Axillary Lymph Node Ultrasound Following Neoadjuvant Chemotherapy in Biopsy-Proven Node-Positive Breast Cancer: Results from the SN FNAC Study
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The sentinel node biopsy following neoadjuvant chemotherapy (SN FNAC) study has shown that in node-positive (N+) breast cancer, sentinel node biopsy (SNB) can be performed following neoadjuvant chemotherapy (NAC), with a low false negative rate (FNR = 8.4%). A secondary endpoint of the SN FNAC study was to determine whether axillary ultrasound (AxUS) could predict axillary pathological complete response (ypN0) and increase the accuracy of SNB.
The SN FNAC trial is a study of patients with biopsy-proven N+ breast cancer who underwent SNB followed by completion node dissection. All patients had AxUS following NAC and the axillary nodes were classified as either positive (AxUS+) or negative (AxUS−). AxUS was compared with the final axillary pathology results.
There was no statistical difference in the baseline characteristics of patients with AxUS+ versus those with AxUS−. Overall, 82.5% (47/57) of AxUS+ patients had residual positive lymph nodes (ypN+) at surgery and 53.8% (42/78) of AxUS− patients had ypN+. Post NAC AxUS sensitivity was 52.8%, specificity 78.3%, and negative predictive value 46.2%. AxUS FNR was 47.2%, versus 8.4% for SNB. If post-NAC AxUS− was used to select patients for SNB, FNR would decrease from 8.4 to 2.7%. However, using post-NAC AxUS in addition to SNB as an indication for ALND would have led to unnecessary ALND in 7.8% of all patients.
AxUS is not appropriate as a standalone staging procedure, and SNB itself is sufficient to assess the axilla post NAC in patients who present with N+ breast cancer.
We would like to thank the following authors would participated in the original SN FNAC study published in the Journal of Clinical Oncology on 20 January 2015: Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l’Université de Montreal; Lucas Sideris, Hôpital Maisonneuve-Rosemont, Université de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre; Brigitte Poirier and Louise Provencher, Hôpital Saint-Sacrement, Université Laval; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine.
The original SN FNAC study was supported by the Quebec Breast Cancer Foundation, Cancer Research Society, Week-end to End Women’s Cancers, and Montreal Jewish General Segal Cancer Centre.
Dominique Morency, Sinziana Dumitra, Elena Parvez, Karyne Martel, Mark Basik, André Robidoux, Brigitte Poirier, Claire M.B. Holloway, Louis Gaboury, Lucas Sideris, Sarkis Meterissian, and Jean-François Boileau have no disclosures to declare.
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