Cross-sectional imaging to evaluate the extent of regional nodal disease in breast cancer patients undergoing neoadjuvant systemic therapy.

Abstract

PURPOSE:

Cross-sectional imaging often is performed in breast cancer patients undergoing neoadjuvant systemic therapy (NST) and may identify level III axillary and extra-axillary nodal disease. Our aim was to investigate associations of radiologic nodal staging with pathological N (pN) stage at operation and to explore how this might aid surgical and radiotherapy treatment planning.

MATERIALS AND METHODS:

With IRB approval, we reviewed pre-treatment breast MRI, PET/CT, and CT imaging and clinicopathologic data on 348 breast cancer patients with imaging available for review undergoing NST followed by operation at our institution 1/2008-9/2013. We defined abnormal lymph node findings on MRI, CT, and PET/CT to include cortical thickening, FDG-avidity and loss of fatty hilum. Patients were assigned a radiologic nodal (rN) stage based on imaging findings. Statistical analysis was performed using JMP 10.1 software RESULTS: Pre-NST imaging included axillary ultrasound in 338 patients (97%), breast MRI in 305 (88%) and PET/CT or CT in 215 (62%). 213 patients (61%) were biopsy-proven axillary lymph node-positive (LN+) pre-treatment. cT stage was T1 in 9%, T2 in 49%, T3 in 29%, T4 in 12%; median tumor size was 4cm. Pre-treatment rN stage across all the patients was rN0 in 86 (25%), rN1 in 173 (50%), and rN3 in 89 (26%). rN3 disease included level III axillary, supraclavicular and suspicious internal mammary lymph nodes in 47 (53%), 32 (37%) and 45 (52%), respectively. Of patients LN+ at diagnosis, 78 (37%) were rN3. After NST, 162 patients (47%) were node-positive at operation with a median (mean) of 3 (5.9±0.4) positive lymph nodes including 128 of 213 (60%) LN+ at diagnosis. Pre-NST rN stage correlated with the likelihood and extent of axillary disease at operation, p=0.002. Fifty four of 89 rN3 patients (61%) were node-positive at operation with a median (mean) of 5 (8±1) positive nodes. rN3 patients had larger nodal metastases (median 9 vs 6mm) and more frequent extranodal extension (61% vs 43%) than rN0/rN1 patients, both p<0.03.

CONCLUSIONS:

Information on rN stage from pre-NST cross-sectional imaging informs the likelihood and extent of axillary nodal disease at operation. This information may be used for surgical and radiotherapy treatment planning and to inform patient expectations.

• Authors: Tara L Anderson, Katrina N Glazebrook, Brittany L Murphy, Lyndsay D Viers, Tina J Hieken
• Journal: European journal of radiology (Eur J Radiol) Vol. 89 Pg. 163-168 (Apr 2017) ISSN: 1872-7727 [Electronic] Ireland
• PMID: 28267534 (Publication Type: Evaluation Study, Journal Article)
• Copyright: Copyright © 2017 Elsevier B.V. All rights reserved.

Topics

• Adult
• Axilla (pathology)
• Biopsy
• Breast (pathology)
• Breast Neoplasms (pathology, therapy)
• Female
• Humans
• Lymph Nodes (pathology)
• Lymphatic Metastasis
• Magnetic Resonance Imaging
• Middle Aged
• Multimodal Imaging
• Neoadjuvant Therapy
• Positron Emission Tomography Computed Tomography
• Tomography, X-Ray Computed