Abstract
BackgroundIn this study, we aimed to develop an objective staging system to determine the degree of nodal metastasis in breast cancer patients undergoing neoadjuvant systemic treatment (NST).MethodsWe reviewed the pretreatment computed tomography (CT) images of 392 breast cancer patients who received NST. The association between the patterns of the enlarged regional lymph nodes and treatment outcome was analyzed.ResultsIn the development cohort of 260 patients, 88 (33.8%) patients experienced tumor recurrence and had a significantly higher number of enlarged lymph nodes on the pretreatment CT compared to patients with no recurrence. When patients were classified according to the numbers and locations of enlarged lymph nodes on pretreatment CT, the number of lymph nodes larger than 1 cm was most significantly associated with tumor recurrence. The accuracy of the CT-based nodal staging system was validated in an independent cohort of 132 patients. The presence of the enlarged supraclavicular nodes was associated with worse outcome, but the effect seemed to originate from the accompanied extensive axillary nodal burden. The prognostic effect of the objectively measured axillary nodal metastasis was more pronounced in hormone receptor-negative tumors.ConclusionsWe have developed and validated an objective method of nodal staging in breast cancer patients who undergo NST based on the number of enlarged axillary lymph nodes. Our system can improve the current subjective approach, which uses physical examination alone.
Highlights
In this study, we aimed to develop an objective staging system to determine the degree of nodal metastasis in breast cancer patients undergoing neoadjuvant systemic treatment (NST)
Patient characteristics and the prevalence of computed tomography (CT)-detected lymph node enlargement We reviewed the data of 536 breast cancer patients who received NST between January 2006 and December 2011
Many previous studies have attempted to explore the value of imaging studies, including contrast-enhanced breast magnetic resonance imaging, ultrasonography, and positron emission tomography (PET) scan, in determining nodal status in patients with breast cancer [15]
Summary
We aimed to develop an objective staging system to determine the degree of nodal metastasis in breast cancer patients undergoing neoadjuvant systemic treatment (NST). Neoadjuvant systemic therapy (NST) is increasingly used for the treatment of operable breast cancer in patients [1]. The increased use of NST has given rise to some controversial issues such as the optimal method of determining the residual extent of tumor and the use of sentinel node. TNM staging system recommends physical examination to determine the N stage in patients receiving NST, based on the presence of the fixed nature or locations of the palpable nodes [9]. Studies have reported limited accuracy of physical examination in determining clinical N stage in patients with breast cancer, with a sensitivity around 30% [10,11,12,13]. Clinical N staging with physical examination is a highly subjective method, and the accuracy may vary among surgeons
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