title: Clinical impact of breast MRI with regard to axillary reverse mapping in clinically node positive breast cancer patients following neo-adjuvant chemotherapy.
abstract: BACKGROUND
  Axillary reverse mapping (ARM) is a technique that discerns axillary lymphatic drainage of the arm from the breast. In the current study, we retrospectively evaluated the incidence of metastatic axillary lymph node involvement, including ARM lymph nodes, in clinically node positive breast cancer patients (cN+ patients) in whom neo-adjuvant chemotherapy (NAC) was administered followed by primary ALND using breast MRI.
  
  
  METHODS
  Data from 98 cN+ breast cancer patients were analysed retrospectively. Patients without residual axillary disease at breast MRI following NAC (RAD-, n = 64) were compared with patients with residual axillary disease (RAD+, n = 34). Presence of suspect axillary lymph nodes on pre-NAC and post-NAC breast MRI was determined by experienced breast radiologists and was correlated to histopathological findings.
  
  
  RESULTS
  In the RAD-group residual axillary disease on pathological analysis following NAC was found in 25 patients (39.1%), as compared to 24 patients (70.6%) in the RAD + group (p = 0.003). Metastatic involvement of ARM lymph nodes following NAC was demonstrated in 5 patients (7.8%) in the RAD-group as compared to 10 patients (29.4%) in the RAD + group (p = 0.005).
  
  
  CONCLUSIONS
  Breast MRI following NAC is not suitable to detect residual metastatic disease of the axilla. However, breast MRI post-NAC may be of use to identify cN+ patients with a low risk of ARM lymph node metastases. This may help to select a subgroup of cN+ patients in whom sparing of ARM lymph nodes during axillary lymph node dissection can be considered.
authors.affiliation: Department of Surgery, Amphia Hospital, Breda, The Netherlands. Electronic address: MBeek@amphia.nl.
authors.forename: M A
authors.initials: MA
authors.lastname: Beek
authors.affiliation: Department of Radiology, Amphia Hospital, Breda, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Tetteroo
authors.affiliation: Department of Surgery, Amphia Hospital, Breda, The Netherlands.
authors.forename: E J T
authors.initials: EJ
authors.lastname: Luiten
authors.affiliation: Department of Surgery, Amphia Hospital, Breda, The Netherlands.
authors.forename: P D
authors.initials: PD
authors.lastname: Gobardhan
authors.affiliation: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Surgery, Maastricht University, Maastricht, The Netherlands.
authors.forename: H J T
authors.initials: HJ
authors.lastname: Rutten
authors.affiliation: Department of Oncology, Amphia Hospital, Breda, The Netherlands.
authors.forename: J B
authors.initials: JB
authors.lastname: Heijns
authors.affiliation: Department of Epidemiology, Faculty of Health Medicine and Life Sciences, Research Institute Growth and Development (GROW), Maastricht University, Maastricht, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Organisation, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Voogd
authors.affiliation: Department of Radiology, The Netherlands Cancer Institute, The Netherlands.
authors.forename: E G
authors.initials: EG
authors.lastname: Klompenhouwer
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla / Q000473:pathology* / Q000601:surgery*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003287:Contrast Media; D005260:Female; D006571:Heterocyclic Compounds; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology*; D008209:Lymphedema / Q000517:prevention & control; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018365:Neoplasm, Residual / Q000175:diagnosis; D009426:Netherlands; D009942:Organometallic Compounds; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; C050823:gadolinium 1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetate
keywords: Axillary reverse mapping; Breast cancer; Lymphedema; MRI