Anastasia Peppe1, Robin Wilson2, Romney Pope3, Kate Downey4, Jennifer Rusby5. 1. Department of Breast Surgery, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK. 2. Department of Breast Radiology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK. 3. Department of Breast Radiology, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK. 4. Department of Breast Radiology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK; Department of Breast Radiology, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK. 5. Department of Breast Surgery, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK; Institute for Cancer Research, Cotswold Road, Sutton, SM2 5NG, UK. Electronic address: jennifer.rusby@rmh.nhs.uk.
Abstract
INTRODUCTION: Ultrasound (US) is the imaging modality of choice for staging the axilla prior to surgery in patients with breast cancer (BC). High pathological complete response rates in the axilla after NACT mean a more conservative approach to surgery can be considered. Radiological re-staging is important in this decision making. After the presentation of results from ACOSOG Z1071 in December 2012, formal ultrasound re-assessment of the axilla after primary therapy was specifically requested in our institution. We report on the accuracy of axillary US (aUS) for identifying residual axillary disease post-NACT. METHODS: Data were collected on patients who had proven axillary disease prior to NACT and underwent axillary lymph node dissection after NACT between January 2013 and December 2015. Post-chemotherapy aUS reports and axillary pathology reports were classified as positive or negative for abnormal lymph nodes and for residual disease (cCR and pCR respectively). RESULTS: The sensitivity and specificity of aUS was 71% and 88% respectively. The negative predictive value (NPV) was 83%. The false negative rate was 29%. CONCLUSIONS: Axillary ultrasound provides clinically useful information post-NACT, which will guide surgical decision-making. Patients with aUS-negative axillae are likely to have a lower false negative rate of SLNB after NACT (Boughey et al.). However, aUS does not replace the need to identify and biopsy the nodes which were proven to be positive prior to NACT.
INTRODUCTION: Ultrasound (US) is the imaging modality of choice for staging the axilla prior to surgery in patients with breast cancer (BC). High pathological complete response rates in the axilla after NACT mean a more conservative approach to surgery can be considered. Radiological re-staging is important in this decision making. After the presentation of results from ACOSOG Z1071 in December 2012, formal ultrasound re-assessment of the axilla after primary therapy was specifically requested in our institution. We report on the accuracy of axillary US (aUS) for identifying residual axillary disease post-NACT. METHODS: Data were collected on patients who had proven axillary disease prior to NACT and underwent axillary lymph node dissection after NACT between January 2013 and December 2015. Post-chemotherapy aUS reports and axillary pathology reports were classified as positive or negative for abnormal lymph nodes and for residual disease (cCR and pCR respectively). RESULTS: The sensitivity and specificity of aUS was 71% and 88% respectively. The negative predictive value (NPV) was 83%. The false negative rate was 29%. CONCLUSIONS: Axillary ultrasound provides clinically useful information post-NACT, which will guide surgical decision-making. Patients with aUS-negative axillae are likely to have a lower false negative rate of SLNB after NACT (Boughey et al.). However, aUS does not replace the need to identify and biopsy the nodes which were proven to be positive prior to NACT.
Authors: Sofia Aragon-Sanchez; M Reyes Oliver-Perez; Ainhoa Madariaga; M Jose Tabuenca; Mario Martinez; Alberto Galindo; M Luisa Arroyo; Marta Gallego; Marta Blanco; Eva M Ciruelos-Gil Journal: Breast J Date: 2022-08-05 Impact factor: 2.269