Assessment of axillary node status by ultrasound after neoadjuvant chemotherapy in patients with clinically node-positive breast cancer according to breast cancer subtype

Yurina Maeshima,Yumi Kokubu,Shinji Ohno,Yoko Takahashi,Akiko Ogiya,Takayuki Ueno,Takehiko Sakai,Yoshinori Ito,Tomo Osako,Shunji Takahashi,Yumi Miyagi

doi:10.1038/s41598-021-89738-8

Yurina Maeshima, Yumi Kokubu + Show 9 more

Open Access

https://doi.org/10.1038/s41598-021-89738-8

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Journal: Scientific Reports	Publication Date: May 25, 2021
Citations: 5	License type: open-access

Affiliation: Japanese Foundation For Cancer Research

Abstract

The use of sentinel node biopsy (SNB) following neoadjuvant chemotherapy (NAC) for patients with cN1 breast cancer is controversial. Improvements of negative predictive value (NPV) by axillary ultrasound (AUS), which corresponds to the accurate prediction rate of node-negative status after NAC, would lead to decreased FNR of SNB following NAC. In this study, we retrospectively investigated the accurate prediction rate of NPV by AUS after NAC in patients with cytologically node-positive breast cancer treated between January 2012 and December 2016. Of 279 eligible patients, the NPV was 49.2% in all patients, but varied significantly by tumor subtype (p < 0.001) and tumor response determined by magnetic resonance imaging (MRI) (p = 0.0003). Of the 23 patients with clinically node negative (ycN0) by AUS and clinical complete response in primary lesion by MRI, the NPV was 100% in patients with HR±/HER2+ or HR−/HER2− breast cancer. In conclusion, regarding FNR reduction post-NAC, it will be of clinical value to take tumor subtype and primary tumor response using MRI into account to identify patients for SNB after NAC.

Highlights

The use of sentinel node biopsy (SNB) following neoadjuvant chemotherapy (NAC) for patients with cN1 breast cancer is controversial
Eligibility criteria were met by 279 patients, and 19 patients were excluded because 11 had no nodal assessment by axillary ultrasound (AUS) at our institution and 8 had two or fewer cycles of chemotherapy (Fig. 2)
Clinical tumor responses in the breast assessed by magnetic resonance imaging (MRI) were complete response (CR) in 38 patients (13.6%), partial response (PR) in 193 (69.2%), stable disease (SD) in 40 (14.3%), and progressive disease (PD) in 8 (2.9%)

Summary

Introduction

The use of sentinel node biopsy (SNB) following neoadjuvant chemotherapy (NAC) for patients with cN1 breast cancer is controversial. Improvements of negative predictive value (NPV) by axillary ultrasound (AUS), which corresponds to the accurate prediction rate of node-negative status after NAC, would lead to decreased FNR of SNB following NAC. Three major prospective trials previously evaluated the use of SNB in patients with clinically node-positive breast cancer receiving NAC: American College of Surgeons Oncology Group (ACOSOG) Z1071 trial, SENTINA trial, and SN FNAC trial These three trials reported respective FNRs of 12.6%, 14.2%, and 13.4%, all of which were above the currently accepted cut off of 10%3–5. It is conceivable that improvements of negative predictive value (NPV) by AUS, which corresponds to the accurate prediction rate of node-negative status after NAC, would lead to decreased FNR of SNB following NAC. In this study, we retrospectively investigated the accurate prediction rate of NPV by AUS after NAC in patients with cytologically node-positive breast cancer and investigated factors related to the rate

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Results

Conclusion