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Is Clinical Exam of the Axilla Sufficient to Select Node-Positive Patients Who Downstage After NAC for SLNB? A Comparison of the Accuracy of Clinical Exam Versus MRI

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

Abstract

Background

The National Comprehensive Cancer Network (NCCN) endorses sentinel lymph node biopsy (SLNB) in patients with clinically positive axillary nodes who downstage after neoadjuvant chemotherapy (NAC). In this study, we compared the accuracy of post-NAC MRI to clinical exam alone in predicting pathologic status of sentinel lymph nodes in cN1 patients.

Methods

We identified patients with T0-3, N1 breast cancer who underwent NAC and subsequent SLNB from March 2014 to July 2017. Patients were grouped based on whether a post-NAC MRI was done. MRI accuracy in predicting SLN status was assessed versus clinical exam alone.

Results

A total of 450 patients met initial study criteria; 269 were analyzed after excluding patients without biopsy-confirmed nodal disease, palpable disease after NAC, and failed SLN mapping. Median age was 49 years. Post-NAC MRI was done in 68% (182/269). Patients undergoing lumpectomy vs mastectomy more frequently received a post-NAC MRI (88 vs 54%, p < 0.001). All other clinicopathologic parameters were comparable between those who did and did not have a post-NAC MRI. Thirty percent (55/182) had abnormal lymph nodes on MRI. Among these, 58% (32/55) had a positive SLN on final pathology versus 42% (53/127) of patients with no abnormal lymph nodes on MRI and 52% (45/87) of patients who had clinical exam alone (p = 0.09). MRI sensitivity was 38%, specificity was 76%, and overall SLN status prediction accuracy was 58%.

Conclusions

Post-NAC MRI is no more accurate than clinical exam alone in predicting SLN pathology in patients presenting with cN1 disease. Abnormal lymph nodes on MRI should not preclude SLNB.

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Acknowledgment

The preparation of this study was funded in part by NIH/NCI Cancer Center Support Grant No. P30 CA008748 to Memorial Sloan Kettering Cancer Center. This study was presented in podium format at the Society of Surgical Oncology 72nd Annual Cancer Symposium, March 27–30, 2019, San Diego, CA.

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Authors and Affiliations

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

    Tracy-Ann Moo MD, Michelle Stempel MPH, Monica Raiss BA, Anita Mamtani MD, Audree B. Tadros MD, Mahmoud El-Tamer MD & Monica Morrow MD

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

    Maxine S. Jochelson MD

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

    Emily C. Zabor DrPH

Authors
  1. Tracy-Ann Moo MD
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  2. Maxine S. Jochelson MD
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  3. Emily C. Zabor DrPH
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  4. Michelle Stempel MPH
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  5. Monica Raiss BA
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  6. Anita Mamtani MD
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  7. Audree B. Tadros MD
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  8. Mahmoud El-Tamer MD
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  9. Monica Morrow MD
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Corresponding author

Correspondence to Tracy-Ann Moo MD.

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Disclosures

Dr. Monica Morrow has received speaking honoraria from Genomic Health and Roche. Dr. Mahmoud El-Tamer received honoraria from Blue Earth Diagnostic in 2016. All other authors have no conflict of interest disclosures to report.

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Moo, TA., Jochelson, M.S., Zabor, E.C. et al. Is Clinical Exam of the Axilla Sufficient to Select Node-Positive Patients Who Downstage After NAC for SLNB? A Comparison of the Accuracy of Clinical Exam Versus MRI. Ann Surg Oncol 26, 4238–4243 (2019). https://doi.org/10.1245/s10434-019-07867-x

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  • DOI: https://doi.org/10.1245/s10434-019-07867-x

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