The use of ultrasound in the clinical re-staging of the axilla after neoadjuvant chemotherapy (NACT)

Peppe, Anastasia; Wilson, Robin; Pope, Romney; Downey, Kate; Rusby, Jennifer

doi:10.1016/j.breast.2017.05.015

Cited by 25 publications

(17 citation statements)

References 34 publications

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“…Peppe et al reported that there were notable variations in NPV and PPV by AUS according to tumor subtype, with HER2+ cases having a higher NPV, which is concordant with our results. However, other related factors were not investigated 19 . Several studies have reported factors associated with pathological response in nodes following NAC.…”

Section: Discussionmentioning

confidence: 99%

“…Although both studies showed that AUS reduced FNR, investigators took the position that US alone is not accurate enough to assess axillary response. Admittedly, the accurate prediction rate of node-negative status after NAC by AUS varies ranging from 46.2 to 89.6% in a number of studies [17][18][19] . Similarly, we found in our cohort that the NPV by AUS after NAC was 50.8%.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of axillary node status by ultrasound after neoadjuvant chemotherapy in patients with clinically node-positive breast cancer according to breast cancer subtype

Maeshima

Sakai

Ogiya

et al. 2021

Sci Rep

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The use of sentinel node biopsy (SNB) following neoadjuvant chemotherapy (NAC) for patients with cN1 breast cancer is controversial. Improvements of negative predictive value (NPV) by axillary ultrasound (AUS), which corresponds to the accurate prediction rate of node-negative status after NAC, would lead to decreased FNR of SNB following NAC. In this study, we retrospectively investigated the accurate prediction rate of NPV by AUS after NAC in patients with cytologically node-positive breast cancer treated between January 2012 and December 2016. Of 279 eligible patients, the NPV was 49.2% in all patients, but varied significantly by tumor subtype (p < 0.001) and tumor response determined by magnetic resonance imaging (MRI) (p = 0.0003). Of the 23 patients with clinically node negative (ycN0) by AUS and clinical complete response in primary lesion by MRI, the NPV was 100% in patients with HR±/HER2+ or HR−/HER2− breast cancer. In conclusion, regarding FNR reduction post-NAC, it will be of clinical value to take tumor subtype and primary tumor response using MRI into account to identify patients for SNB after NAC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Assessment of axillary node status by ultrasound after neoadjuvant chemotherapy in patients with clinically node-positive breast cancer according to breast cancer subtype

Maeshima

Sakai

Ogiya

et al. 2021

Sci Rep

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“…Axillary ultrasound (AUS) is a convenient and useful imaging method for clinical axilla staging prior to surgery in breast cancer patients with or without NAC. [19][20][21] Thus, numerous institutions have adopted AUS as a routine practice to evaluate axillary status prior to surgery in the management of patients with breast cancer. However, to the best of our knowledge, there has been no model including pre-surgery AUS to predict the risk of non-SLN metastasis in patients after NAC.…”

Section: Introductionmentioning

confidence: 99%

<p>A New Model Incorporating Axillary Ultrasound After Neoadjuvant Chemotherapy to Predict Non-Sentinel Lymph Node Metastasis in Invasive Breast Cancer</p>

Zhang

Zhu

Sheng

et al. 2020

CMAR

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These authors contributed equally to this workPurpose: Few models with good discriminative power have been introduced to predict the risk of non-sentinel lymph node (non-SLN) metastasis in breast cancer after neoadjuvant chemotherapy (NAC). We aimed to develop a new and simple model for predicting the probability of non-SLN metastasis in breast cancer and facilitate the selection of patients who could avoid unnecessary axillary lymph node dissection following NAC. Patients and Methods: A total of 298 patients diagnosed with invasive breast cancer, who underwent SLN biopsy after completing NAC and subsequently breast surgery, were included and classified into the training set (n=228) and testing set (n=70). Univariate and multivariate analyses were used to select factors that could be determined prior to breast surgery and significantly correlated with non-SLN metastasis in the training set. A logistic regression model was developed based on these factors and validated in the testing set. Results: Nodal status before NAC, post-NAC axillary ultrasound status, SLN number, and SLN metastasis number were independent predictors of non-SLN metastases in breast cancer after NAC. A predictive model based on these factors yielded an area under the curve of 0.838 (95% confidence interval: 0.774-0.902, p< 0.001) in the training set. When applied to the testing set, this model yielded an area under the curve of 0.808 (95% confidence interval: 0.609-1.000, p= 0.003). Conclusion:A new and simple model, which incorporated factors that could be determined prior to breast surgery, was developed to predict non-SLN metastasis in invasive breast cancer following NAC. Although this model performed excellently in internal validation, it requires external validation before it can be widely utilized in the clinical setting.

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“…The differences in these results can be explained by the methodology of the studies, racial differences, and variables in the clinicopathological characteristics of the patients included in the studies. The summary results of the previous studies are presented in Table 5 [5][6][7][8][9][10][11][12][13][15][16][17][18][19][20]. The key limitations of this study are its retrospective design and the relatively small sample size.…”

Section: Discussionmentioning

confidence: 99%

“…The differences in these results can be explained by the methodology of the studies, racial differences, and variables in the clinicopathological characteristics of the patients included in the studies. The summary results of the previous studies are presented in Table 5 [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 15 , 16 , 17 , 18 , 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of US, MRI, and F-18 FDG-PET/CT for Detecting Axillary Lymph Node Metastasis after Neoadjuvant Chemotherapy in Breast Cancer Patients

et al. 2021

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Background: The aim of this study was to investigate the efficacy of post-neoadjuvant chemotherapy (NAC) ultrasound (US), magnetic resonance imaging (MRI), and F-18fluorodeoxyglucose positron emission tomography (F-18 FDG-PET/CT) for detecting post-NAC axillary lymph node(ALN) metastasis in patients who had ALN metastasis at the time of diagnosis. Methods: This study included all breast cancer patients who received NAC for ALN metastasis; underwent axillary assessment with US, MRI, or F18FDG-PET/CT; and then were operated on in the General Surgery Clinic, Adana City Research and Training Hospital, Turkey. Patients’ data were recorded, including demographic data, clinicopathological parameters, NAC regimens, and operation types. The axillary response to chemotherapy on post-NAC US, MRI, and F-18 FDG-PET/CT was compared with the postoperative histopathological result of the ALN. Results: The study included a total of 171 female patients. The mean age of the patients was 53.28 ± 10.62 years. The post-NAC assessment revealed that the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of US for detecting ALN metastasis were 59.42%, 82.35%, 82.00%, and 60.00%, respectively, while the same measures regarding MRI for detecting ALN metastasis were 36.67%, 77.78%, 73.33%, and 42.42%, respectively. The sensitivity, specificity, PPV, and NPV of F-18FDG-PET/CT were 47.50%, 76.67%, 73.08%, and 52.27%, respectively. The evaluation of dual combinations of these three imaging techniques showed that the specificity and PPV of the combined use of US and F-18FDG-PET/CT was 100%. Conclusions: The results showed that US has the highest sensitivity and specificity for detecting ALN metastasis after NAC. Furthermore, ALND may be preferred for these patients instead of SLNB if both examinations simultaneously indicate lymph node metastasis in the post-NAC assessment with US and F-18 FDG-PET/CT. SLNB may be preferred if these two examinations simultaneously show a complete response.

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The use of ultrasound in the clinical re-staging of the axilla after neoadjuvant chemotherapy (NACT)

Cited by 25 publications

References 34 publications

Assessment of axillary node status by ultrasound after neoadjuvant chemotherapy in patients with clinically node-positive breast cancer according to breast cancer subtype

Assessment of axillary node status by ultrasound after neoadjuvant chemotherapy in patients with clinically node-positive breast cancer according to breast cancer subtype

<p>A New Model Incorporating Axillary Ultrasound After Neoadjuvant Chemotherapy to Predict Non-Sentinel Lymph Node Metastasis in Invasive Breast Cancer</p>

Efficacy of US, MRI, and F-18 FDG-PET/CT for Detecting Axillary Lymph Node Metastasis after Neoadjuvant Chemotherapy in Breast Cancer Patients

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