Axillary Ultrasound for Predicting Response to Neoadjuvant Treatment in Breast Cancer

Staff Writer: Andre McGowan

A retrospective study found that axillary ultrasound falsely predicted nodal response to neoadjuvant systemic treatment in approximately half of node-positive breast cancer patients, which may result in the overtreatment of breast cancer patients. However, the interpretation of axillary ultrasound in luminal human epidermal growth factor receptor 2 negative cancer is useful and is associated with a high positive predictive value.

Patients diagnosed with node-positive breast cancer can become node-negative following neoadjuvant systemic treatment (NAST). NAST facilitates the avoidance of axillary lymph node dissection (ALND) in certain patients. The re-staging of breast cancer patients is commonly performed by axillary ultrasound (AUS). 

A recent study evaluated the positive and negative predictive value, sensitivity, and specificity of AUS following NAST in predicting nodal response to treatment. The findings are published in the World Journal of Surgical Oncology.

Study Characteristics

The study enrolled a total of 437 breast cancer patients with clinically positive lymph nodes at the time of presentation who were given NAST and underwent surgery. Out of these, 244 patients underwent AUS following NAST. The median age of these patients was 48 years (range, 27–78 years). Of these patients, 124, 78, and 42 were diagnosed with luminal, human epidermal growth factor receptor 2 (HER-2) positive, and triple-negative breast cancer subtypes, respectively.

Axillary Ultrasound Following Neoadjuvant Systemic Treatment

Of the approximately 55.8% of patients who underwent AUS following NAST, AUS was negative in 73.4%, and the remaining patients had a suspicious or positive AUS.

Nodal Pathologic Complete Response in Breast Cancer Patients

Approximately 36.5% of the patients who underwent AUS following NAST had achieved nodal pathological complete response on final histopathology evaluation. Pathological complete response was observed in 30.8% of the breast cancer patients with suspicious or positive AUS.  Primary ALND was performed in 91 out of 244 patients.

Predictive Efficacy of Axillary Ultrasound in Breast Cancer Patients

AUS accurately predicted nodal response to NAST in 46.7% of the patients. The overall positive predictive value, negative predictive value, sensitivity, and specificity of AUS in predicting nodal response were estimated to be 69.2%, 38.5%, 29%, and 77.5%, respectively.

Source:

Pislar, N., Gašljević, G., Mušič, M. M., Borštnar, S., Žgajnar, J., & Perhavec, A. (2023). Axillary ultrasound for predicting response to neoadjuvant treatment in breast cancer patients—a single institution experience. World Journal of Surgical Oncology, 21(1). https://doi.org/10.1186/s12957-023-03174-8