Elena Leinert , Stefan Lukac , Lukas Schwentner , Antonia Coenen , Visnja Fink , Kristina Veselinovic , Davut Dayan , Wolfgang Janni , Thomas W.P. Friedl
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This study aims to answer the question, whether AUS can be used as a reliable diagnostic tool for restaging of axillary nodal status after NACT.</span></p></div><div><h3>Patients and methods</h3><p>We collected data of 96 patients with nodal positive primary breast cancer who received NACT between 2009 and 2015 at the Breast Cancer Center of the University Hospital Ulm. Patients were classified as node negative or positive by AUS after NACT (ycN + or ycN0) and the results were compared to the pathological result obtained after axillary lymph node dissection (ypN + vs ypN0) in all patients.</p></div><div><h3>Results</h3><p>58.3 % of the patients had pathological complete remission of axillary lymph nodes after NACT (ypN0). The sensitivity and specificity of AUS were 57.5 % and 78.6 %, respectively. The FNR was 42.5 %. The Positive and Negative Predictive Values (PPV and NPV) were 65.7 % and 72.1 %, respectively. The accuracy of AUS was 69.8 % and not associated with any of the investigated clinico-pathological parameters.</p></div><div><h3>Conclusion</h3><p>AUS alone is not accurate enough to replace surgical restaging of the axilla after NACT in initially node positive breast cancer patients.</p></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The use of axillary ultrasound (AUS) to assess the nodal status after neoadjuvant chemotherapy (NACT) in primary breast cancer patients\",\"authors\":\"Elena Leinert , Stefan Lukac , Lukas Schwentner , Antonia Coenen , Visnja Fink , Kristina Veselinovic , Davut Dayan , Wolfgang Janni , Thomas W.P. Friedl\",\"doi\":\"10.1016/j.suronc.2023.102016\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p><span>Axillary Ultrasound (AUS) is standard for pre-therapeutic axillary staging in early breast cancer patients. 35–75 % of the breast cancer (BC) patients with positive axillary lymph nodes receiving </span>neoadjuvant chemotherapy<span> (NACT) convert to pathological node negative. For those patients, axillary surgery after NACT could be de-escalated, if an accurate prediction of the pathologic nodal status following NACT was possible. This study aims to answer the question, whether AUS can be used as a reliable diagnostic tool for restaging of axillary nodal status after NACT.</span></p></div><div><h3>Patients and methods</h3><p>We collected data of 96 patients with nodal positive primary breast cancer who received NACT between 2009 and 2015 at the Breast Cancer Center of the University Hospital Ulm. Patients were classified as node negative or positive by AUS after NACT (ycN + or ycN0) and the results were compared to the pathological result obtained after axillary lymph node dissection (ypN + vs ypN0) in all patients.</p></div><div><h3>Results</h3><p>58.3 % of the patients had pathological complete remission of axillary lymph nodes after NACT (ypN0). The sensitivity and specificity of AUS were 57.5 % and 78.6 %, respectively. The FNR was 42.5 %. The Positive and Negative Predictive Values (PPV and NPV) were 65.7 % and 72.1 %, respectively. The accuracy of AUS was 69.8 % and not associated with any of the investigated clinico-pathological parameters.</p></div><div><h3>Conclusion</h3><p>AUS alone is not accurate enough to replace surgical restaging of the axilla after NACT in initially node positive breast cancer patients.</p></div>\",\"PeriodicalId\":51185,\"journal\":{\"name\":\"Surgical Oncology-Oxford\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2023-11-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Surgical Oncology-Oxford\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0960740423001160\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgical Oncology-Oxford","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0960740423001160","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
腋窝超声(AUS)是早期乳腺癌患者治疗前腋窝分期的标准。35 - 75%接受新辅助化疗(NACT)的腋窝淋巴结阳性乳腺癌(BC)患者转化为病理淋巴结阴性。对于这些患者,如果能够准确预测NACT后的病理淋巴结状态,则可以减少NACT后的腋窝手术。本研究旨在回答AUS是否可以作为NACT术后腋窝淋巴结状态重新定位的可靠诊断工具。患者和方法我们收集了2009年至2015年间在乌尔姆大学医院乳腺癌中心接受NACT治疗的96例淋巴结阳性原发性乳腺癌患者的数据。将所有患者经NACT (ycN +或ycN0)治疗后的病理结果(ypN + vs ypN0)与经NACT (ypN0)治疗后的腋窝淋巴结病理完全缓解率(58.3%)进行比较。AUS的敏感性为57.5%,特异性为78.6%。FNR为42.5%。阳性预测值(PPV)为65.7%,阴性预测值(NPV)为72.1%。AUS的准确率为69.8%,与所研究的任何临床病理参数无关。结论单纯aus不足以替代原发性淋巴结阳性乳腺癌患者NACT术后腋窝再植手术。
The use of axillary ultrasound (AUS) to assess the nodal status after neoadjuvant chemotherapy (NACT) in primary breast cancer patients
Introduction
Axillary Ultrasound (AUS) is standard for pre-therapeutic axillary staging in early breast cancer patients. 35–75 % of the breast cancer (BC) patients with positive axillary lymph nodes receiving neoadjuvant chemotherapy (NACT) convert to pathological node negative. For those patients, axillary surgery after NACT could be de-escalated, if an accurate prediction of the pathologic nodal status following NACT was possible. This study aims to answer the question, whether AUS can be used as a reliable diagnostic tool for restaging of axillary nodal status after NACT.
Patients and methods
We collected data of 96 patients with nodal positive primary breast cancer who received NACT between 2009 and 2015 at the Breast Cancer Center of the University Hospital Ulm. Patients were classified as node negative or positive by AUS after NACT (ycN + or ycN0) and the results were compared to the pathological result obtained after axillary lymph node dissection (ypN + vs ypN0) in all patients.
Results
58.3 % of the patients had pathological complete remission of axillary lymph nodes after NACT (ypN0). The sensitivity and specificity of AUS were 57.5 % and 78.6 %, respectively. The FNR was 42.5 %. The Positive and Negative Predictive Values (PPV and NPV) were 65.7 % and 72.1 %, respectively. The accuracy of AUS was 69.8 % and not associated with any of the investigated clinico-pathological parameters.
Conclusion
AUS alone is not accurate enough to replace surgical restaging of the axilla after NACT in initially node positive breast cancer patients.
期刊介绍:
Surgical Oncology is a peer reviewed journal publishing review articles that contribute to the advancement of knowledge in surgical oncology and related fields of interest. Articles represent a spectrum of current technology in oncology research as well as those concerning clinical trials, surgical technique, methods of investigation and patient evaluation. Surgical Oncology publishes comprehensive Reviews that examine individual topics in considerable detail, in addition to editorials and commentaries which focus on selected papers. The journal also publishes special issues which explore topics of interest to surgical oncologists in great detail - outlining recent advancements and providing readers with the most up to date information.