Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
Breast Cancer Res Treat. 2022 Sep;195(2):181-189. doi: 10.1007/s10549-022-06677-2. Epub 2022 Jul 28.
Routine axillary ultrasound (AxUS) in patients receiving neoadjuvant chemotherapy (NAC) remains controversial. Here, we report rates of AxUS-detected nodal disease among patients with normal clinical exams, and rates of pathologic nodal disease after NAC based on method of nodal disease detection.
Clinicopathologic findings were prospectively collected for stage I-III breast cancer patients selected for NAC. All patients had pre-treatment AxUS, suspicious nodes were biopsied. The following four patient cohorts were examined: patients with suspicious exam or AxUS but negative biopsy (Suspicious cN0); those with normal exam and normal AxUS (Not Suspicious cN0); those with normal exam but suspicious AxUS and positive biopsy (AxUS-detected cN1); and those with abnormal exam and positive biopsy (exam-detected cN1). Sentinel (SLN) and non-sentinel lymph nodes (non-SLN) were evaluated by immunohistochemistry; nodal metastases of any size were considered positive.
500 patients were included. Of 310 patients with normal axillary exams, 160 had suspicious AxUS, 65 were biopsy-negative (Suspicious cN0) and 95/310 (30.6%) were biopsy-positive (AxUS-detected cN1). Of 190 with abnormal axillary exams, 166 were biopsy-proven node-positive (exam-detected cN1) and 24 were AxUS or biopsy-negative (Suspicious cN0). Rates of pathologic nodal disease were 20/150 (13.3%) among Not Suspicious cN0 patients, 12/89 (13.5%) among Suspicious cN0 (p = 0.97). Rates of residual nodal disease were 55/95 (57.9%) among AxUS-detected cN1 patients, 102/166 (61.4%) among exam-detected cN1 (p = 0.57).
AxUS detected nodal disease in 30.6% of patients with normal clinical exams selected for NAC. Rates of pathologic nodal disease were similar among AxUS-detected and exam-detected cN1 patients.
在接受新辅助化疗（NAC）的患者中，常规腋窝超声（AxUS）仍存在争议。在此，我们报告了根据淋巴结疾病检测方法，在临床检查正常的患者中，AxUS 检测到的淋巴结疾病的发生率，以及 NAC 后病理淋巴结疾病的发生率。
前瞻性收集了选择接受 NAC 的 I-III 期乳腺癌患者的临床病理资料。所有患者均行治疗前 AxUS 检查，可疑淋巴结行活检。检查了以下四个患者队列：临床检查或 AxUS 可疑但活检阴性的患者（可疑 cN0）；临床检查正常且 AxUS 正常的患者（非可疑 cN0）；临床检查正常但 AxUS 可疑且活检阳性的患者（AxUS 检测到的 cN1）；临床检查异常且活检阳性的患者（临床检查检测到的 cN1）。通过免疫组织化学评估前哨（SLN）和非前哨淋巴结（non-SLN）；任何大小的淋巴结转移均被视为阳性。
共纳入 500 例患者。在 310 例临床腋窝检查正常的患者中，160 例 AxUS 可疑，65 例活检阴性（可疑 cN0），95/310（30.6%）活检阳性（AxUS 检测到的 cN1）。在 190 例临床腋窝检查异常的患者中，166 例活检证实淋巴结阳性（临床检查检测到的 cN1），24 例 AxUS 或活检阴性（可疑 cN0）。在非可疑 cN0 患者中，病理淋巴结疾病的发生率为 20/150（13.3%），在可疑 cN0 患者中为 12/89（13.5%）（p=0.97）。在 AxUS 检测到的 cN1 患者中，残留淋巴结疾病的发生率为 55/95（57.9%），在临床检查检测到的 cN1 患者中为 102/166（61.4%）（p=0.57）。
在选择接受 NAC 的临床检查正常的患者中，AxUS 检测到 30.6%的淋巴结疾病。AxUS 检测到的 cN1 患者和临床检查检测到的 cN1 患者的病理淋巴结疾病发生率相似。
