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Ultrasound may lead to less invasive surgery in lymph node-positive breast cancer
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Women with lymph node-positive breast cancer who demonstrate complete nodal response by axillary ultrasound after neoadjuvant chemotherapy may be able to avoid axillary dissection, according to study results.
“Our goal here is really to try to get away from, ‘Every patient with breast cancer needs these drugs and this amount of chemotherapy and surgery,’ and instead to personalize surgical treatment based on how the patient responds to chemotherapy,” Judy Boughey, MD, chair of the division of surgery research at Mayo Clinic in Rochester, Minnesota, said in a press release.
Judy Boughey
The American College of Surgeons Oncology Group (ACOSOG) Z1071 trial included 687 patients with T0-4, N1-2, M0 primary invasive breast cancer. All patients completed neoadjuvant chemotherapy, underwent sentinel lymph node surgery and axillary dissection, and had axillary ultrasound images available for review.
Previously published results indicated a 12.6% false-negative rate for sentinel lymph node surgery after neoadjuvant chemotherapy for patients who presented with node-positive disease and had two or more sentinel lymph nodes identified and removed. This false-negative rate exceeded the predetermined acceptable rate of 10%. The result suggested patient selection or technique must be improved prior to widespread adoption of sentinel lymph node surgery in this setting, according to study background.
In the current analysis, Boughey and colleagues assessed whether axillary ultrasound after neoadjuvant chemotherapy could identify abnormal nodes, thereby improving patient selection for sentinel lymph node surgery.
The researchers reviewed axillary ultrasound images for 611 patients.
Results showed 130 of 181 (71.8%) patients with suspicious axillary ultrasound images were found to have positive nodes at surgery, whereas 243 of 430 (56.5%) of patients with normal axillary ultrasound images were found to be node-positive at surgery (P < .001).
Patients with suspicious ultrasound images had a greater number of positive nodes and a greater metastasis size than those with normal ultrasounds (P < .001).
“Using a strategy whereby clinical response — normal axillary ultrasound after chemotherapy — is used to select patients for sentinel lymph node surgery, patients with normal nodes as assessed by postchemotherapy axillary ultrasound could undergo sentinel lymph node surgery,” Boughey and colleagues wrote.
If any sentinel lymph nodes are positive, the patient would undergo axillary lymph node dissection. If two or more sentinel lymph nodes are resected and found to be negative, no additional axillary surgery would be necessary, the researchers wrote.
Boughey and colleagues determined that if patients enrolled in the Z1071 trial had been “selected for sentinel lymph node surgery based on axillary ultrasound findings and undergone sentinel lymph node surgery with resection of at least two sentinel lymph nodes,” the false-negative rate would have decreased to 9.8% (90% CI, 7.1-13.2).
This method of patient selection could reduce the number of women who experience surgery-related complications and also reduce costs, according to researchers.
“That’s one of the really nice things about giving chemotherapy up front,” Boughey said. “It allows us to be less invasive with surgery, both in terms of breast surgery and lymph node surgery, and to tailor treatment based on response to chemotherapy.” – by Anthony SanFilippo
Disclosure: The researchers report research funding from Antigen Express and Galena Biopharma.
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