title: Predictive value of axillary nodal imaging by magnetic resonance imaging based on breast cancer subtype after neoadjuvant chemotherapy.
abstract: Magnetic resonance imaging (MRI) is commonly used to determine residual breast disease after neoadjuvant chemotherapy (NCT) for cancer. Few studies have assessed its role in predicting nodal response, by cancer subtype.
  
  
  
  A retrospective review was completed using our institutional cancer registry. Patients who started NCT from 2005 to 2010 with clinically node positive disease were evaluated. Those who underwent post-NCT breast MRI were selected. Radiologic response was determined by an independent review. Nodal involvement was confirmed pathologically after surgery.
  
  
  
  A total of 135 patients underwent post-NCT breast MRI. The positive and negative predictive values of MRI are 93% and 26%, respectively. A subset analysis by cancer phenotype demonstrates triple negative cancers have the highest sensitivity (68%) and luminal cancers have the highest positive predictive value (100%).
  
  
  
  This study demonstrates that MRI post-NCT, even by cancer subtype, cannot reliably predict residual nodal disease because of high false-negative rates (low negative-predictive value).
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. Electronic address: steiman@surgery.wisc.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Steiman
authors.affiliation: Department of Surgery, Magee-Womens Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Atilla
authors.initials: A
authors.lastname: Soran
authors.affiliation: Department of Surgery, Magee-Womens Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Priscilla
authors.initials: P
authors.lastname: McAuliffe
authors.affiliation: Department of Surgery, Magee-Womens Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Emilia
authors.initials: E
authors.lastname: Diego
authors.affiliation: Department of Surgery, Magee-Womens Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Marguerite
authors.initials: M
authors.lastname: Bonaventura
authors.affiliation: Department of Surgery, Magee-Womens Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Ronald
authors.initials: R
authors.lastname: Johnson
authors.affiliation: Department of Surgery, Magee-Womens Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Ahrendt
authors.affiliation: Department of Surgery, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Kandace
authors.initials: K
authors.lastname: McGuire
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018365:Neoplasm, Residual; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Axillary lymph node dissection; Breast cancer; MRI; Neoadjuvant chemotherapy; Pathologic complete response