An objective nodal staging system for breast cancer patients undergoing neoadjuvant systemic treatment

Yoo, Tae Kyung; Chang, Jung Min; Shin, Hyopil; Han, Wonshik; Noh, Dong Young; Moon, Hyeong‐Gon

doi:10.1186/s12885-017-3380-8

Cited by 3 publications

(2 citation statements)

References 34 publications

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“…Incorporation of cross-sectional imaging, including chest CT, PET/CT, and MRI, had been suggested to predict pCR, because these techniques allow superior visualization of regional LNs located in the apex or outside the axilla and overcome the limitations of US evaluation, which is often limited to axillary level I and II. The results showed that pretreatment axillary nodal stage correlated with final surgery results and survival outcome (105,106). When PET/CT results were used to triage axillary treatment in combination with the MARI procedure, unnecessary treatment was reduced in 74% of the patients (107).…”

Section: Axillary Nodal Evaluation Following Nacmentioning

confidence: 97%

Axillary Nodal Evaluation in Breast Cancer: State of the Art

Leung²,

et al. 2020

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Axillary lymph node (LN) metastasis is the most important predictor of overall recurrence and survival in patients with breast cancer, and accurate assessment of axillary LN involvement is an essential component in staging breast cancer. Axillary management in patients with breast cancer has become much less invasive and individualized with the introduction of sentinel LN biopsy (SLNB). Emerging evidence indicates that axillary LN dissection may be avoided in selected patients with node-positive as well as nodenegative cancer. Thus, assessment of nodal disease burden to guide multidisciplinary treatment decision making is now considered to be a critical role of axillary imaging and can be achieved with axillary US, MRI, and US-guided biopsy. For the node-positive patients treated with neoadjuvant chemotherapy, restaging of the axilla with US and MRI and targeted axillary dissection in addition to SLNB is highly recommended to minimize the false-negative rate of SLNB. Efforts continue to develop prediction models that incorporate imaging features to predict nodal disease burden and to select proper candidates for SLNB. As methods of axillary nodal evaluation evolve, breast radiologists and surgeons must work closely to maximize the potential role of imaging and to provide the most optimized treatment for patients.

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Section: Axillary Nodal Evaluation Following Nacmentioning

confidence: 97%

Axillary Nodal Evaluation in Breast Cancer: State of the Art

Leung²,

et al. 2020

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“…However, PET and PET/CT are not sufficiently sensitive for the evaluation of positive axillary LNs; therefore, they are recommended for primary nodal staging [ 10 ]. Additionally, data pertaining to the evaluation of axillary nodal burden using CT are limited because they exhibit only moderate sensitivity and specificity [ 11 12 ].…”

Section: Introductionmentioning

confidence: 99%

Prediction of Residual Axillary Nodal Metastasis Following Neoadjuvant Chemotherapy for Breast Cancer: Radiomics Analysis Based on Chest Computed Tomography

et al. 2023

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Objective To evaluate the diagnostic performance of chest computed tomography (CT)-based qualitative and radiomics models for predicting residual axillary nodal metastasis after neoadjuvant chemotherapy (NAC) for patients with clinically node-positive breast cancer. Materials and Methods This retrospective study included 226 women (mean age, 51.4 years) with clinically node-positive breast cancer treated with NAC followed by surgery between January 2015 and July 2021. Patients were randomly divided into the training and test sets (4:1 ratio). The following predictive models were built: a qualitative CT feature model using logistic regression based on qualitative imaging features of axillary nodes from the pooled data obtained using the visual interpretations of three radiologists; three radiomics models using radiomics features from three (intranodal, perinodal, and combined) different regions of interest (ROIs) delineated on pre-NAC CT and post-NAC CT using a gradient-boosting classifier; and fusion models integrating clinicopathologic factors with the qualitative CT feature model (referred to as clinical-qualitative CT feature models) or with the combined ROI radiomics model (referred to as clinical-radiomics models). The area under the curve (AUC) was used to assess and compare the model performance. Results Clinical N stage, biological subtype, and primary tumor response indicated by imaging were associated with residual nodal metastasis during the multivariable analysis (all P < 0.05). The AUCs of the qualitative CT feature model and radiomics models (intranodal, perinodal, and combined ROI models) according to post-NAC CT were 0.642, 0.812, 0.762, and 0.832, respectively. The AUCs of the clinical-qualitative CT feature model and clinical-radiomics model according to post-NAC CT were 0.740 and 0.866, respectively. Conclusion CT-based predictive models showed good diagnostic performance for predicting residual nodal metastasis after NAC. Quantitative radiomics analysis may provide a higher level of performance than qualitative CT features models. Larger multicenter studies should be conducted to confirm their performance.

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Features of combined treatment for breast cancer with isolated supraclavicular or parasternal lymph node metastasis

Zikiryakhodzhaev¹,

Рассказова²,

Ермощенкова³

et al. 2019

Onkol. Z. im. P.A. Gercena

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Проведен анализ современных подходов к диагностике и лечению рака молочной железы (РМЖ) с метастазами в надключичных и парастернальных лимфатических узлах (ЛУ). Рассмотрены особенности метастазирования РМЖ, указано, что из надключичных ЛУ выделяют анатомически наиболее важный сигнальный, или сторожевой, узел. Отмечено, что при локализации опухоли в медиальных и центральных квадрантах железы возрастает роль парастернального пути, поскольку внутренний грудной коллектор является одним из основных путей метастазирования РМЖ. Рассмотрена роль лучевой терапии в качестве одного из методов локального воздействия на пoраженный метастазами коллектор. Приведены результаты проведенных к настоящему времени клинических исследований по оценке эффективности и безопасности лечения РМЖ с метастазами в надключичных и парастернальных ЛУ. Отмечено, что для таких больных характерен высокий риск недиагностированных отдаленных метастазов даже в отсутствие явных клинических признаков их наличия. Этим пациенткам рекомендуют назначать комбинированное лечение (химиотерапия, хирургическое лечение и лучевая терапия). В то же время убедительные данные, подтверждающие целесообразность назначения комбинированного лечения рассматриваемой категории больных РМЖ, на сегодняшний день отсутствуют, а роль хирургического лечения при метастазах в надключичных ЛУ на сегодняшний день исследована недостаточно. Тем не менее установлено, что лимфаденэктомия надключичной группы является предиктором общей выживаемости данного контингента пациенток. Ряд авторов полагают, что с учетом этого РМЖ с метастазами в надключичных и парастернальных ЛУ без признаков отдаленного метастазирования можно рассматривать как регионарный и, следовательно, потенциально излечимый. Ключевые слова: рак молочной железы, местно-распространенный рак молочной железы, метастазы в парастернальных лимфатических узлах, лучевая терапия, первично-множественный метахронный рак молочных желез, комплексное лечение.

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An objective nodal staging system for breast cancer patients undergoing neoadjuvant systemic treatment

Cited by 3 publications

References 34 publications

Axillary Nodal Evaluation in Breast Cancer: State of the Art

Axillary Nodal Evaluation in Breast Cancer: State of the Art

Prediction of Residual Axillary Nodal Metastasis Following Neoadjuvant Chemotherapy for Breast Cancer: Radiomics Analysis Based on Chest Computed Tomography

Features of combined treatment for breast cancer with isolated supraclavicular or parasternal lymph node metastasis

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