Imaging Response and Residual Metastatic Axillary Lymph Node Disease after Neoadjuvant Chemotherapy for Primary Breast Cancer

Abstract

Performance characteristics of AUS, MRI, and PET-CT, while informative, were inadequate to preclude surgical axillary staging of in breast cancer patients after NAC. Whether this information might be used to tailor surgical and postsurgical treatment requires further investigation.

Axillary Ultrasound Identifies Residual Nodal Disease After Chemotherapy: Results From the American College of Surgeons Oncology Group Z1071 Trial (Alliance)

“…The positive predictive value for nodal metastases was reported as 93.1% for nodal ultrasound with core biopsy in a retrospective study of 662 patients with newly suspected breast cancer [14]. It has been suggested that the absence of a fatty hilum on imaging be an indicator for performing biopsy [17, 18]. …”

MRI and Prediction of Pathologic Complete Response in the Breast and Axilla after Neoadjuvant Chemotherapy for Breast Cancer

“…Exact cortical measurement on MRI may change depending on positioning, and morphologic nodal change from round to oval may also be affected by patient position. 9 Additionally, there are other technical aspects which may affect MRI analysis of LN response, including respiratory motion artifact from the chest wall and potential false identification of LNs from adjacent vascular structures. 9,24 Hieken used perinodal enhancement to gauge suspicious adenopathy.…”

“…9 Additionally, there are other technical aspects which may affect MRI analysis of LN response, including respiratory motion artifact from the chest wall and potential false identification of LNs from adjacent vascular structures. 9,24 Hieken used perinodal enhancement to gauge suspicious adenopathy. 9 They demonstrated that ultrasound was the most sensitive method of evaluating the post-NAC axilla, with respective sensitivities of 70% by ultrasound, 63% by position emission tomography (PET), and 61% by MRI.…”

“…6–8 Little has been published regarding the ability to detect response to NAC in the ALNs by MRI, while MRI remains the imaging modality most often used to gauge response in the breast primary tumor. 9–14 …”

“…18,19 Many studies have reported pCR can be used as a surrogate endpoint for predicting long-term clinical benefits such as disease-free survival and overall survival. 9,20 There is an evolving question about the value of surgical resection of the tumor bed and ALNs in patients who have achieved a pCR. To consider omitting surgical intervention after NAC, it is paramount to accurately identify patients who achieve a pCR in the breast and the ALNs.…”