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Rates of pathologic nodal disease among cN0 and cN1 patients undergoing routine axillary ultrasound and neoadjuvant chemotherapy

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Routine axillary ultrasound (AxUS) in patients receiving neoadjuvant chemotherapy (NAC) remains controversial. Here, we report rates of AxUS-detected nodal disease among patients with normal clinical exams, and rates of pathologic nodal disease after NAC based on method of nodal disease detection.

Methods

Clinicopathologic findings were prospectively collected for stage I-III breast cancer patients selected for NAC. All patients had pre-treatment AxUS, suspicious nodes were biopsied. The following four patient cohorts were examined: patients with suspicious exam or AxUS but negative biopsy (Suspicious cN0); those with normal exam and normal AxUS (Not Suspicious cN0); those with normal exam but suspicious AxUS and positive biopsy (AxUS-detected cN1); and those with abnormal exam and positive biopsy (exam-detected cN1). Sentinel (SLN) and non-sentinel lymph nodes (non-SLN) were evaluated by immunohistochemistry; nodal metastases of any size were considered positive.

Results

500 patients were included. Of 310 patients with normal axillary exams, 160 had suspicious AxUS, 65 were biopsy-negative (Suspicious cN0) and 95/310 (30.6%) were biopsy-positive (AxUS-detected cN1). Of 190 with abnormal axillary exams, 166 were biopsy-proven node-positive (exam-detected cN1) and 24 were AxUS or biopsy-negative (Suspicious cN0). Rates of pathologic nodal disease were 20/150 (13.3%) among Not Suspicious cN0 patients, 12/89 (13.5%) among Suspicious cN0 (p = 0.97). Rates of residual nodal disease were 55/95 (57.9%) among AxUS-detected cN1 patients, 102/166 (61.4%) among exam-detected cN1 (p = 0.57).

Conclusion

AxUS detected nodal disease in 30.6% of patients with normal clinical exams selected for NAC. Rates of pathologic nodal disease were similar among AxUS-detected and exam-detected cN1 patients.

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Data availability

This data can be de-identified and provided for review/reproducibility, upon request.

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Acknowledgements

We would like to acknowledge Tonia Parker and Julie Vincuilla for maintaining our institutional database, and Valerie Hope Goldstein for editing this manuscript.

Funding

This work was funded in part by the Dana-Farber/Harvard Cancer Center Breast Specialized Program of Research Excellence (SPORE), an NCI-funded program, Grant No. 1P50CA168504. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health/NCI. EAM receives support from the Rob and Karen Hale Distinguished Chair in Surgical Oncology.

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Authors and Affiliations

  1. Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Anna Weiss, Claire King, Julie Vincuilla, Tonia Parker, Faina Nakhlis, Laura Dominici, Elizabeth A. Mittendorf & Tari A. King

  2. Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA

    Anna Weiss, Claire King, Julie Vincuilla, Tonia Parker, Leah Portnow, Faina Nakhlis, Laura Dominici, Elizabeth A. Mittendorf & Tari A. King

  3. Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA

    Leah Portnow

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Contributions

AW: collected and analyzed the data and wrote the manuscript. CK and SG: collected the data. LP, SR, FN, LD, and EAM: provided critical review of the manuscript. TAK: provided critical oversight during data analysis and provided critical review of the manuscript. All authors approved the final submitted version.

Corresponding author

Correspondence to Anna Weiss.

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Conflict of interest

AW reports institutional research funding from Myriad Laboratories Inc. EAM: reports clinical trial funding from Roche/Genentech (via SU2C grant) and Gilead; compensated advisory board service for, and consulting fees from, Roche/Genentech, Merck, and Exact Sciences; compensated advisory board service for AstraZeneca; honoraria from Physicians’ Education Resource; and uncompensated service on the Board of Directors for the American Society of Clinical Oncology, the steering committees of Roche/Genentech, Bristol-Myers Squibb, and Eli Lilly, and uncompensated service as a Scientific Advisor for Susan G. Komen for the Cure Foundation. TAK reports Speakers honoraria and an advisory board role for Exact Sciences; Faculty, PrecisCA cancer information service; and is on the global advisory board of Besins Healthcare.

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Institutional Quality Improvement approval was obtained prior to data review and manuscript preparation.

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The need for informed consent was waived for this study; this was reviewed and approved as a quality improvement project by our institution.

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Weiss, A., King, C., Vincuilla, J. et al. Rates of pathologic nodal disease among cN0 and cN1 patients undergoing routine axillary ultrasound and neoadjuvant chemotherapy. Breast Cancer Res Treat 195, 181–189 (2022). https://doi.org/10.1007/s10549-022-06677-2

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