001) in the training group, respectively, and the value was 0.50 vs. 0.60 (P<0.001) in the validation group, respectively. The clinical model nomogram was shown to have high efficiency in predicting ALN status among our research population. The area under the curve (AUC) was 0.89 in the training group and 0.90 in the validation group and the accuracy was 85.79% and 81.63%, respectively. Conclusions:The clinical model nomogram based on tumor circularity and US-reported ALN status is a non-invasive approach for ALN metastasis prediction in ESIBC patients with high efficacy.

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Section: Original Articlementioning

confidence: 99%

Non-invasive prediction of lymph node status for patients with early-stage invasive breast cancer based on a morphological feature from ultrasound images

Jiang¹,

Su²,

Zhao³

et al. 2021

Quant Imaging Med Surg

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“…On the one hand, there is a trend towards de-escalation of surgical and systemic therapy (de Meric de Bellefon et al 2018, Mariotto et al 2020Tolaney et al 2015;van der Voort et al 2021;Veronesi et al 2002).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of different imaging modalities for axillary lymph node staging in breast cancer patients to provide a personalized and optimized therapy algorithm

Diessner

Anders

Herbert

et al. 2022

J Cancer Res Clin Oncol

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Purpose The reliable detection of tumor-infiltrated axillary lymph nodes for breast cancer [BC] patients plays a decisive role in further therapy. We aimed to find out whether cross-sectional imaging techniques could improve sensitivity for pretherapeutic axillary staging in nodal-positive BC patients compared to conventional imaging such as mammography and sonography. Methods Data for breast cancer patients with tumor-infiltrated axillary lymph nodes having received surgery between 2014 and 2020 were included in this study. All examinations (sonography, mammography, computed tomography [CT] and magnetic resonance imaging [MRI]) were interpreted by board-certified specialists in radiology. The sensitivity of different imaging modalities was calculated, and binary logistic regression analyses were performed to detect variables influencing the detection of positive lymph nodes. Results All included 382 breast cancer patients had received conventional imaging, while 52.61% of the patients had received cross-sectional imaging. The sensitivity of the combination of all imaging modalities was 68.89%. The combination of MRI and CT showed 63.83% and the combination of sonography and mammography showed 36.11% sensitivity. Conclusion We could demonstrate that cross-sectional imaging can improve the sensitivity of the detection of tumor-infiltrated axillary lymph nodes in breast cancer patients. Only the safe detection of these lymph nodes at the time of diagnosis enables the evaluation of the response to neoadjuvant therapy, thereby allowing access to prognosis and improving new post-neoadjuvant therapies.

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“…Axillary lymph node dissection could mostly be replaced by sentinel node biopsy and breastconserving surgery could prove a comparable outcome to radical mastectomy. Consequently, therapeutic side effects were reduced drastically [13,25]. In terms of systemic therapy multigene assays helped individualize the therapeutic approach and to reduce the application of adjuvant chemotherapies [26][27][28].…”

Section: Discussionmentioning

confidence: 99%

“…Over the past decades, different management strategies have emerged in axillary lymph node surgery favoring less invasive procedures. To that effect ALND has been replaced by sentinel lymph node biopsy (SNB) in early stages of BC [13]. Especially after the publication of the ACOSOG Z0011 and AMAROSclinical trials which have shown that even in patients with nodal involvement (1 or 2 positive sentinel nodes) -who meet certain criteria -there seems to be no additional bene t of the ALND regarding clinical outcome [14,15].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Different Imaging Modalities for Axillary Lymph Node Staging in Breast Cancer Patients to Provide A Personalized and Optimized Therapy Algorithm

Diessner¹,

Anders²,

Herbert³

et al. 2021

Preprint

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Purpose The prognostic importance of lymph node infiltration in breast cancer patients before and after neoadjuvant therapy has increased significantly in recent years. For that reason, the reliable detection of tumor-infiltrated axillary lymph nodes at the time of diagnosis plays a decisive role in further therapy. We therefore focused on the sensitivity of different pretherapeutic imaging modalities (sonography, mammography, computed tomography [CT] and magnetic resonance imaging [MRI]) in nodal positive breast cancer patients and aimed to find out whether cross-sectional imaging techniques (MRI, CT) could improve sensitivity for pretherapeutic axillary staging compared to conventional imaging such as mammography and sonography. Methods Breast cancer patients with tumor-infiltrated axillary lymph nodes between 2014 and 2020 having a surgery for breast cancer were included in the study. Results All included 382 breast cancer patients had received conventional imaging, while 52.61% of the patients had received cross-sectional imaging. The sensitivity of the combination of all imaging modalities was 68.89%. The combination of MRI and CT showed 63.83% and the combination of sonography and mammography showed 36.11% sensitivity.Conclusion We could demonstrate that cross-sectional imaging can improve the sensitivity of the detection of tumor-infiltrated axillary lymph nodes in breast cancer patients. Considering the increasing importance of neoadjuvant and post-neoadjuvant therapeutic algorithms, the reliable detection of tumor-infiltrated lymph nodes gains increasing importance. Only the safe detection of tumor-infiltrated lymph nodes at the time of diagnosis enables the evaluation of the response to neoadjuvant therapy and thereby allows access to prognosis–improving post-neoadjuvant therapies.

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Management of the Axilla in the Era of Breast Cancer Heterogeneity

Cited by 10 publications

References 55 publications

Non-invasive prediction of lymph node status for patients with early-stage invasive breast cancer based on a morphological feature from ultrasound images

Non-invasive prediction of lymph node status for patients with early-stage invasive breast cancer based on a morphological feature from ultrasound images

Evaluation of different imaging modalities for axillary lymph node staging in breast cancer patients to provide a personalized and optimized therapy algorithm

Evaluation of Different Imaging Modalities for Axillary Lymph Node Staging in Breast Cancer Patients to Provide A Personalized and Optimized Therapy Algorithm

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