Predicting nodal status using dynamic contrast-enhanced magnetic resonance imaging in patients with locally advanced breast cancer undergoing neoadjuvant chemotherapy with and without sequential trastuzumab
Predicting nodal status using dynamic contrast-enhanced magnetic resonance imaging in patients with locally advanced breast cancer undergoing neoadjuvant chemotherapy with and without sequential trastuzumab
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DOI：
10.1001/archsurg.142.9.855
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发表时间：
2007-09-01
影响因子：
--
通讯作者：
Butler, John A.
中科院分区：
文献类型：
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作者：
Hsiang, David J.;Yatnamoto, Maki;Butler, John A.
假设：动态对比增强（DCE）磁共振成像（MRI）是监测乳腺原发性肿瘤反应的可靠和准确的方法，可用作预测最终腋窝淋巴结状态的替代方法。设计：回顾性研究（2004年10月1日至2006年2月28日）46例临床分期为局部晚期乳腺癌的患者。46例局部晚期乳腺癌患者。干预措施：新辅助化疗（NAC）、DCE-MRI、乳房切除术和肿块切除术以及腋窝淋巴结清扫术。主要结果指标：乳腺和腋窝淋巴结的DCE-MRI结果和病理反应。结果：46例患者接受了盐酸多柔比星和环磷酰胺的NAC，随后是紫杉醇和卡铂，根据人表皮生长因子受体2（HER 2/neu）状态，联合或不联合曲妥珠单抗。21例患者（46%）有完全病理学缓解。HER 2/neu阳性患者的完全病理缓解率为70%（14/20）。原发肿瘤缓解预测腋窝淋巴结状态的准确性、敏感性和特异性分别为78%、88%和72%。DCE-MRI测量的原发肿瘤反应预测腋窝淋巴结状态的准确性、敏感性和特异性分别为74%、62%和82%。对于HER 2/neu阳性的患者，准确性，敏感性和特异性提高到80%，75%，和82%，respectively.Conclusions：结果的DCE-MRI的原发性肿瘤可以预测腋窝淋巴结的状态，特别是在接受曲妥珠单抗谁是HER 2/ neu阳性的患者。在DCE-MRI上具有完全临床缓解的HER 2/neu阳性患者极不可能从腋窝淋巴结清扫术中获益。对于HER 2/neu阴性患者，需要进行前哨淋巴结采样。
Hypothesis: Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) is a reliable and accurate method for monitoring primary tumor response in the breast and can be used as a surrogate to predict final axillary nodal status.Design: Retrospective study (October 1, 2004, through February 28, 2006) of 46 patients with clinically staged locally advanced breast cancer.Patients: Forty-six patients with locally advanced breast cancer.Interventions: Neoadjuvant chemotherapy (NAC), DCE-MRI, mastectomy and lumpectomy, and axillary lymph node dissection.Main Outcome Measures: The DCE-MRI results and pathologic response of the breast and axillary lymph nodes.Results: Forty-six patients underwent NAC with doxorubicin hydrochloride and cyclophosphamide, followed by paclitaxel and carboplatin, with or without trastuzumab based on human epidermal growth factor receptor 2 (HER2/neu) status. Twenty-one patients (46%) had a complete pathologic response. For the HER2/neupositive patients, the complete pathologic response rate was 70% (14/20). The accuracy, sensitivity, and specificity of the primary tumor response in predicting the axillary nodal status were 78%, 88%, and 72%, respectively. The accuracy, sensitivity, and specificity of the DCE-MRI-measured response in the primary tumor in predicting axillary nodal status were 74%, 62%, and 82%, respectively. For the HER2/neu-positive patients, the accuracy, sensitivity, and specificity improved to 80%, 75%, and 82%, respectively.Conclusions: The results of DCE-MRI of the primary tumor can be predictive of axillary nodal status, especially in patients receiving trastuzumab who are HER2/ neu positive. The HER2/neu-positive patients with a complete clinical response on DCE-MRI are highly unlikely to benefit from an axillary lymph node dissection. For HER2/neu-negative patients, sentinel lymph node sampling is warranted.