Anderson Tara L, Glazebrook Katrina N, Murphy Brittany L, Viers Lyndsay D, Hieken Tina J
Mayo Clinic, Department of Radiology, 200 First Street SW, Rochester, MN, 55905, USA.
Mayo Clinic, Department of Surgery, 200 First Street SW, Rochester, MN, 55905, USA.
Eur J Radiol. 2017 Apr;89:163-168. doi: 10.1016/j.ejrad.2017.01.030. Epub 2017 Feb 7.
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.
目的：横断面成像常用于接受新辅助全身治疗（NST）的乳腺癌患者，可能会发现Ⅲ级腋窝及腋窝外淋巴结疾病。我们的目的是研究放射学淋巴结分期与手术时病理N（pN）分期之间的关联，并探讨这如何有助于手术和放射治疗计划的制定。 材料与方法：经机构审查委员会（IRB）批准，我们回顾了2008年1月至2013年9月在我院接受NST并随后接受手术的348例乳腺癌患者的治疗前乳腺MRI、PET/CT和CT成像以及临床病理数据，这些患者的成像资料可供审查。我们将MRI、CT和PET/CT上异常淋巴结表现定义为包括皮质增厚、FDG摄取及脂肪门消失。根据成像结果为患者指定放射学淋巴结（rN）分期。使用JMP 10.1软件进行统计分析。结果：NST前成像包括338例患者（97%）进行了腋窝超声检查，305例（88%）进行了乳腺MRI检查，215例（62%）进行了PET/CT或CT检查。213例患者（61%）在治疗前经活检证实腋窝淋巴结阳性（LN+）。cT分期为T1期的占9%，T2期的占49%，T3期的占29%，T4期的占12%；肿瘤中位大小为4cm。所有患者治疗前rN分期为rN0的有86例（25%），rN1的有173例（50%），rN3的有89例（26%）。rN3疾病分别包括Ⅲ级腋窝、锁骨上及可疑内乳淋巴结，分别为47例（53%）、32例（37%）和45例（52%）。诊断时LN+的患者中，78例（37%）为rN3。NST后，162例患者（47%）手术时淋巴结阳性，阳性淋巴结中位数（平均数）为3个（5.9±0.4个），其中213例诊断时LN+的患者中有128例（60%）。治疗前rN分期与手术时腋窝疾病的可能性及范围相关，p = 0.002。89例rN3患者中有54例（61%）手术时淋巴结阳性，阳性淋巴结中位数（平均数）为5个（8±1个）。rN3患者的淋巴结转移灶比rN0/rN1患者更大（中位值9 vs 6mm）且结外扩展更频繁（61% vs 43%），两者p均<0.03。 结论：治疗前横断面成像的rN分期信息可提示手术时腋窝淋巴结疾病的可能性及范围。该信息可用于手术和放射治疗计划的制定，并告知患者预期情况。
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