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



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.


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.


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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Fig. 1
Fig. 2



Axillary lymph node dissection


The area under the receiver operating characteristic curve


Oestrogen receptor


Human epidermal growth factor receptor 2




Lymph node


Neoadjuvant chemotherapy


Negative predictive value


Pathologic complete response


Progesterone receptor


Sentinel lymph node biopsy




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Correspondence to Ji Hyun Youk.

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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.

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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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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).

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