Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2019 Dec;26(13):4238-4243. doi: 10.1245/s10434-019-07867-x. Epub 2019 Oct 3.
The National Comprehensive Cancer Network (NCCN) endorses sentinel lymph node biopsy (SLNB) in patients with clinically positive axillary nodes who downstage after neoadjuvant chemotherapy (NAC). In this study, we compared the accuracy of post-NAC MRI to clinical exam alone in predicting pathologic status of sentinel lymph nodes in cN1 patients.
We identified patients with T0-3, N1 breast cancer who underwent NAC and subsequent SLNB from March 2014 to July 2017. Patients were grouped based on whether a post-NAC MRI was done. MRI accuracy in predicting SLN status was assessed versus clinical exam alone.
A total of 450 patients met initial study criteria; 269 were analyzed after excluding patients without biopsy-confirmed nodal disease, palpable disease after NAC, and failed SLN mapping. Median age was 49 years. Post-NAC MRI was done in 68% (182/269). Patients undergoing lumpectomy vs mastectomy more frequently received a post-NAC MRI (88 vs 54%, p < 0.001). All other clinicopathologic parameters were comparable between those who did and did not have a post-NAC MRI. Thirty percent (55/182) had abnormal lymph nodes on MRI. Among these, 58% (32/55) had a positive SLN on final pathology versus 42% (53/127) of patients with no abnormal lymph nodes on MRI and 52% (45/87) of patients who had clinical exam alone (p = 0.09). MRI sensitivity was 38%, specificity was 76%, and overall SLN status prediction accuracy was 58%.
Post-NAC MRI is no more accurate than clinical exam alone in predicting SLN pathology in patients presenting with cN1 disease. Abnormal lymph nodes on MRI should not preclude SLNB.
美国国家综合癌症网络（NCCN）支持对新辅助化疗（NAC）后降期的临床阳性腋窝淋巴结患者进行前哨淋巴结活检（SLNB）。在这项研究中，我们比较了 NAC 后 MRI 与单独临床检查在预测 cN1 患者前哨淋巴结病理状态方面的准确性。
我们从 2014 年 3 月至 2017 年 7 月，确定了接受 NAC 和随后 SLNB 的 T0-3、N1 乳腺癌患者。患者根据是否进行 NAC 后 MRI 分为两组。评估 MRI 在预测 SLN 状态方面的准确性，与单独临床检查进行比较。
共有 450 例患者符合初步研究标准；排除活检证实淋巴结疾病、NAC 后可触及疾病和前哨淋巴结定位失败的患者后，对 269 例患者进行了分析。中位年龄为 49 岁。68%（182/269）的患者进行了 NAC 后 MRI。接受保乳术的患者比接受乳房切除术的患者更常进行 NAC 后 MRI（88%比 54%，p<0.001）。在有和没有 NAC 后 MRI 的患者之间，所有其他临床病理参数均相似。182 例中有 30%（55/182）的患者 MRI 显示淋巴结异常。在这些患者中，最终病理显示 58%（32/55）的前哨淋巴结阳性，而 MRI 显示无异常淋巴结的患者中为 42%（53/127），单独进行临床检查的患者中为 52%（45/87）（p=0.09）。MRI 的敏感性为 38%，特异性为 76%，总体 SLN 状态预测准确性为 58%。
在 cN1 疾病患者中，NAC 后 MRI 预测 SLN 病理的准确性并不优于单独临床检查。MRI 显示淋巴结异常不应排除 SLNB。
