Department of Diagnostic Imaging and Intervention, Akershus University Hospital (AHUS), Postboks 1000, 1478, Lørenskog, Norway.
Institute of Clinical Medicine, Campus AHUS, University of Oslo, Postboks 1000, 1478, Lørenskog, Norway.
BMC Cancer. 2022 Jun 25;22(1):702. doi: 10.1186/s12885-022-09813-9.
Axillary lymph node (LN) metastasis is one of the most important predictors of recurrence and survival in breast cancer, and accurate assessment of LN involvement is crucial. Determining extent of residual disease is key for surgical planning after neoadjuvant therapy. The aim of the study was to evaluate the diagnostic reliability of MRI for nodal disease in locally advanced breast cancer patients treated with neoadjuvant endocrine therapy (NET).
Thirty-three clinically node-positive locally advanced breast cancer patients who underwent NET and surgery were prospectively enrolled. Two radiologists reviewed the axillary nodes at 3 separate time points MRI examinations at baseline (before the first treatment regimen), interim (following at least 2 months after the first cycle and prior to crossing-over), and preoperative (after the final administration of therapy and immediately before surgery). According to LN status after surgery, imaging features and diagnostic performance were analyzed.
All 33 patients had a target LN reduction, the greatest treatment benefit from week 8 to week 16. There was a positive correlation between the maximal diameter of the most suspicious LN measured by MRI and pathology during and after NET, being highest at therapy completion (r = 0.6, P ≤ .001). Mean and median differences of maximal diameter of the most suspicious LN were higher with MRI than with pathology. Seven of 33 patients demonstrated normal posttreatment MRI nodal status (yrN0). Of these 7 yrN0, 3 exhibited no metastasis on final pathology (ypN0), 2 ypN1 and 2 ypN2. Reciprocally, MRI diagnosed 3 cases of ypN0 as yrN + . Diffusion -weighted imaging (DWI) was the only axillary node characteristic significant when associated with pathological node status (χ(4) = 8.118, P = .072).
Performance characteristics of MRI were not completely sufficient to preclude surgical axillary staging. To our knowledge, this is the first study on MRI LN assessment following NET in locally advanced breast cancer, and further studies with larger sample sizes are required to consolidate the results of this preliminary study.
Institutional Review Board approval was obtained (this current manuscript is from a prospective, open-label, randomized single-center cohort substudy of the NEOLETEXE trial). NEOLETEXE, a phase 2 clinical trial, was registered on March 23, 2015 in the National trial database of Norway and approved by the Regional Ethical Committee of the South-Eastern Health Region in Norway; registration number: REK-SØ-84-2015 .
腋窝淋巴结（LN）转移是乳腺癌复发和生存的最重要预测因素之一，准确评估 LN 受累情况至关重要。确定残留疾病的程度是新辅助治疗后手术计划的关键。本研究旨在评估 MRI 对接受新辅助内分泌治疗（NET）的局部晚期乳腺癌患者淋巴结疾病的诊断可靠性。
前瞻性纳入 33 例临床淋巴结阳性的局部晚期乳腺癌患者，接受 NET 联合手术治疗。两名放射科医生分别在基线（治疗方案前）、中期（首次周期后至少 2 个月和交叉前）和术前（最后一次治疗后立即手术前）3 个时间点对腋窝淋巴结进行 MRI 检查。根据术后淋巴结状态分析影像学特征和诊断性能。
所有 33 例患者均有目标 LN 减少，第 8 周至第 16 周治疗获益最大。NET 期间和之后，MRI 测量的最可疑 LN 的最大直径与病理之间呈正相关，在治疗结束时相关性最高（r=0.6，P≤0.001）。MRI 测量的最可疑 LN 的最大直径的平均和中位数差值高于病理检查。33 例患者中有 7 例治疗后 MRI 淋巴结状态正常（yrN0）。在这 7 例 yrN0 中，3 例最终病理检查未见转移（ypN0），2 例 ypN1，2 例 ypN2。相反，MRI 诊断 3 例 ypN0 为 yrN+。弥散加权成像（DWI）是唯一与淋巴结病理状态相关的腋窝淋巴结特征（χ(4)=8.118，P=0.072）。
MRI 的性能特征不完全足以排除手术腋窝分期。据我们所知，这是第一项关于局部晚期乳腺癌 NET 后 MRI 淋巴结评估的研究，需要进一步的大样本量研究来巩固本初步研究的结果。
获得机构审查委员会批准（本手稿来自 NEOLETEXE 试验的前瞻性、开放标签、随机单中心队列子研究）。NEOLETEXE 是一项 2 期临床试验，于 2015 年 3 月 23 日在挪威国家试验数据库注册，并获得挪威南东卫生区区域伦理委员会批准；注册号：REK-SØ-84-2015。
