The incidence of metastases detected on a staging CT scan prior to neoadjuvant chemotherapy in early stage breast cancer

Abstract

Background: With the increased use of neoadjuvant chemotherapy (NAC), as well as increasing efficacy of systemic therapy, a substantial proportion of clinically nodepositive patients may achieve a nodal pathologic complete response (pCR) with chemotherapy. Instead of axillary lymph node dissection (ALND), a novel surgical technique called targeted axillary dissection (TAD) including removal of sentinel lymph nodes (SLNs) and clip-marked node has been gaining acceptance in recent years. Logically, preoperative identification of patients with pCR or residual disease would allow for the optimization of axillary surgery for performing a TAD or proceeding to a ALND after NAC, thus sparing patients unnecessary procedures or expense. The aim of this study was to investigate the value of 18 F-FDG PET/CT in tailoring axillary surgery by predicting nodal response among node-positive breast cancer patients after NAC. Methods: Breast cancer patients with biopsy-confirmed nodal metastasis were prospectively enrolled. At least one 18 F-FDG PET/CT scan was performed before NAC (a second one after two cycles with baseline SUV max in axillary lymph nodes 2.5), among whom a subset of patients had underwent TAD. All the patients ultimately underwent ALND. The accuracy was calculated by a comparison with the final pathologic results. Results: Table . Accuracy of 18 F-FDG PET/CT to Predict Ax-pCR in Overall Population and Different Subtypes Overall population ER-HER2þ subtype The rest subtypes No. of patients 111 31 80 Ax-pCR rate (%) 55.

Expanded criteria for pretreatment staging CT in breast cancer

“…A recent analysis of 204 patients with stage I or II breast cancer who underwent staging with CT and/or MRI and/or bone scan identified lymph node involvement and stage IIb disease as risk factors for an increased incidence of distant metastases 19 . An abstract 26 published in 2019 reported a 10 per cent incidence of distant disease among 163 patients selected for neoadjuvant chemotherapy who underwent staging CT, as well as a correlation between increasing T category and metastatic disease in patients with clinically node-negative disease. Two other studies 27 , 28 also found similar significant correlations between the presence of metastatic disease and increasing tumour size and nodal involvement.…”