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Is Routine Axillary Imaging Necessary in Clinically Node-Negative Patients Undergoing Neoadjuvant Chemotherapy?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

ABSTRACT

Background

The National Comprehensive Cancer Network guidelines recommend axillary imaging prior to neoadjuvant chemotherapy (NAC) in breast cancer patients who are clinically node negative (cN0) by physical examination. However, the benefit of this approach remains uncertain. The purpose of this study was to determine whether abnormal axillary imaging pre-NAC predicts nodal metastases post-NAC (ypN+) in cN0 patients.

Methods

cN0 patients undergoing NAC followed by axillary surgery were identified. Rates of ypN+ were compared among patients with abnormal pre-treatment axillary imaging vs. normal or no pre-treatment imaging using Fisher’s exact test.

Results

From May 2008 to March 2016, 402 eligible cN0 patients were identified. The median age of the patients was 49.5 years, and the median tumor size was 4 cm. Of these patients, 38% were estrogen receptor-positive (ER+) and human epidermal growth factor receptor 2-negative (HER2−), 30% were HER2+ , and 32% were triple negative. All had pre-NAC mammograms, 40% axillary ultrasound, 83% MRI, and 51% PET. Abnormal nodes on imaging were seen in 208 patients (52%); 128 had pre-NAC node biopsy, and 75 were positive. Overall, 28% of the patients (n = 111) were ypN+ post-NAC. Although the incidence of ypN+ was significantly higher in patients with abnormal nodes on pre-NAC imaging (p = 0.001), 54% did not require axillary lymph node dissection (ALND) post-NAC. Among the patients with normal nodes on pre-NAC imaging, 20% were ypN+ post-NAC.

Conclusions

Half of patients with abnormal nodes on pre-NAC imaging did not require ALND post-NAC, while 20% of those with normal pre-NAC nodes had disease post-NAC, indicating that in cN0 patients already selected for NAC, axillary imaging pre-NAC does not predict the need for axillary surgery post-NAC with sufficient accuracy to be clinically useful.

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ACKNOWLEDGEMENTS

A National Institutes of Health/National Cancer Institute Cancer Center Support Grant (No. P30 CA008748) supported the preparation of this report.

Conflict of interest

There are no conflicts of interest.

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Author notes

    Authors and Affiliations

    1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

      Andrea V. Barrio MD, Anita Mamtani MD, Michelle Stempel MPH & Monica Morrow MD

    2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

      Anne Eaton MS

    3. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

      Sandra Brennan MD

    Authors
    1. Andrea V. Barrio MD
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    2. Anita Mamtani MD
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    3. Anne Eaton MS
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    4. Sandra Brennan MD
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    5. Michelle Stempel MPH
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    6. Monica Morrow MD
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    Corresponding author

    Correspondence to Andrea V. Barrio MD.

    Additional information

    Andrea V. Barrio and Anita Mamtani contributed equally to this study and share first authorship.

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    Barrio, A.V., Mamtani, A., Eaton, A. et al. Is Routine Axillary Imaging Necessary in Clinically Node-Negative Patients Undergoing Neoadjuvant Chemotherapy?. Ann Surg Oncol 24, 645–651 (2017). https://doi.org/10.1245/s10434-017-5765-y

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    • DOI: https://doi.org/10.1245/s10434-017-5765-y

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