Kim Tae Hee, Kang Doo Kyoung, Kim Ji Young, Han Sehwan, Jung Yongsik
Department of Radiology, Ajou University School of Medicine, Suwon, Korea.
Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
J Breast Cancer. 2015 Dec;18(4):394-9. doi: 10.4048/jbc.2015.18.4.394. Epub 2015 Dec 23.
The purposes our study was to find out any histologic factors associated with negative conversion of axillary lymph node (ALN) after neoadjuvant chemotherapy (NAC). We also evaluated the association between the decrease in size of primary breast tumor and negative conversion of ALN.
From January 2012 to November 2014, we included 133 breast cancer patients who underwent NAC and who had ALN metastases which were confirmed on fine-needle aspiration or core needle biopsy at initial diagnosis. All 133 patients underwent initial magnetic resonance imaging (MRI) at the time of diagnosis and preoperative MRI after completion of NAC. We measured the longest dimension of primary breast cancer on MRI.
Of 133 patients, 39 patients (29%) showed negative conversion of ALN and of these 39 patients, 25 patients (64%) showed pathologic complete remission of primary breast. On univariate analysis, mean percent decrease in longest dimension, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 status and histologic grade were significantly associated with the ALN status after NAC (p<0.001, p=0.001, p< 0.001, p=0.001, p=0.002, respectively). On multivariate logistic regression analysis, percent decrease in longest dimension (odds ratio, 1.026; 95% confidence interval [CI], 1.009-1.044) and histologic grade (odds ratio, 3.964; 95% CI, 1.151-13.657) were identified as being independently associated with the ALN status after NAC. The area under the receiver operating characteristic curve was 0.835 with the best cutoff value of 80% decrease in longest dimension. Combination of high histologic grade and more than 80% decrease in longest dimension showed 64% sensitivity and 92% specificity.
High histologic grade and more than 80% decrease in primary tumor dimension were associated with negative conversion of ALN after NAC.
本研究旨在找出与新辅助化疗（NAC）后腋窝淋巴结（ALN）转阴相关的任何组织学因素。我们还评估了原发性乳腺肿瘤大小的减小与ALN转阴之间的关联。
2012年1月至2014年11月，我们纳入了133例接受NAC且在初始诊断时经细针穿刺或粗针活检证实有ALN转移的乳腺癌患者。所有133例患者在诊断时均接受了初始磁共振成像（MRI）检查，并在NAC完成后接受了术前MRI检查。我们在MRI上测量了原发性乳腺癌的最长径。
133例患者中，39例（29%）显示ALN转阴，在这39例患者中，25例（64%）显示原发性乳腺病理完全缓解。单因素分析显示，最长径平均减小百分比、雌激素受体、孕激素受体、人表皮生长因子受体2状态和组织学分级与NAC后的ALN状态显著相关（p分别<0.001、p = 0.001、p<0.001、p = 0.001、p = 0.002）。多因素逻辑回归分析显示，最长径减小百分比（比值比，1.026；95%置信区间[CI]，1.009 - 1.044）和组织学分级（比值比，3.964；95%CI，1.151 - 13.657）被确定为与NAC后的ALN状态独立相关。受试者工作特征曲线下面积为0.835，最长径最佳截断值为减小80%。高组织学分级与最长径减小超过80%的组合显示出64%的敏感性和92%的特异性。
高组织学分级和原发性肿瘤径减小超过80%与NAC后ALN转阴相关。
