Accuracy of breast MRI in evaluating nodal status after neoadjuvant therapy in invasive lobular carcinoma

Abstract Neoadjuvant therapy in breast cancer can downstage axillary lymph nodes and reduce extent of axillary surgery. As such, accurate determination of nodal status after neoadjuvant therapy and before surgery impacts surgical management. There are scarce data on the diagnostic accuracy of breast...

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Autores principales: Mary Kathryn Abel, Heather Greenwood, Tatiana Kelil, Ruby Guo, Case Brabham, Nola Hylton, Jasmine Wong, Michael Alvarado, Cheryl Ewing, Laura J. Esserman, Judy C. Boughey, Rita A. Mukhtar
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Publicado: Nature Portfolio 2021
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Acceso en línea:https://doaj.org/article/1b187953753b420cbc254c12bdb82efa
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spelling oai:doaj.org-article:1b187953753b420cbc254c12bdb82efa2021-12-02T13:32:53ZAccuracy of breast MRI in evaluating nodal status after neoadjuvant therapy in invasive lobular carcinoma10.1038/s41523-021-00233-92374-4677https://doaj.org/article/1b187953753b420cbc254c12bdb82efa2021-03-01T00:00:00Zhttps://doi.org/10.1038/s41523-021-00233-9https://doaj.org/toc/2374-4677Abstract Neoadjuvant therapy in breast cancer can downstage axillary lymph nodes and reduce extent of axillary surgery. As such, accurate determination of nodal status after neoadjuvant therapy and before surgery impacts surgical management. There are scarce data on the diagnostic accuracy of breast magnetic resonance imaging (MRI) for nodal evaluation after neoadjuvant therapy in patients with invasive lobular carcinoma (ILC), a diffusely growing tumor type. We retrospectively analyzed patients with stage 1–3 ILC who underwent pre-operative breast MRI after either neoadjuvant chemotherapy or endocrine therapy at our institution between 2006 and 2019. Two breast radiologists reviewed MRIs and evaluated axillary nodes for suspicious features. All patients underwent either sentinel node biopsy or axillary dissection. We evaluated sensitivity, specificity, negative and positive predictive values, and overall accuracy of the post-treatment breast MRI in predicting pathologic nodal status. Of 79 patients, 58.2% received neoadjuvant chemotherapy and 41.8% neoadjuvant endocrine therapy. The sensitivity and negative predictive value of MRI were significantly higher in the neoadjuvant endocrine therapy cohort than in the neoadjuvant chemotherapy cohort (66.7 vs. 37.9%, p = 0.012 and 70.6 vs. 40%, p = 0.007, respectively), while overall accuracy was similar. Upstaging from clinically node negative to pathologically node positive occurred in 28.0 and 41.7%, respectively. In clinically node positive patients, those with an abnormal post-treatment MRI had a significantly higher proportion of patients with ≥4 positive nodes on pathology compared to those with a normal MRI (61.1 versus 16.7%, p = 0.034). Overall, accuracy of breast MRI for predicting nodal status after neoadjuvant therapy in ILC was low in both chemotherapy and endocrine therapy cohorts. However, post-treatment breast MRI may help identify patients with a high burden of nodal disease (≥4 positive nodes), which could impact pre-operative systemic therapy decisions. Further studies are needed to assess other imaging modalities to evaluate for nodal disease following neoadjuvant therapy and to improve clinical staging in patients with ILC.Mary Kathryn AbelHeather GreenwoodTatiana KelilRuby GuoCase BrabhamNola HyltonJasmine WongMichael AlvaradoCheryl EwingLaura J. EssermanJudy C. BougheyRita A. MukhtarNature PortfolioarticleNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENnpj Breast Cancer, Vol 7, Iss 1, Pp 1-8 (2021)
institution DOAJ
collection DOAJ
language EN
topic Neoplasms. Tumors. Oncology. Including cancer and carcinogens
RC254-282
spellingShingle Neoplasms. Tumors. Oncology. Including cancer and carcinogens
RC254-282
Mary Kathryn Abel
Heather Greenwood
Tatiana Kelil
Ruby Guo
Case Brabham
Nola Hylton
Jasmine Wong
Michael Alvarado
Cheryl Ewing
Laura J. Esserman
Judy C. Boughey
Rita A. Mukhtar
Accuracy of breast MRI in evaluating nodal status after neoadjuvant therapy in invasive lobular carcinoma
description Abstract Neoadjuvant therapy in breast cancer can downstage axillary lymph nodes and reduce extent of axillary surgery. As such, accurate determination of nodal status after neoadjuvant therapy and before surgery impacts surgical management. There are scarce data on the diagnostic accuracy of breast magnetic resonance imaging (MRI) for nodal evaluation after neoadjuvant therapy in patients with invasive lobular carcinoma (ILC), a diffusely growing tumor type. We retrospectively analyzed patients with stage 1–3 ILC who underwent pre-operative breast MRI after either neoadjuvant chemotherapy or endocrine therapy at our institution between 2006 and 2019. Two breast radiologists reviewed MRIs and evaluated axillary nodes for suspicious features. All patients underwent either sentinel node biopsy or axillary dissection. We evaluated sensitivity, specificity, negative and positive predictive values, and overall accuracy of the post-treatment breast MRI in predicting pathologic nodal status. Of 79 patients, 58.2% received neoadjuvant chemotherapy and 41.8% neoadjuvant endocrine therapy. The sensitivity and negative predictive value of MRI were significantly higher in the neoadjuvant endocrine therapy cohort than in the neoadjuvant chemotherapy cohort (66.7 vs. 37.9%, p = 0.012 and 70.6 vs. 40%, p = 0.007, respectively), while overall accuracy was similar. Upstaging from clinically node negative to pathologically node positive occurred in 28.0 and 41.7%, respectively. In clinically node positive patients, those with an abnormal post-treatment MRI had a significantly higher proportion of patients with ≥4 positive nodes on pathology compared to those with a normal MRI (61.1 versus 16.7%, p = 0.034). Overall, accuracy of breast MRI for predicting nodal status after neoadjuvant therapy in ILC was low in both chemotherapy and endocrine therapy cohorts. However, post-treatment breast MRI may help identify patients with a high burden of nodal disease (≥4 positive nodes), which could impact pre-operative systemic therapy decisions. Further studies are needed to assess other imaging modalities to evaluate for nodal disease following neoadjuvant therapy and to improve clinical staging in patients with ILC.
format article
author Mary Kathryn Abel
Heather Greenwood
Tatiana Kelil
Ruby Guo
Case Brabham
Nola Hylton
Jasmine Wong
Michael Alvarado
Cheryl Ewing
Laura J. Esserman
Judy C. Boughey
Rita A. Mukhtar
author_facet Mary Kathryn Abel
Heather Greenwood
Tatiana Kelil
Ruby Guo
Case Brabham
Nola Hylton
Jasmine Wong
Michael Alvarado
Cheryl Ewing
Laura J. Esserman
Judy C. Boughey
Rita A. Mukhtar
author_sort Mary Kathryn Abel
title Accuracy of breast MRI in evaluating nodal status after neoadjuvant therapy in invasive lobular carcinoma
title_short Accuracy of breast MRI in evaluating nodal status after neoadjuvant therapy in invasive lobular carcinoma
title_full Accuracy of breast MRI in evaluating nodal status after neoadjuvant therapy in invasive lobular carcinoma
title_fullStr Accuracy of breast MRI in evaluating nodal status after neoadjuvant therapy in invasive lobular carcinoma
title_full_unstemmed Accuracy of breast MRI in evaluating nodal status after neoadjuvant therapy in invasive lobular carcinoma
title_sort accuracy of breast mri in evaluating nodal status after neoadjuvant therapy in invasive lobular carcinoma
publisher Nature Portfolio
publishDate 2021
url https://doaj.org/article/1b187953753b420cbc254c12bdb82efa
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