Axillary ultrasound during neoadjuvant systemic therapy in triple-negative breast cancer patients

Rosalind P Candelaria; Beatriz E Adrada; Kenneth Hess; Lumarie Santiago; Deanna L Lane; Alastair M Thompson; Stacy L Moulder; Monica L Huang; Elsa M Arribas; Gaiane M Rauch; Jessica W T Leung; W Fraser Symmans; Vicente Valero; Elizabeth E Ravenberg; Jason B White; Wei Tse Yang

doi:10.1016/j.ejrad.2020.109170

Axillary ultrasound during neoadjuvant systemic therapy in triple-negative breast cancer patients

Eur J Radiol. 2020 Sep:130:109170. doi: 10.1016/j.ejrad.2020.109170. Epub 2020 Jul 10.

Authors

Rosalind P Candelaria¹, Beatriz E Adrada², Kenneth Hess³, Lumarie Santiago⁴, Deanna L Lane⁵, Alastair M Thompson⁶, Stacy L Moulder⁷, Monica L Huang⁸, Elsa M Arribas⁹, Gaiane M Rauch¹⁰, Jessica W T Leung¹¹, W Fraser Symmans¹², Vicente Valero¹³, Elizabeth E Ravenberg¹⁴, Jason B White¹⁵, Wei Tse Yang¹⁶

Affiliations

¹ Breast Imaging Department, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Electronic address: [email protected].
² Breast Imaging Department, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Electronic address: [email protected].
³ Department of Biostatistics, Unit 1411, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
⁴ Breast Imaging Department, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Electronic address: [email protected].
⁵ Breast Imaging Department, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Electronic address: [email protected].
⁶ Department of Breast Surgical Oncology, Unit 1434, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Electronic address: [email protected].
⁷ Department of Breast Medical Oncology, Unit 1354, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Electronic address: [email protected].
⁸ Breast Imaging Department, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Electronic address: [email protected].
⁹ Breast Imaging Department, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Electronic address: [email protected].
¹⁰ Breast Imaging Department, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Electronic address: [email protected].
¹¹ Breast Imaging Department, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Electronic address: [email protected].
¹² Department of Pathology, Unit 085, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Electronic address: [email protected].
¹³ Department of Breast Medical Oncology, Unit 1354, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Electronic address: [email protected].
¹⁴ Department of Breast Medical Oncology, Unit 1354, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Electronic address: [email protected].
¹⁵ Department of Breast Medical Oncology, Unit 1354, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Electronic address: [email protected].
¹⁶ Breast Imaging Department, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Electronic address: [email protected].

Abstract

Purpose: To investigate the value of performing mid-treatment axillary ultrasound (AUS) in triple-negative breast cancer (TNBC) patients who are undergoing neoadjuvant systemic therapy (NAST) by determining the optimal cutoff number of abnormal nodes associated with residual nodal disease on surgical pathology.

Materials and methods: This sub-study, an interim analysis of an ongoing single-institution clinical trial enrolling patients with stage I-III TNBC, included 106 patients. Number of abnormal nodes at mid-treatment was assessed and recorded by experienced breast radiologists, who empirically categorized lymph nodes using a binary approach of sonographically-normal versus abnormal. Pathologic lymph node positivity was defined as presence of macrometastasis or micrometastasis in ≥1 axillary node from sentinel lymph node biopsy and/or axillary lymph node dissection.

Results: Of 106 patients, 26 (25 %) had residual nodal disease and 80 (75 %) had no nodal disease at surgery. Median number of abnormal nodes at mid-treatment was 5 (standard deviation [SD], 5) for patients with residual nodal disease and 0 (SD, 2) for patients with no nodal disease at surgery (p < 0.0001). TNBC patients with >4 abnormal nodes at mid-treatment had a significantly higher chance of being node-positive at surgery (AUC = 0.908, p < 0.0001; PPV = 90 %).

Conclusion: Our data suggest that a cutoff of >4 abnormal nodes on mid-treatment AUS is associated with residual disease post-NAST. If our findings are substantiated by subsequent analyses, then mid-treatment AUS could be used to identify patients unlikely to achieve nodal pathologic complete response and who should be offered alternative therapy.

Keywords: Axillary lymph node; Neoadjuvant systemic therapy; Triple-negative breast cancer; Ultrasound.

MeSH terms

Adult
Axilla / pathology
Female
Humans
Lymph Nodes / diagnostic imaging*
Lymph Nodes / pathology
Middle Aged
Neoadjuvant Therapy / methods*
Prospective Studies
Sentinel Lymph Node Biopsy
Triple Negative Breast Neoplasms / pathology*
Triple Negative Breast Neoplasms / therapy*
Ultrasonography / methods*

Grants and funding

P30 CA016672/CA/NCI NIH HHS/United States