Cross-sectional imaging to evaluate the extent of regional nodal disease in breast cancer patients undergoing neoadjuvant systemic therapy

Anderson, Tara; Glazebrook, Katrina N.; Murphy, Brittany L.; Viers, Lyndsay D.; Hieken, Tina J.

doi:10.1016/j.ejrad.2017.01.030

Cited by 13 publications

(9 citation statements)

References 26 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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“…Historically, SCL involvement presented as palpable disease, and the IMN involvement was confirmed after surgical excision such as extended radical mastectomy. With the development of imaging technologies such as positron emission tomography–computed tomography (PET-CT), however, extra-axillary regional lymph nodes in locally advanced breast cancer have been increasingly detected [6-8]. Despite the possibility of over-diagnosis, non-palpable SCL and/or clinically detected IMN involvement is becoming more and more common, and more data on the treatment outcome in this setting is needed.…”

Section: Introductionmentioning

confidence: 99%

Impact of Regional Nodal Irradiation for Breast Cancer Patients with Supraclavicular and/or Internal Mammary Lymph Node Involvement: A Multicenter, Retrospective Study (KROG 16-14)

et al. 2019

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PurposeThe purpose of this study was to evaluate the treatment outcomes of radiotherapy (RT) for breast cancer with ipsilateral supraclavicular (SCL) and/or internal mammary (IMN) lymph node involvement.Materials and MethodsA total of 353 patients from 11 institutions were included. One hundred and thirty-six patients had SCL involvement, 148 had IMN involvement, and 69 had both. All patients received neoadjuvant systemic therapy followed by breast-conserving surgery or mastectomy, and postoperative RT to whole breast/chest wall. As for regional lymph node irradiation, SCL RT was given to 344 patients, and IMN RT to 236 patients. The median RT dose was 50.4 Gy.ResultsThe median follow-up duration was 61 months (range, 7 to 173 months). In-field progression was present in SCL (n=20) and/or IMN (n=7). The 5-year disease-free survival (DFS) and overall survival rates were 57.8% and 75.1%, respectively. On multivariate analysis, both SCL/IMN involvement, number of axillary lymph node ≥ 4, triple-negative subtype, and mastectomy were significant adverse prognosticators for DFS (p=0.022, p=0.001, p=0.001, and p=0.004, respectively). Regarding the impact of regional nodal irradiation, SCL RT dose ≥ 54 Gy was not associated with DFS (5-year rate, 52.9% vs. 50.9%; p=0.696) in SCL-involved patients, and the receipt of IMN RT was not associated with DFS (5-year rate, 56.1% vs. 78.1%; p=0.099) in IMN-involved patients.ConclusionNeoadjuvant chemotherapy followed by surgery and postoperative RT achieved an acceptable in-field regional control rate in patients with SCL and/or IMN involvement. However, a higher RT dose to SCL or IMN RT was not associated with the improved DFS in these patients.

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“…Moreover, ALND also increases the risk of post-operative complications and even in some cases can cause mortality. Accurate assessment of axillary lymph nodes meta-stasis is very valuable in planning for chemotherapy extent and helps to decide surgical approach 13 . Therefore, in present study we determined the role of US axillary examination in predicting the presence of meta-stasis in breast cancer patients.…”

Section: Discussionmentioning

confidence: 99%

Axillary Ultrasound as Preoperative Staging in Clinical Negative Axillary Lymph Node Breast Cancer Patient

Javid¹,

Barry²

2021

PJMHS

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Objective: To determine the diagnostic accuracy of axillary US as a preoperative investigation by comparing it with the histology outcome of nodal status. Methods: This validation analysis was conducted in Mater Misericordia university hospital, Dublin Ireland form Feb 2007 to Feb 2015. All female patients with impalpable axillary lymph node and histology proven unifocal breast cancer between ages 18 to 75 years were included. Patients with the diagnosis of breast cancer were followed with Ultrasound imaging and results in Picture Archiving and communication system (PACS) and histology was confirmed using the patient center data base in both preoperative and postoperative course of breast cancer, including both sentinel lymph nodes and axillary lymph nodes. Results: A total of 625 patients had axillary ultrasound (US) to assess the preoperative axillary nodal status with mean age of 56±12 years. cN0 was diagnosed in 469 (75%) cases, cN1 in 136 (21.8%) cases and cN2 in 20 (3.2%) cases. After negative axillary ultrasound cN0 pathology shows positive pN2 and pN3 disease in 14 (2.9%) cases with the NPV of 97.01%. Axillary ultrasound had shown cN1 disease in 136 cases with the pathology outcome of pN2 and pN3 in 41 (30.14%) cases with the negative predictive value (NPV) of 69.85%. The overall sensitivity and specificity of the axillary US in detection of the positive node was 51.6% and 92.8% with PPV of 82.69% and NPV of 74.2%. Conclusion: Axillary US is a useful modality for screening of breast cancer patients. The negative US findings exclude the presence of advanced nodal disease. However, it cannot accurate distinguish between pN1 and pN2 or pN3 nodal disease. Keywords: Axillary ultrasound, Axillary lymph nodes, Breast cancer.

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Cross-sectional imaging to evaluate the extent of regional nodal disease in breast cancer patients undergoing neoadjuvant systemic therapy

Cited by 13 publications

References 26 publications

Axillary Nodal Evaluation in Breast Cancer: State of the Art

Axillary Nodal Evaluation in Breast Cancer: State of the Art

Impact of Regional Nodal Irradiation for Breast Cancer Patients with Supraclavicular and/or Internal Mammary Lymph Node Involvement: A Multicenter, Retrospective Study (KROG 16-14)

Axillary Ultrasound as Preoperative Staging in Clinical Negative Axillary Lymph Node Breast Cancer Patient

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