Anna Weiss1,2, Claire King3,4, Julie Vincuilla3,4, Tonia Parker3,4, Leah Portnow4,5, Faina Nakhlis3,4, Laura Dominici3,4, Elizabeth A Mittendorf3,4, Tari A King3,4. 1. Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. aweiss5@bwh.harvard.edu. 2. Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA. aweiss5@bwh.harvard.edu. 3. Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. 4. Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA. 5. Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
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.
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.
Authors: Sara M Tolaney; Hao Guo; Sonia Pernas; William T Barry; Deborah A Dillon; Lauren Ritterhouse; Bryan P Schneider; Fei Shen; Kit Fuhrman; Michele Baltay; Chau T Dang; Denise A Yardley; Beverly Moy; P Kelly Marcom; Kathy S Albain; Hope S Rugo; Mathew J Ellis; Iuliana Shapira; Antonio C Wolff; Lisa A Carey; Beth Overmoyer; Ann H Partridge; Clifford A Hudis; Ian E Krop; Harold J Burstein; Eric P Winer Journal: J Clin Oncol Date: 2019-04-02 Impact factor: 44.544
Authors: Gavin Kane; Christina Fleming; Helen Heneghan; Damian McCartan; Philip James; Robert Trueick; Luke Harrington; Fionn Nally; Cecily Quinn; Ann O'Doherty; Sorcha McNally; Jane Rothwell; Denis Evoy; James Geraghty; Enda McDermott; Ruth Prichard Journal: Breast J Date: 2019-06-13 Impact factor: 2.431
Authors: Chelsea Horwood; Nina Ma; Joseph Hayek; Alicia M Terando; Doreen M Agnese; Valerie Grignol Journal: Breast J Date: 2019-08-21 Impact factor: 2.431