Dashevsky Brittany Z, Altman Ashley, Abe Hiroyuki, Jaskowiak Nora, Bao Jean, Schacht David V, Sheth Deepa, Kulkarni Kirti
University of Chicago Medical Center, Department of Radiology, Chicago, IL 60637, United States.
University of Chicago Medical Center, Department of Surgery, Chicago, IL 60637, United States.
Clin Imaging. 2018 Mar-Apr;48:69-73. doi: 10.1016/j.clinimag.2017.10.003. Epub 2017 Oct 7.
To evaluate whether the disease status of the pre-neoadjuvant chemotherapy (NAC) core biopsied lymph node (preNACBxLN) in patients with node positive breast cancer corresponds to nodal status of all surgically retrieved lymph nodes (LNs) post-NAC and whether wire localization of this LN is feasible.
HIPPA compliant IRB approved retrospective study including breast cancer patients (a.) with preNACBxLN confirmed metastases, (b.) who received NAC, and (c.) underwent wire localization of the preNACBxLN. Electronic medical records were reviewed. Fisher's exact test was used to compare differences in residual disease post-NAC among breast cancer subtypes.
28 women with node positive breast cancer underwent ultrasound guided wire localization of the preNACBxLN, without complication. There was no evidence of residual nodal disease for 16 patients, with mean 4.4 (median 4) LNs resected. 12 patients had residual nodal metastases, with mean 9.2 (median 7) LNs resected and mean 2.3 (median 2) LNs with tumor involvement. 11 patients had metastases detected within the localized LN. One patient had micrometastasis in a sentinel LN, despite no residual disease in the preNACBxLN. Patients with luminal A/B breast cancer more often had residual nodal metastases (86%) at pathology, as compared to patients with HER2+ (20%) and Triple Negative breast cancer (50%), though not quite achieving statistical significance (p=0.055).
Ultrasound guided wire localization of the preNACBxLN is feasible and may improve detection of residual tumor in patients post-NAC.
评估淋巴结阳性乳腺癌患者新辅助化疗（NAC）前核心活检淋巴结（preNACBxLN）的疾病状态是否与NAC后所有手术切除淋巴结（LN）的淋巴结状态相对应，以及该淋巴结的金属丝定位是否可行。
一项符合HIPPA规定且经机构审查委员会（IRB）批准的回顾性研究，纳入了以下乳腺癌患者：（a）preNACBxLN确诊有转移；（b）接受了NAC；（c）对preNACBxLN进行了金属丝定位。对电子病历进行了回顾。采用Fisher精确检验比较乳腺癌各亚型NAC后残留疾病的差异。
28例淋巴结阳性乳腺癌女性患者接受了preNACBxLN的超声引导下金属丝定位，无并发症发生。16例患者没有残留淋巴结疾病的证据，平均切除4.4个（中位数4个）LN。12例患者有残留淋巴结转移，平均切除9.2个（中位数7个）LN，平均有2.3个（中位数2个）LN有肿瘤累及。11例患者在定位的LN内检测到转移。1例患者前哨淋巴结有微转移，尽管preNACBxLN没有残留疾病。与HER2 +（20%）和三阴性乳腺癌（50%）患者相比，腔面A/B型乳腺癌患者在病理检查时更常出现残留淋巴结转移（86%），尽管未达到统计学意义（p = 0.055）。
preNACBxLN的超声引导下金属丝定位是可行的，可能会提高NAC后患者残留肿瘤的检测率。
