Ji Hyeon Joo1, Su Ssan Kim2, Seung-Do Ahn1, Eun Kyung Choi1, Jin Hong Jung1, Yuri Jeong1, Sei Hyun Ahn3, Byung Ho Son3, Jong Won Lee3, Hee Jung Kim3, Beom Seok Go3, Hak Hee Kim4, Joo Hee Cha4, Hee Jung Shin4, Eun Young Chae4. 1. Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 138-736, South Korea. 2. Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 138-736, South Korea. watermountain@hanmail.net. 3. Department of Breast and Endocrine Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. 4. Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Abstract
PURPOSE: To analyze the prognostic role of pathologic confirmation of internal mammary lymph nodes (IMNs) for breast cancer patients who received neoadjuvant chemotherapy. METHODS: Of the patients who were treated with neoadjuvant chemotherapy, surgery, and radiation therapy between 2009 and 2013, 114 women had suspicious IMNs and FNAB was attempted. Clinical IMN metastasis was diagnosed by 18F-FDG PET/CT positivity or pathologic confirmation (N = 70). Patients were divided into the FNAB(+) or FNAB(-) IMN group. RESULTS: The pathologic confirmation rate was 57% (40 of 70 patients). Rates were 74% in US-positive, 70% in MRI-positive, and 55% in PET-positive patients. Nodal stage was cN2b (6%) or cN3b (94%). Five-year progression-free survival (PFS) was significantly worse in patients with FNAB(+) IMN metastasis than FNAB(-) IMN metastasis (61% vs. 87%, P = 0.03). FNAB(+) IMN patients showed worse distant metastasis and regional recurrence-free survival without statistical significance (69% vs. 86%, P = 0.06, and 81% vs. 96%, P = 0.06). With median follow-up of 50.5 months (13.0-97.0 months), overall survival at 5 years was 77%, and PFS was 72%. CONCLUSIONS: Patients with FNAB-proven IMN metastasis had worse treatment outcomes compared to patients with clinically diagnosed IMN metastasis in cN2b/N3b breast cancer.
PURPOSE: To analyze the prognostic role of pathologic confirmation of internal mammary lymph nodes (IMNs) for breast cancerpatients who received neoadjuvant chemotherapy. METHODS: Of the patients who were treated with neoadjuvant chemotherapy, surgery, and radiation therapy between 2009 and 2013, 114 women had suspicious IMNs and FNAB was attempted. Clinical IMN metastasis was diagnosed by 18F-FDG PET/CT positivity or pathologic confirmation (N = 70). Patients were divided into the FNAB(+) or FNAB(-) IMN group. RESULTS: The pathologic confirmation rate was 57% (40 of 70 patients). Rates were 74% in US-positive, 70% in MRI-positive, and 55% in PET-positive patients. Nodal stage was cN2b (6%) or cN3b (94%). Five-year progression-free survival (PFS) was significantly worse in patients with FNAB(+) IMN metastasis than FNAB(-) IMN metastasis (61% vs. 87%, P = 0.03). FNAB(+) IMN patients showed worse distant metastasis and regional recurrence-free survival without statistical significance (69% vs. 86%, P = 0.06, and 81% vs. 96%, P = 0.06). With median follow-up of 50.5 months (13.0-97.0 months), overall survival at 5 years was 77%, and PFS was 72%. CONCLUSIONS:Patients with FNAB-proven IMN metastasis had worse treatment outcomes compared to patients with clinically diagnosed IMN metastasis in cN2b/N3b breast cancer.
Entities:
Keywords:
Breast neoplasms; Lymph nodes; Neoplasm metastasis; Radiotherapy; Survival
Authors: Kyubo Kim; Yuri Jeong; Kyung Hwan Shin; Jin Ho Kim; Seung Do Ahn; Su Ssan Kim; Chang-Ok Suh; Yong Bae Kim; Doo Ho Choi; Won Park; Jihye Cha; Mison Chun; Dong Soo Lee; Sun Young Lee; Jin Hee Kim; Hae Jin Park; Wonguen Jung Journal: Cancer Res Treat Date: 2019-03-15 Impact factor: 4.679