Department of Medical Oncology, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey.
Department of Radiology, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey.
Neoplasma. 2022 May;69(3):741-746. doi: 10.4149/neo_2022_220127N122. Epub 2022 Apr 26.
Sentinel lymph node dissection (SLND) is a reliable method that provides axillary staging in clinical node-negative (cN0) breast cancer patients before neoadjuvant chemotherapy (NACT). However, it is not a standard method on its own due to the high false-negative rates (FNR) reported in initially clinical node-positive patients (cN1-cN3). The contribution of magnetic resonance imaging (MRI) to SLND after chemotherapy is not well understood. In our study, we aimed to investigate the contribution of post-NACT MRI to SLND in breast cancer patients receiving NACT. Between January 2014 and December 2020, patients who had MRI images including the axilla after NACT and had axillary lymph nodes evaluation performed simultaneously with SLND were included in the study. MRI images of all patients were re-evaluated by 2 experienced clinicians. MRI and SLND results were analyzed to detect axillary lymph node metastasis. 117 patients were included in the study. The median age of the patients was 49 years. Before chemotherapy, 108 patients (92.3%) had tumor metastases in their axilla pathologically confirmed by tru-cut biopsy. Axillary downstage was obtained in 48.1% (n=52) of the patients after NACT. Of the 56 patients with axillary node positivity, 3 patients had no metastasis in the SLND evaluation (FNR=5.4%). The sensitivity of post-NACT MRI in detecting node positivity was 69.6%, the specificity was 90.2%, the positive predictive value (PPV) was 86.7% and the negative predictive value (NPV) was 76.4. SLND together with MRI predicted all node-positive patients (FNR=0%). In summary, SLND may not detect a group of patients with residual axillary lymph node metastases after NACT. We have shown that MRI can contribute to identifying these patients. If no metastases are detected by both methods (SLND and MRI), avoidance of axillary dissection may be an acceptable choice.
前哨淋巴结活检（SLND）是一种可靠的方法，可在接受新辅助化疗（NACT）前对临床淋巴结阴性（cN0）乳腺癌患者进行腋窝分期。然而，由于最初临床淋巴结阳性患者（cN1-cN3）报告的假阴性率（FNR）较高，因此它本身并不是一种标准方法。化疗后磁共振成像（MRI）对 SLND 的贡献尚不清楚。在我们的研究中，我们旨在研究化疗后 MRI 对接受 NACT 的乳腺癌患者 SLND 的贡献。2014 年 1 月至 2020 年 12 月，纳入了接受 NACT 后具有包括腋窝在内的 MRI 图像且同时进行 SLND 腋窝淋巴结评估的患者。所有患者的 MRI 图像均由 2 名经验丰富的临床医生重新评估。分析 MRI 和 SLND 结果以检测腋窝淋巴结转移。研究纳入了 117 名患者。患者的中位年龄为 49 岁。在化疗前，通过 tru-cut 活检病理证实 108 例（92.3%）患者腋窝有肿瘤转移。NACT 后，48.1%（n=52）的患者获得腋窝降期。在 56 例腋窝淋巴结阳性患者中，3 例 SLND 评估无转移（FNR=5.4%）。NACT 后 MRI 检测淋巴结阳性的灵敏度为 69.6%，特异性为 90.2%，阳性预测值（PPV）为 86.7%，阴性预测值（NPV）为 76.4%。SLND 联合 MRI 可预测所有淋巴结阳性患者（FNR=0%）。总之，NACT 后 SLND 可能无法检测到一组残留腋窝淋巴结转移的患者。我们已经表明，MRI 可以帮助识别这些患者。如果两种方法（SLND 和 MRI）均未检测到转移，则可以选择避免腋窝清扫。
