Karina Cox1, Nicky Dineen2, Sian Taylor-Phillips3, Nisha Sharma4, Catherine Harper-Wynne5, Deborah Allen2, Jennifer Weeks2, Ritchie Chalmers2, Deepika Akolekar2, Russell Burcombe5, Rema Jyothirmayi5, Ali Sever6. 1. Peggy Wood Breast Unit, Maidstone Hospital, Hermitage Lane, Maidstone, Kent, ME16 9QQ, UK. karina.cox@nhs.net. 2. Peggy Wood Breast Unit, Maidstone Hospital, Hermitage Lane, Maidstone, Kent, ME16 9QQ, UK. 3. WMS-Population Evidence and Technologies, University of Warwick, Coventry, CV4 7AL, UK. 4. Leeds Breast Unit, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK. 5. Kent Oncology Centre, Maidstone Hospital, Hermitage Lane, Maidstone, Kent, ME16 9QQ, UK. 6. Guy's Breast Unit, Great Maze Pond, London, SE1 9RT, UK.
Abstract
PURPOSE: The purpose of this study is to measure pre-treatment diagnostic yield of malignant lymph nodes (LN) using contrast-enhanced ultrasound (CEUS) in addition to B-mode axillary ultrasound and compare clinicopathological features, response to NACT and long-term outcomes of patients with malignant LN detected with B-mode ultrasound versus CEUS. METHODS: Between August 2009 and October 2016, NACT patients were identified from a prospective database. Follow-up data were collected until May 2019. RESULTS: 288 consecutive NACT patients were identified; 77 were excluded, 110 had malignant LN identified by B-mode ultrasound (Group A) and 101 patients with negative B-mode axillary ultrasound had CEUS with biopsy of sentinel lymph nodes (SLN). In two cases CEUS failed. Malignant SLN were identified in 35/99 (35%) of B-mode ultrasound-negative cases (Group B). Patients in Group A were similar to those in Group B in age, mean diagnostic tumour size, grade and oestrogen receptor status. More Group A patients had a ductal phenotype. In the breast, 34 (31%) Group A patients and 8 (23%) Group B patients achieved a pathological complete response (PCR). In the axilla, 41 (37%) and 13 (37%) Groups A and B patients, respectively, had LN PCR. The systemic relapse rate was not statistically different (5% and 16% for Groups A and B, respectively). CONCLUSIONS: Enhanced assessment with CEUS before NACT identifies patients with axillary metastases missed by conventional B-mode ultrasound. Without CEUS, 22 (63%) of cases in Group B (negative B-mode ultrasound) may have been erroneously classed as progressive disease by surgical SLN excision after NACT.
PURPOSE: The purpose of this study is to measure pre-treatment diagnostic yield of malignant lymph nodes (LN) using contrast-enhanced ultrasound (CEUS) in addition to B-mode axillary ultrasound and compare clinicopathological features, response to NACT and long-term outcomes of patients with malignant LN detected with B-mode ultrasound versus CEUS. METHODS: Between August 2009 and October 2016, NACT patients were identified from a prospective database. Follow-up data were collected until May 2019. RESULTS: 288 consecutive NACT patients were identified; 77 were excluded, 110 had malignant LN identified by B-mode ultrasound (Group A) and 101 patients with negative B-mode axillary ultrasound had CEUS with biopsy of sentinel lymph nodes (SLN). In two cases CEUS failed. Malignant SLN were identified in 35/99 (35%) of B-mode ultrasound-negative cases (Group B). Patients in Group A were similar to those in Group B in age, mean diagnostic tumour size, grade and oestrogen receptor status. More Group A patients had a ductal phenotype. In the breast, 34 (31%) Group A patients and 8 (23%) Group B patients achieved a pathological complete response (PCR). In the axilla, 41 (37%) and 13 (37%) Groups A and B patients, respectively, had LN PCR. The systemic relapse rate was not statistically different (5% and 16% for Groups A and B, respectively). CONCLUSIONS: Enhanced assessment with CEUS before NACT identifies patients with axillary metastases missed by conventional B-mode ultrasound. Without CEUS, 22 (63%) of cases in Group B (negative B-mode ultrasound) may have been erroneously classed as progressive disease by surgical SLN excision after NACT.
Authors: Jiaqi Zhu; Ethan M Rowland; Sevan Harput; Kai Riemer; Chee Hau Leow; Brett Clark; Karina Cox; Adrian Lim; Kirsten Christensen-Jeffries; Ge Zhang; Jemma Brown; Christopher Dunsby; Robert J Eckersley; Peter D Weinberg; Meng-Xing Tang Journal: Radiology Date: 2019-04-16 Impact factor: 11.105