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Prediction of axillary response by monitoring with ultrasound and MRI during and after neoadjuvant chemotherapy in breast cancer patients

European Radiology volume 30, pages 1460–1469 (2020)Cite this article

Abstract

Purpose

To investigate whether monitoring with ultrasound and MR imaging before, during and after neoadjuvant chemotherapy (NAC) can predict axillary response in breast cancer patients.

Materials and methods

A total of 131 breast cancer patients with clinically positive axillary lymph node (LN) who underwent NAC and subsequent surgery were enrolled. They had ultrasound and 3.0 T-MR examinations before, during and after NAC. After reviewing ultrasound and MR images, axillary LN features and tumour size (T size) were noted. According to LN status after surgery, imaging features and their diagnostic performances were analysed.

Results

Of the 131 patients, 60 (45.8%) had positive LNs after surgery. Pre-NAC T size at ultrasound and MR was different in positive LN status after surgery (p < 0.01). There were significant differences in mid- and post-NAC number, cortical thickness (CxT), T size and T size reduction at ultrasound and mid- and post-NAC CxT, hilum, T size and T size reduction, and post-NAC ratio of diameter at MR (p < 0.03). On multivariate analysis, pre-NAC MR T size (OR, 1.03), mid-NAC ultrasound T size (OR, 1.05) and CxT (OR, 1.53), and post-NAC MR T size (OR, 1.06) and CxT (OR, 1.64) were independently associated with positive LN (p < 0.004). Combined mid-NAC ultrasound T size and CxT showed the best diagnostic performance with AUC of 0.760.

Conclusion

Monitoring ultrasound and MR axillary LNs and T size can be useful to predict axillary response to NAC in breast cancer patients.

Key Points

• Monitoring morphologic features of LNs is useful to predict axillary response.

• Monitoring tumour size by imaging is useful to predict axillary response.

• The axillary ultrasound during NAC showed the highest diagnostic performance.

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Abbreviations

ALND:

Axillary lymph node dissection

AUC:

The area under the receiver operating characteristic curve

ER:

Oestrogen receptor

HER2:

Human epidermal growth factor receptor 2

IHC:

Immunohistochemistry

LN:

Lymph node

NAC:

Neoadjuvant chemotherapy

NPV:

Negative predictive value

pCR:

Pathologic complete response

PR:

Progesterone receptor

SLNB:

Sentinel lymph node biopsy

US:

Ultrasound

References

  1. Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B (2001) Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr 30:96–102

  2. Kaufmann M, von Minckwitz G, Mamounas EP et al (2012) Recommendations from an international consensus conference on the current status and future of neoadjuvant systemic therapy in primary breast cancer. Ann Surg Oncol 19:1508–1516

    Article  Google Scholar 

  3. Rouzier R, Extra JM, Klijanienko J et al (2002) Incidence and prognostic significance of complete axillary downstaging after primary chemotherapy in breast cancer patients with T1 to T3 tumors and cytologically proven axillary metastatic lymph nodes. J Clin Oncol 20:1304–1310

    Article  Google Scholar 

  4. Hennessy BT, Hortobagyi GN, Rouzier R et al (2005) Outcome after pathologic complete eradication of cytologically proven breast cancer axillary node metastases following primary chemotherapy. J Clin Oncol 23:9304–9311

    Article  Google Scholar 

  5. von Minckwitz G, Untch M, Blohmer JU et al (2012) Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol 30:1796–1804

    Article  Google Scholar 

  6. Lucci A, McCall LM, Beitsch PD et al (2007) Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol 25:3657–3663

    Article  Google Scholar 

  7. Boughey JC, Suman VJ, Mittendorf EA et al (2013) Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA 310:1455–1461

    Article  CAS  Google Scholar 

  8. Kuehn T, Bauerfeind I, Fehm T et al (2013) Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol 14:609–618

    Article  Google Scholar 

  9. Boughey JC, Ballman KV, Hunt KK et al (2015) Axillary ultrasound after neoadjuvant chemotherapy and its impact on sentinel lymph node surgery: results from the American College of Surgeons Oncology Group Z1071 Trial (Alliance). J Clin Oncol 33:3386–3393

    Article  CAS  Google Scholar 

  10. Peppe A, Wilson R, Pope R, Downey K, Rusby J (2017) The use of ultrasound in the clinical re-staging of the axilla after neoadjuvant chemotherapy (NACT). Breast 35:104–108

    Article  Google Scholar 

  11. Hieken TJ, Boughey JC, Jones KN, Shah SS, Glazebrook KN (2013) Imaging response and residual metastatic axillary lymph node disease after neoadjuvant chemotherapy for primary breast cancer. Ann Surg Oncol 20:3199–3204

    Article  Google Scholar 

  12. You S, Kang DK, Jung YS, An YS, Jeon GS, Kim TH (2015) Evaluation of lymph node status after neoadjuvant chemotherapy in breast cancer patients: comparison of diagnostic performance of ultrasound, MRI and 18F-FDG PET/CT. Br J Radiol 88:20150143

    Article  CAS  Google Scholar 

  13. Schipper RJ, Moossdorff M, Beets-Tan RGH, Smidt ML, Lobbes MBI (2015) Noninvasive nodal restaging in clinically node positive breast cancer patients after neoadjuvant systemic therapy: a systematic review. Eur J Radiol 84:41–47

    Article  CAS  Google Scholar 

  14. Ha SM, Cha JH, Kim HH, Shin HJ, Chae EY, Choi WJ (2017) Diagnostic performance of breast ultrasonography and MRI in the prediction of lymph node status after neoadjuvant chemotherapy for breast cancer. Acta Radiol 58:1198–1205

    Article  Google Scholar 

  15. Candelaria RP, Bassett RL, Symmans WF et al (2017) Performance of mid-treatment breast ultrasound and axillary ultrasound in predicting response to neoadjuvant chemotherapy by breast cancer subtype. Oncologist 22:394–401

    Article  CAS  Google Scholar 

  16. Saffar B, Bennett M, Metcalf C, Burrows S (2015) Retrospective preoperative assessment of the axillary lymph nodes in patients with breast cancer and literature review. Clin Radiol 70:954–959

    Article  CAS  Google Scholar 

  17. Hammond ME, Hayes DF, Wolff AC, Mangu PB, Temin S (2010) American society of clinical oncology/college of american pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Oncol Pract 6:195–197

    Article  Google Scholar 

  18. Wolff AC, Hammond ME, Hicks DG et al (2013) Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. J Clin Oncol 31:3997–4013

    Article  Google Scholar 

  19. Ye BB, Zhao HM, Yu Y, Ge J, Wang X, Cao XC (2017) Accuracy of axillary ultrasound after different neoadjuvant chemotherapy cycles in breast cancer patients. Oncotarget 8:36696–36706

    PubMed  Google Scholar 

  20. Kim HS, Shin MS, Kim CJ et al (2017) Improved model for predicting axillary response to neoadjuvant chemotherapy in patients with clinically node-positive breast cancer. J Breast Cancer 20:378–385

    Article  Google Scholar 

  21. Kim R, Chang JM, Lee HB et al (2019) Predicting axillary response to neoadjuvant chemotherapy: breast MRI and US in patients with node-positive breast cancer. Radiology. https://doi.org/10.1148/radiol.2019190014:190014

  22. Le-Petross HT, McCall LM, Hunt KK et al (2018) Axillary ultrasound identifies residual nodal disease after chemotherapy: results from the American College of Surgeons Oncology Group Z1071 Trial (Alliance). AJR Am J Roentgenol 210:669–676

    Article  Google Scholar 

  23. Kim WH, Kim HJ, Park HY et al (2019) Axillary pathologic complete response to neoadjuvant chemotherapy in clinically node-positive breast cancer patients: a predictive model integrating the imaging characteristics of ultrasound restaging with known clinicopathologic characteristics. Ultrasound Med Biol 45:702–709

    Article  Google Scholar 

  24. Schwartz TL, Margenthaler JA (2017) Axillary ultrasound before neoadjuvant chemotherapy for breast cancer: don’t discount the benefits yet! Ann Surg Oncol 24:618–620

    Article  Google Scholar 

  25. Kantor O, Sipsy LM, Yao K, James TA (2018) A predictive model for axillary node pathologic complete response after neoadjuvant chemotherapy for breast cancer. Ann Surg Oncol 25:1304–1311

    Article  Google Scholar 

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Funding

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Authors and Affiliations

  1. Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea

    Na Lae Eun, Eun Ju Son, Hye Mi Gweon, Jeong-Ah Kim & Ji Hyun Youk

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  1. Na Lae Eun
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  2. Eun Ju Son
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  3. Hye Mi Gweon
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Correspondence to Ji Hyun Youk.

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Guarantor

The scientific guarantor of this publication is Professor Ji Hyun Youk, MD, PhD, at Yonsei University College of Medicine.

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The authors declare that they have no competing interests.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Cite this article

Eun, N.L., Son, E.J., Gweon, H.M. et al. Prediction of axillary response by monitoring with ultrasound and MRI during and after neoadjuvant chemotherapy in breast cancer patients. Eur Radiol 30, 1460–1469 (2020). https://doi.org/10.1007/s00330-019-06539-4

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  • DOI: https://doi.org/10.1007/s00330-019-06539-4

Keywords

  • Breast cancer
  • Lymph nodes
  • Ultrasound
  • Magnetic resonance imaging
  • Neoadjuvant therapy