Association of the initial number of sonographically abnormal nodes with nodal pathological response and its implication

Yan, Zhiyan; Ng, Ruey Pyng; Lee, Yien Sien; Allen, John C.; Lim, Geok Hoon

doi:10.1016/j.clinimag.2021.03.002

Cited by 2 publications

(2 citation statements)

References 7 publications

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“…In our study, ypT was statistically associated with the nodal pCR. This finding was consistent with literature which reported similar findings (13). Breast tumor pCR have been reported to be highly correlated with nodal pCR (14).…”

Section: Discussionsupporting

confidence: 93%

Determining the benefit of neoadjuvant chemotherapy in reduction of axillary dissection rates in Z0011 trial cohort with high nodal burden

Yan¹,

Ng²,

Lee³

et al. 2022

Gland Surg

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Background: In breast cancer patients fulfilling the Z0011 trial criteria, axillary lymph node dissection (ALND) is reserved for patients with a high nodal burden of ≥3 metastatic nodes. In this group of patients, to avoid an ALND, neoadjuvant chemotherapy (NACT) could be given instead to achieve nodal pathological complete response (pCR). However, the benefit of NACT in achieving nodal pCR and avoiding ALND in this group of patients is unknown. We aimed to determine the nodal pCR rate in this group of patients who otherwise would have needed an ALND.Methods: cT1-2N0 breast cancer patients, with histologically proven nodal metastasis, who underwent NACT were identified from a prospectively maintained database. The sonographic criteria of ≥3 abnormal nodes, which has been reported as highly predictive of high nodal burden, was then used to identify the high nodal burden group. Nodal pCR was determined based on the ALND following NACT.Results: Twenty-four patients with high nodal burden were identified. Mean age was 55.2 years. 91.7% had invasive ductal carcinoma and 29.2% had grade III cancer. 54.2% achieved nodal pCR which was associated with ypT (P=0.006). Nodal pCR was 75%, 70% and 30% in the triple negative, human epidermal growth factor receptor2 (HER2) positive and ER/PR+HER2-tumors, respectively.Conclusions: In the postulated T1-2 breast cancer patients with high nodal burden, needing an upfront ALND, NACT could result in nodal pCR of 54.2%, with higher pCR in certain subtypes. Hence, to minimize ALND risk, NACT should be offered in this high nodal burden group.

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Section: Discussionsupporting

confidence: 93%

Determining the benefit of neoadjuvant chemotherapy in reduction of axillary dissection rates in Z0011 trial cohort with high nodal burden

Yan¹,

Ng²,

Lee³

et al. 2022

Gland Surg

Self Cite

View full text Add to dashboard Cite

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“…In another study involving patients with locally advanced breast cancer, there was again no difference in the nodal pCR between patients with initially N1/N2/N3 disease [7]. This was demonstrated again in another study which showed that nodal pCR was independent of the initial nodal burden on ultrasound [8]. However, both studies included patients of all biologic subtypes and not of the Her2 negative and HR positive tumour subset as in our study.…”

Section: Discussionsupporting

confidence: 70%

Use of axillary ultrasound to guide breast cancer management in the genomic assay era

Lim,

Allen,

Lee

et al. 2024

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INTRODUCTION: Chemotherapy is conventionally offered to non-stage IV breast cancer patients with metastatic nodes. However, the RxPONDER trial showed that chemotherapy can be omitted in selected patients with 1–3 metastatic nodes if the 21-gene assay recurrence score is ≤25. We aimed to investigate if axillary ultrasound can identify this group of patients with limited nodal burden so that they can undergo upfront surgery followed by gene assay testing, to potentially avoid chemotherapy. METHODS: T1-3, node positive, hormone receptor-positive and HER2-negative breast cancer patients ≥50 years old with axillary lymph node dissection (ALND) were reviewed from 2 centres. Patients with neoadjuvant chemotherapy and bilateral cancers were excluded. Number of ultrasound-detected abnormal axillary nodes, demographic and histological parameters were correlated with the number of metastatic nodes found on ALND. RESULTS: 138 patients were included, 59 (42.8%) and 79 (57.2%) patients had 1–3 and >3 metastatic nodes on ALND respectively. On logistic regression and ROC analysis, the number of ultrasound-detected abnormal nodes was significant (p < 0.001) for predicting limited nodal burden (ROC AUC = 0.7135). Probabilities of <4 metastatic nodes with ultrasound cut-offs of 5, 6 and 8 abnormal nodes were 0.057, 0.026 and 0.005 respectively, with 100% specificity. CONCLUSION: A cut-off of ≤5 ultrasound-detected abnormal nodes can distinguish between patients with limited versus high nodal burden, with high specificity. Hence, incorporating the number of abnormal ultrasound-detected nodes into clinical practice may prove useful in guiding between upfront surgery and gene assay testing or neoadjuvant chemotherapy in this group of patients.

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Association of the initial number of sonographically abnormal nodes with nodal pathological response and its implication

Cited by 2 publications

References 7 publications

Determining the benefit of neoadjuvant chemotherapy in reduction of axillary dissection rates in Z0011 trial cohort with high nodal burden

Determining the benefit of neoadjuvant chemotherapy in reduction of axillary dissection rates in Z0011 trial cohort with high nodal burden

Use of axillary ultrasound to guide breast cancer management in the genomic assay era

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