title: Diagnostic performance of breast ultrasonography and MRI in the prediction of lymph node status after neoadjuvant chemotherapy for breast cancer.
abstract: Background Neoadjuvant chemotherapy (NAC) is widely used to treat breast cancer. Sentinel lymph node biopsy has replaced axillary lymph node dissection in patients who convert to node-negative status after NAC. However, few studies have evaluated the diagnostic performance of ultrasonography and magnetic resonance imaging (MRI) in determining axillary lymph node status after NAC. Purpose To evaluate the diagnostic performance of breast ultrasonography and MRI in determining residual metastatic axillary lymph node status after NAC for breast cancer and to identify histopathological factors affecting radiological performance. Material and Methods This study included 157 patients who underwent initial and follow-up preoperative breast ultrasonography and MRI before NAC between January and December 2010. The sensitivity, specificity, negative and positive predictive values, and accuracy of ultrasonography, MRI, and their combinations were evaluated. Results The sensitivity of ultrasonography, MRI, and their combination in post-NAC axillary imaging was 60.00%, 57.33%, and 65.33%, respectively; the specificity was 60.47%, 72.09%, and 60.47%, respectively. The positive predictive value was highest with MRI (78.18%). On univariate analysis, positive estrogen receptor status was associated with misdiagnosis by ultrasonography ( P = 0.002), MRI ( P = 0.002), and their combination ( P = 0.001). When residual metastatic lymph nodes were present, lymph nodes with macrometastasis (>2.0 mm) were associated with correct ultrasonography-based diagnosis ( P = 0.0027). Conclusion Imaging assists in predicting axillary lymph node status in patients undergoing NAC; however, is imprudent to omit sentinel lymph node biopsy or axillary lymph node dissection for staging in women determined to be node-positive.
authors.affiliation: 1 Department of Radiology, Research Institute of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea.
authors.forename: Su Min
authors.initials: SM
authors.lastname: Ha
authors.affiliation: 2 Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Joo Hee
authors.initials: JH
authors.lastname: Cha
authors.affiliation: 2 Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Hak Hee
authors.initials: HH
authors.lastname: Kim
authors.affiliation: 2 Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Shin
authors.affiliation: 2 Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Chae
authors.affiliation: 2 Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Woo Jung
authors.initials: WJ
authors.lastname: Choi
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D020360:Neoadjuvant Therapy / Q000379:methods*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary
keywords: Neoadjuvant chemotherapy; axillary lymph node metastasis; breast neoplasm; magnetic resonance imaging (MRI); ultrasonography