Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Department of Nuclear Medicine, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Br J Surg. 2017 Aug;104(9):1188-1196. doi: 10.1002/bjs.10555. Epub 2017 May 19.
The treatment of axillary lymph node metastases after neoadjuvant systemic therapy (NST) remains debatable and axillary lymph node dissection (ALND) is still the standard of care. Marking axillary lymph nodes with radioactive iodine seeds (MARI procedure) is accurate in restaging the axilla after NST (false-negative rate 7 per cent). Here, the potential of tailored axillary treatment, determined by combining the results of PET-CT before NST with those of the MARI procedure after NST, was analysed.
A cohort of axillary node-positive patients was used to construct a hypothetical treatment algorithm based on a combination of PET-CT and the MARI procedure. In the algorithm, the number of fluorodeoxyglucose (FDG)-avid axillary lymph nodes (1-3 versus 4 or more) before NST and the tumour status of the MARI node (positive versus negative) after NST were used to tailor axillary treatment. All patients in the cohort underwent ALND, allowing estimation of potential overtreatment and undertreatment.
A total of 93 patients were included in the study. Between one and three FDG-avid axillary lymph nodes were observed in 59 patients, and four or more in 34 patients. The MARI node was tumour-negative in 32 patients and showed residual disease in 61. Treatment according to the constructed algorithm would have resulted in 74 per cent of patients avoiding an ALND, with potential undertreatment in three patients (3 per cent) and overtreatment in 16 (17 per cent).
Tailored axillary treatment after NST in node-positive patients, by combining PET-CT before NST and the MARI procedure after NST, has the potential for ALND to be avoided in 74 per cent of patients.
新辅助全身治疗（NST）后腋窝淋巴结转移的治疗仍存在争议，腋窝淋巴结清扫（ALND）仍然是标准治疗方法。放射性碘种子标记腋窝淋巴结（MARI 程序）在 NST 后对腋窝进行重新分期非常准确（假阴性率为 7%）。在此，通过将 NST 前的 PET-CT 结果与 NST 后的 MARI 程序结果相结合，分析了由 NST 前 PET-CT 和 MARI 程序后结果联合确定的个体化腋窝治疗的潜力。
使用一组腋窝淋巴结阳性患者，根据 NST 前的 PET-CT 和 NST 后的 MARI 程序构建一个假设的治疗算法。在该算法中，NST 前氟脱氧葡萄糖（FDG）摄取的腋窝淋巴结数量（1-3 个与 4 个或更多）和 NST 后 MARI 节点的肿瘤状态（阳性与阴性）用于个体化腋窝治疗。队列中的所有患者均接受 ALND，以评估潜在的过度治疗和治疗不足。
本研究共纳入 93 例患者。59 例患者有 1-3 个 FDG 摄取的腋窝淋巴结，34 例患者有 4 个或更多。32 例 MARI 节点为阴性，61 例显示残留疾病。根据构建的算法进行治疗，74%的患者可以避免接受 ALND，3 例（3%）可能治疗不足，16 例（17%）可能过度治疗。
在淋巴结阳性患者中，通过将 NST 前的 PET-CT 和 NST 后的 MARI 程序相结合，对 NST 后进行个体化腋窝治疗，有 74%的患者有潜力避免 ALND。
