Breast MRI and tumour biology predict axillary lymph node response to neoadjuvant chemotherapy for breast cancer

Samia Al-hattali, Sarah J. Vinnicombe, Nazleen Muhammad Gowdh, Andrew Evans, Sharon Armstrong, Douglas Adamson, Colin A. Purdie, E. Jane Macaskill (Lead / Corresponding author)

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Abstract

Background: In patients who have had axillary nodal metastasis diagnosed prior to neoadjuvant chemotherapy for breast cancer, there is little consensus on how to manage the axilla subsequently. The aim of this study was to explore whether a combination of breast magnetic resonance imaging (MRI) assessed response and primary tumour pathology factors could identify a subset of patients that might be spared axillary node clearance.

Methods: A retrospective data analysis was performed of patients with core biopsy-proven axillary nodal metastasis prior to commencement of neoadjuvant chemotherapy (NAC) who had subsequent axillary node clearance (ANC) at definitive breast surgery. Breast tumour and axillary response at MRI before, during and on completion of NAC, core biopsy tumour grade, tumour type and immunophenotype were correlated with pathological response in the breast and the number of metastatic nodes in the ANC specimens.

Results: Of 87 consecutive patients with MRI at baseline, interim and after neoadjuvant chemotherapy who underwent ANC at time of breast surgery, 33 (38%) had no residual macrometastatic axillary disease, 28 (32%) had 1–2 metastatic nodes and 26 (30%) had more than 2 metastatic nodes. Factors that predicted axillary nodal complete response were MRI complete response in the breast (p < 0.0001), HER2 positivity (p = 0.02) and non-lobular tumour type (p = 0.015).

Conclusion: MRI assessment of breast tumour response to NAC and core biopsy factors are predictive of response in axillary nodes, and can be used to guide decision making regarding appropriate axillary surgery.
Original languageEnglish
Article number91
Pages (from-to)1-9
Number of pages9
JournalCancer Imaging
Volume19
Issue number1
DOIs
Publication statusPublished - 26 Dec 2019

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Breast
Lymph Nodes
Magnetic Resonance Imaging
Breast Neoplasms
Drug Therapy
Neoplasms
Biopsy
Neoplasm Metastasis
Axilla
Consensus
Decision Making
Pathology

Keywords

  • Neoadjuvant chemotherapy
  • Axilla lymph node
  • Breast cancer
  • Magnetic resonance imaging
  • Sentinel node biopsy

Cite this

Al-hattali, S., Vinnicombe, S. J., Gowdh, N. M., Evans, A., Armstrong, S., Adamson, D., ... Macaskill, E. J. (2019). Breast MRI and tumour biology predict axillary lymph node response to neoadjuvant chemotherapy for breast cancer. Cancer Imaging, 19(1), 1-9. [91]. https://doi.org/10.1186/s40644-019-0279-4
Al-hattali, Samia ; Vinnicombe, Sarah J. ; Gowdh, Nazleen Muhammad ; Evans, Andrew ; Armstrong, Sharon ; Adamson, Douglas ; Purdie, Colin A. ; Macaskill, E. Jane. / Breast MRI and tumour biology predict axillary lymph node response to neoadjuvant chemotherapy for breast cancer. In: Cancer Imaging. 2019 ; Vol. 19, No. 1. pp. 1-9.
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abstract = "Background: In patients who have had axillary nodal metastasis diagnosed prior to neoadjuvant chemotherapy for breast cancer, there is little consensus on how to manage the axilla subsequently. The aim of this study was to explore whether a combination of breast magnetic resonance imaging (MRI) assessed response and primary tumour pathology factors could identify a subset of patients that might be spared axillary node clearance.Methods: A retrospective data analysis was performed of patients with core biopsy-proven axillary nodal metastasis prior to commencement of neoadjuvant chemotherapy (NAC) who had subsequent axillary node clearance (ANC) at definitive breast surgery. Breast tumour and axillary response at MRI before, during and on completion of NAC, core biopsy tumour grade, tumour type and immunophenotype were correlated with pathological response in the breast and the number of metastatic nodes in the ANC specimens.Results: Of 87 consecutive patients with MRI at baseline, interim and after neoadjuvant chemotherapy who underwent ANC at time of breast surgery, 33 (38{\%}) had no residual macrometastatic axillary disease, 28 (32{\%}) had 1–2 metastatic nodes and 26 (30{\%}) had more than 2 metastatic nodes. Factors that predicted axillary nodal complete response were MRI complete response in the breast (p < 0.0001), HER2 positivity (p = 0.02) and non-lobular tumour type (p = 0.015).Conclusion: MRI assessment of breast tumour response to NAC and core biopsy factors are predictive of response in axillary nodes, and can be used to guide decision making regarding appropriate axillary surgery.",
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Al-hattali, S, Vinnicombe, SJ, Gowdh, NM, Evans, A, Armstrong, S, Adamson, D, Purdie, CA & Macaskill, EJ 2019, 'Breast MRI and tumour biology predict axillary lymph node response to neoadjuvant chemotherapy for breast cancer', Cancer Imaging, vol. 19, no. 1, 91, pp. 1-9. https://doi.org/10.1186/s40644-019-0279-4

Breast MRI and tumour biology predict axillary lymph node response to neoadjuvant chemotherapy for breast cancer. / Al-hattali, Samia; Vinnicombe, Sarah J.; Gowdh, Nazleen Muhammad; Evans, Andrew; Armstrong, Sharon; Adamson, Douglas; Purdie, Colin A.; Macaskill, E. Jane (Lead / Corresponding author).

In: Cancer Imaging, Vol. 19, No. 1, 91, 26.12.2019, p. 1-9.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Breast MRI and tumour biology predict axillary lymph node response to neoadjuvant chemotherapy for breast cancer

AU - Al-hattali, Samia

AU - Vinnicombe, Sarah J.

AU - Gowdh, Nazleen Muhammad

AU - Evans, Andrew

AU - Armstrong, Sharon

AU - Adamson, Douglas

AU - Purdie, Colin A.

AU - Macaskill, E. Jane

PY - 2019/12/26

Y1 - 2019/12/26

N2 - Background: In patients who have had axillary nodal metastasis diagnosed prior to neoadjuvant chemotherapy for breast cancer, there is little consensus on how to manage the axilla subsequently. The aim of this study was to explore whether a combination of breast magnetic resonance imaging (MRI) assessed response and primary tumour pathology factors could identify a subset of patients that might be spared axillary node clearance.Methods: A retrospective data analysis was performed of patients with core biopsy-proven axillary nodal metastasis prior to commencement of neoadjuvant chemotherapy (NAC) who had subsequent axillary node clearance (ANC) at definitive breast surgery. Breast tumour and axillary response at MRI before, during and on completion of NAC, core biopsy tumour grade, tumour type and immunophenotype were correlated with pathological response in the breast and the number of metastatic nodes in the ANC specimens.Results: Of 87 consecutive patients with MRI at baseline, interim and after neoadjuvant chemotherapy who underwent ANC at time of breast surgery, 33 (38%) had no residual macrometastatic axillary disease, 28 (32%) had 1–2 metastatic nodes and 26 (30%) had more than 2 metastatic nodes. Factors that predicted axillary nodal complete response were MRI complete response in the breast (p < 0.0001), HER2 positivity (p = 0.02) and non-lobular tumour type (p = 0.015).Conclusion: MRI assessment of breast tumour response to NAC and core biopsy factors are predictive of response in axillary nodes, and can be used to guide decision making regarding appropriate axillary surgery.

AB - Background: In patients who have had axillary nodal metastasis diagnosed prior to neoadjuvant chemotherapy for breast cancer, there is little consensus on how to manage the axilla subsequently. The aim of this study was to explore whether a combination of breast magnetic resonance imaging (MRI) assessed response and primary tumour pathology factors could identify a subset of patients that might be spared axillary node clearance.Methods: A retrospective data analysis was performed of patients with core biopsy-proven axillary nodal metastasis prior to commencement of neoadjuvant chemotherapy (NAC) who had subsequent axillary node clearance (ANC) at definitive breast surgery. Breast tumour and axillary response at MRI before, during and on completion of NAC, core biopsy tumour grade, tumour type and immunophenotype were correlated with pathological response in the breast and the number of metastatic nodes in the ANC specimens.Results: Of 87 consecutive patients with MRI at baseline, interim and after neoadjuvant chemotherapy who underwent ANC at time of breast surgery, 33 (38%) had no residual macrometastatic axillary disease, 28 (32%) had 1–2 metastatic nodes and 26 (30%) had more than 2 metastatic nodes. Factors that predicted axillary nodal complete response were MRI complete response in the breast (p < 0.0001), HER2 positivity (p = 0.02) and non-lobular tumour type (p = 0.015).Conclusion: MRI assessment of breast tumour response to NAC and core biopsy factors are predictive of response in axillary nodes, and can be used to guide decision making regarding appropriate axillary surgery.

KW - Neoadjuvant chemotherapy

KW - Axilla lymph node

KW - Breast cancer

KW - Magnetic resonance imaging

KW - Sentinel node biopsy

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JO - Cancer Imaging

JF - Cancer Imaging

SN - 1740-5025

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