Rates of pathologic nodal disease among cN0 and cN1 patients undergoing routine axillary ultrasound and neoadjuvant chemotherapy.
Rates of pathologic nodal disease among cN0 and cN1 patients undergoing routine axillary ultrasound and neoadjuvant chemotherapy.
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接受常规腋窝超声和新辅助化疗的 cN0 和 cN1 患者的病理性淋巴结疾病发生率。
DOI：
10.1007/s10549-022-06677-2
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发表时间：
2022
影响因子：
3.8
通讯作者：
King,TariA
中科院分区：
文献类型：
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作者：
Weiss,Anna;King,Claire;Vincuilla,Julie;Parker,Tonia;Portnow,Leah;Nakhlis,Faina;Dominici,Laura;Mittendorf,ElizabethA;King,TariA
目的腋部常规超声（AxUS）在新辅助化疗（NAC）患者中的应用仍存在争议。在这里，我们报告了在正常临床检查的患者中axus检测到的淋巴结疾病的比率，以及基于淋巴结疾病检测方法的NAC后病理淋巴结疾病的比率。方法前瞻性收集I-III期乳腺癌NAC患者的临床病理资料。所有患者治疗前均行AxUS，对可疑淋巴结行活检。以下四组患者进行了检查：可疑检查或AxUS但活检阴性的患者（可疑cN0）；检查正常，AxUS正常（无可疑cN0）者；检查正常但可疑的AxUS和活检阳性（AxUS检测到的cN1）；检查异常、活检阳性（检查检出cN1）者。免疫组化评价前哨淋巴结（SLN）和非前哨淋巴结（non-SLN）；任何大小的淋巴结转移都被认为是阳性。结果共纳入500例患者。310例腋窝检查正常的患者中，160例有可疑的AxUS， 65例活检阴性（可疑cN0）， 95/310（30.6%）活检阳性（AxUS检测到cN1）。在190例腋窝检查异常患者中，166例活检证实淋巴结阳性（检查检测到cN1）， 24例AxUS或活检阴性（可疑cN0）。非可疑cN0患者的病理性淋巴结病变发生率为20/150(13.3%)，可疑cN0患者的病理性淋巴结病变发生率为12/89 (13.5%)（p= 0.97）。axus检测的cN1患者淋巴结残留率为55/95(57.9%)，未检测的cN1患者淋巴结残留率为102/166 (61.4%)（p= 0.57）。结论在临床检查正常的NAC患者中，axus检出淋巴结病变的比例为30.6%。在检测到axus和检查检测到cN1的患者中，病理性淋巴结病的发生率相似。
PurposeRoutine 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.MethodsClinicopathologic 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.Results500 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).ConclusionAxUS 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.