Preoperative Prediction of Node-Negative Disease After Neoadjuvant Chemotherapy in Patients Presenting with Node-Negative or Node-Positive Breast Cancer

Murphy, Brittany L.; Hoskin, Tanya L.; Day, Nicholas; Habermann, Elizabeth B.; Boughey, Judy C.

doi:10.1245/s10434-017-5872-9

Cited by 24 publications

(26 citation statements)

References 19 publications

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“…Moreover, the six independent predictors of axillary pCR are all included in the routine work-up, so additional diagnostic tests are unnecessary to fulfill the model. Our result was consistent with the previous studies, in which axillary pCR was correlated with clinical N stage, HER2 positivity, and clinical response of primary tumor and axillary LNs (8)(9)(10)(11)(12)(13)(14)(15). As expected, HR-negative and HER2-positive cancers had higher axillary pCR rates because they are more sensitive to NAC (24,25).…”

Section: Discussionsupporting

confidence: 93%

“…MRI is the most accurate modality in the assessment of primary breast cancer, especially in the NAC setting (27,28). Because the clinical responses of the primary tumor and axillary LNs are correlated, the inclusion of strengthens our predictive model compared with previous models (8)(9)(10)(11)(12)(13)(14)(15). Furthermore, the variables used in our model are easily retrievable and do not require additional interventional procedures (eg, clipping nodes with seed, wire localization for targeted axillary dissection), which are accurate but laborious for radiologists and troublesome for patients (32,33).…”

Section: Discussionmentioning

confidence: 93%

“…To efficiently select the patients who would benefit from SLNB after NAC, many studies have been performed (8)(9)(10)(11)(12)(13)(14)(15). Some studies included initial clinical T or N stage in their model without consideration of residual LN metastasis after NAC (8)(9)(10)(11). One prediction model included the pathologic tumor response, which cannot be determined before the surgery (12).…”

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confidence: 99%

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Predicting Axillary Response to Neoadjuvant Chemotherapy: Breast MRI and US in Patients with Node-Positive Breast Cancer

et al. 2019

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Background: In patients who are expected to achieve axillary pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC), omission of axillary lymph node (LN) dissection could prevent morbidity and complications. Purpose: To develop a clinical model to predict residual axillary LN metastasis in patients with clinically node-positive breast cancer after NAC by using MRI and US. Materials and Methods: In this retrospective study, women with clinically node-positive breast cancer who were treated with NAC following surgery between January 2015 and September 2017 were included. The patients were randomly assigned to a test and validation set (7:3 ratio). Univariable and multivariable logistic regression analyses were performed to evaluate the independent predictors of residual axillary LN metastasis in the test set. A prediction risk score was developed based on the odds ratios from the multivariable analysis and validated in both sets. Results: A total of 408 women were included (mean age 6 standard deviation, 47.9 years 6 9.6). The axillary pCR rate was 56.6% (231 of 408). Independent predictors of residual axillary LN metastasis were clinical stage N2 or N3, presence of axillary lymphadenopathy at US after NAC, tumor size reduction less than 50% at MRI, Ki-67 negativity, hormone receptor positivity, and human epidermal growth factor receptor 2 negativity (all, P , .05). In a model using these predictors, the area under the receiver operating characteristic curve in the test and validation sets was 0.84 (95% confidence interval: 0.79, 0.88) and 0.78 (95% confidence interval: 0.70, 0.87), respectively. When the patients had a simplified risk score of 1, the false-negative rates ranged between 5%-10%. Conclusion: A prediction model incorporating nodal status stage, US finding, MRI response, and molecular receptor status shows good diagnostic performance for residual axillary lymph node metastasis after neoadjuvant chemotherapy in patients with clinically node-positive breast cancer.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 93%

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confidence: 99%

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Predicting Axillary Response to Neoadjuvant Chemotherapy: Breast MRI and US in Patients with Node-Positive Breast Cancer

et al. 2019

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“…However, these established models were limited because of single-institution experiences or multicenter small sample size of the studies ( 9 – 11 ). Only three models reported in two studies were based on the materials of the National Cancer Data Base (NCDB) ( 12 , 13 ). This study plans to develop a clinical preoperative scoring prediction model for the identification of the likelihood of patients being axillary pCR after NCT based on CSCO-BC and to verify the model based on independent data in Henan Cancer Hospital.…”

Section: Introductionmentioning

confidence: 99%

Establishment and Verification of a Predictive Model for Node Pathological Complete Response After Neoadjuvant Chemotherapy for Initial Node Positive Early Breast Cancer

et al. 2021

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ObjectiveAxillary node status after neoadjuvant chemotherapy (NCT) in early breast cancer patients influences the axillary surgical staging procedure. This study was conducted for the identification of the likelihood of patients being node pathological complete response (pCR) post NCT. We aimed to recognize patients most likely to benefit from sentinel lymph node biopsy (SLNB) following NCT and to reduce the risk of missed detection of positive lymph nodes through the construction and validation of a clinical preoperative scoring prediction model.MethodsThe existing data (from March 2010 to December 2018) of the Chinese Society of Clinical Oncology Breast Cancer Database (CSCO-BC) was used to evaluate the independent related factors of node pCR after NCT by Binary Logistic Regression analysis. A predictive model was established according to the score of considerable factors to identify ypN0. Model performance was confirmed in a cohort of NCT patients treated between January 2019 and December 2019 in Henan Cancer Hospital, and model discrimination was evaluated via assessing the area under the receiver operating characteristic (ROC) curve (AUC).ResultsMultivariate regression analysis showed that the node stage before chemotherapy, the expression level of Ki-67, biologic subtype, and breast pCR were all independent related factors of ypN0 after chemotherapy. According to the transformation and summation of odds ratio (OR) values of each variable, the scoring system model was constructed with a total score of 1–5. The AUC for the ROC curves was 0.715 and 0.770 for the training and the validation set accordingly.ConclusionsA model was established and verified for predicting ypN0 after chemotherapy in newly diagnosed cN+ patients and the model had good accuracy and efficacy. The underlined effective model can suggest axillary surgical planning, and reduce the risk of missing positive lymph nodes by SLNB after NCT. It has great value for identifying initial cN+ patients who are more appropriate for SLNB post-chemotherapy.

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“…This is in line with previous research given that high-grade tumors are associated with higher rates of axillary pCR. [30][31][32][33] The increasing use of NST and the inability to predict the axillary lymph node status after NST have raised questions regarding the patients who do need PMRT and increased the complexity of immediate breast reconstruction planning. Immediate breast reconstruction reduces the number of surgical procedures and has a better aesthetic outcome due to decreased scarring and preservation of the breast skin envelope.…”

Section: Discussionmentioning

confidence: 99%

Risk of positive sentinel lymph node after neoadjuvant systemic therapy in clinically node negative breast cancer -implications for postmastectomy radiation therapy and immediate breast reconstruction

Samiei

Kaathoven

Boersma

et al. 2020

European Journal of Surgical Oncology

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Background. Residual axillary lymph node involvement after neoadjuvant systemic therapy (NST) is the determining factor for postmastectomy radiation therapy (PMRT). Preoperative identification of patients needing PMRT is essential to enable shared decision-making when choosing the optimal timing of breast reconstruction. We determined the risk of positive sentinel lymph node (SLN) after NST in clinically node-negative (cN0) breast cancer. Methods. All cT1-3N0 patients treated with NST followed by mastectomy and SLNB between 2010 and 2016 were identified from the Netherlands Cancer Registry. Rate of positive SLN for different breast cancer subtypes was determined. Logistic regression analysis was performed to determine correlated clinicopathological variables with positive SLN. Results. In total 788 patients were included, of whom 25.0% (197/788) had positive SLN. cT1-3N0 ER?HER2?, cT1-3N0 ER-HER2? , and cT1-2N0 triplenegative patients had the lowest rate of positive SLN: 7.2-11.5%, 0-6.3%, and 2.9-6.2%, respectively. cT1-3N0 ER?HER2-and cT3N0 triple-negative patients had the highest rate of positive SLN: 23.8-41.7% and 30.4%, respectively. Multivariable regression analysis showed that cT2 (odds ratio [OR] 1.93; 95% confidence interval [CI] 1.01-3.96), cT3 (OR 2.56; 95% CI 1.30-5.38), grade 3 (OR 0.44; 95% CI 0.21-0.91), and ER?HER2-subtype (OR 3.94; 95% CI 1.77-8.74) were correlated with positive SLN. Conclusions. In cT1-3N0 ER?HER2?, cT1-3N0 ER-HER2?, and cT1-2N0 triple-negative patients treated with NST, immediate reconstruction can be considered an acceptable option due to low risk of positive SLN. In cT1-3N0 ER?HER2-and cT3N0 triple-negative patients treated with NST, risks and benefits of immediate reconstruction should be discussed with patients due to the relatively high risk of positive SLN.

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Preoperative Prediction of Node-Negative Disease After Neoadjuvant Chemotherapy in Patients Presenting with Node-Negative or Node-Positive Breast Cancer

Abstract: We constructed two models that showed good discrimination for predicting ypN0 status following NAC in cN0 and cN+ patients. These clinically useful models can guide surgical planning after NAC.

Cited by 24 publications

References 19 publications

Predicting Axillary Response to Neoadjuvant Chemotherapy: Breast MRI and US in Patients with Node-Positive Breast Cancer

Predicting Axillary Response to Neoadjuvant Chemotherapy: Breast MRI and US in Patients with Node-Positive Breast Cancer

Establishment and Verification of a Predictive Model for Node Pathological Complete Response After Neoadjuvant Chemotherapy for Initial Node Positive Early Breast Cancer

Risk of positive sentinel lymph node after neoadjuvant systemic therapy in clinically node negative breast cancer -implications for postmastectomy radiation therapy and immediate breast reconstruction

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