Use of ultrasound and MRI to stage the axilla for breast cancer before and after neoadjuvant chemotherapy prior to targeted sentinel lymphadenectomy

Danielle Brabender; April Ballard; Sean Kim; Linda Hovanessian-Larsen; Stephen F Sener

doi:10.1007/s10549-024-07332-8

Use of ultrasound and MRI to stage the axilla for breast cancer before and after neoadjuvant chemotherapy prior to targeted sentinel lymphadenectomy

Breast Cancer Res Treat. 2024 Aug;206(3):595-602. doi: 10.1007/s10549-024-07332-8. Epub 2024 May 3.

Authors

Danielle Brabender^{1

2}, April Ballard^{2

3}, Sean Kim^{1

2}, Linda Hovanessian-Larsen^{2

3}, Stephen F Sener^{4

5}

Affiliations

¹ Department of Surgery, Los Angeles General Medical Center, Clinic Tower, 6A231A, 1100 North State Street, Los Angeles, CA, 90033, USA.
² Norris Comprehensive Cancer Center and Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA.
³ Department of Radiology, Los Angeles General Medical Center, Los Angeles, CA, USA.
⁴ Department of Surgery, Los Angeles General Medical Center, Clinic Tower, 6A231A, 1100 North State Street, Los Angeles, CA, 90033, USA. stephen.sener@med.usc.edu.
⁵ Norris Comprehensive Cancer Center and Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA. stephen.sener@med.usc.edu.

Abstract

Purpose: Prior data from this Center demonstrated that for patients who had biopsy-proven axillary metastases, were ycN0 after neoadjuvant chemotherapy (NAC), and had a wire-directed (targeted) sentinel lymphadenectomy (WD-SLND), 60% were node negative. The hypothesis of this study was that results of axillary imaging either before or after NAC would be predictive of final pathologic status after WD-SLND.

Methods: For patients treated with NAC between 2015 and 2023, ultrasound and MRI images of the axilla were retrospectively reviewed by radiologists specializing in breast imaging, who were blinded to the surgical and pathology results.

Results: Of 113 patients who fit the clinical criteria, 66 (58%) were ypN0 at WD-SLND and 34 (30%) had a pathologic complete response to NAC. There was no correlation between the number of abnormal lymph nodes on pre-NAC ultrasound or MRI imaging and the final pathologic status of the lymph nodes. The positive predictive value (PPV) of abnormal post-NAC axillary imaging was 48% for ultrasound and 53% for MRI. The negative predictive value (NPV) for normal post-NAC axillary imaging was 67% for ultrasound and 68% for MRI.

Conclusion: The results of axillary imaging were not adequate to identify lymph nodes after NAC that were persistently pathologically node positive or those which had become pathologically node negative.

Keywords: Axillary imaging; Axillary metastasis; Breast cancer; Neoadjuvant chemotherapy; Sentinel lymph node.

MeSH terms

Adult
Aged
Axilla*
Breast Neoplasms* / diagnostic imaging
Breast Neoplasms* / drug therapy
Breast Neoplasms* / pathology
Breast Neoplasms* / surgery
Female
Humans
Lymph Node Excision / methods
Lymph Nodes / diagnostic imaging
Lymph Nodes / pathology
Lymph Nodes / surgery
Lymphatic Metastasis
Magnetic Resonance Imaging* / methods
Middle Aged
Neoadjuvant Therapy* / methods
Neoplasm Staging*
Retrospective Studies
Sentinel Lymph Node Biopsy* / methods
Ultrasonography / methods