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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2019

01-12-2019 | Ultrasound | Breast Oncology

Axillary Lymph Node Ultrasound Following Neoadjuvant Chemotherapy in Biopsy-Proven Node-Positive Breast Cancer: Results from the SN FNAC Study

Authors: Dominique Morency, MD, MSc, FRCSC, Sinziana Dumitra, MD, MSc, FRCSC, Elena Parvez, MD, MSc, FRCSC, Karyne Martel, MD, FRCSC, Mark Basik, MD, MSc, FRCSC, André Robidoux, MD, FRCSC, Brigitte Poirier, MD, FRCSC, Claire M. B. Holloway, MD, PhD, FRCPC, Louis Gaboury, MD, PhD, FRCPC, Lucas Sideris, MD, FRCSC, Sarkis Meterissian, MD, FRCSC, Jean-François Boileau, MD, MSc, FRCSC

Published in: Annals of Surgical Oncology | Issue 13/2019

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Abstract

Background

The sentinel node biopsy following neoadjuvant chemotherapy (SN FNAC) study has shown that in node-positive (N+) breast cancer, sentinel node biopsy (SNB) can be performed following neoadjuvant chemotherapy (NAC), with a low false negative rate (FNR = 8.4%). A secondary endpoint of the SN FNAC study was to determine whether axillary ultrasound (AxUS) could predict axillary pathological complete response (ypN0) and increase the accuracy of SNB.

Methods

The SN FNAC trial is a study of patients with biopsy-proven N+ breast cancer who underwent SNB followed by completion node dissection. All patients had AxUS following NAC and the axillary nodes were classified as either positive (AxUS+) or negative (AxUS−). AxUS was compared with the final axillary pathology results.

Results

There was no statistical difference in the baseline characteristics of patients with AxUS+ versus those with AxUS−. Overall, 82.5% (47/57) of AxUS+ patients had residual positive lymph nodes (ypN+) at surgery and 53.8% (42/78) of AxUS− patients had ypN+. Post NAC AxUS sensitivity was 52.8%, specificity 78.3%, and negative predictive value 46.2%. AxUS FNR was 47.2%, versus 8.4% for SNB. If post-NAC AxUS− was used to select patients for SNB, FNR would decrease from 8.4 to 2.7%. However, using post-NAC AxUS in addition to SNB as an indication for ALND would have led to unnecessary ALND in 7.8% of all patients.

Conclusion

AxUS is not appropriate as a standalone staging procedure, and SNB itself is sufficient to assess the axilla post NAC in patients who present with N+ breast cancer.
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Metadata
Title
Axillary Lymph Node Ultrasound Following Neoadjuvant Chemotherapy in Biopsy-Proven Node-Positive Breast Cancer: Results from the SN FNAC Study
Authors
Dominique Morency, MD, MSc, FRCSC
Sinziana Dumitra, MD, MSc, FRCSC
Elena Parvez, MD, MSc, FRCSC
Karyne Martel, MD, FRCSC
Mark Basik, MD, MSc, FRCSC
André Robidoux, MD, FRCSC
Brigitte Poirier, MD, FRCSC
Claire M. B. Holloway, MD, PhD, FRCPC
Louis Gaboury, MD, PhD, FRCPC
Lucas Sideris, MD, FRCSC
Sarkis Meterissian, MD, FRCSC
Jean-François Boileau, MD, MSc, FRCSC
Publication date
01-12-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 13/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07809-7

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