Radiological versus pathological response of the axilla to neoadjuvant chemotherapy: Assessing the accuracy of MRI response prediction
Association of Breast Surgery ePoster Library. McLean R. 05/13/19; 257051; P007
Mr. Ross McLean
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P007
Topic: Axilla
Introduction: Neoadjuvant chemotherapy (NAC) can be used to downstage breast cancer and axillary disease to facilitate more conservative surgery. It is important to determine an imaging modality that can accurately determine which patients are appropriate for conservative treatment. This study aims to measure the accuracy of MRI in assessing the radiological response of axillary disease to NAC. MethodsRetrospective data collection from a single institution, including all patients who underwent axillary node clearance (ANC) following NAC between May 2014-November 2017. Results45 patients were included. Radiological complete response (rCR) was seen in 15 patients (33%). Four of these patients (27%) had 1-2 macrometastatic nodes on pathology, and three of these patients had ≥3 macrometastases (20%).17 patients (38%) had pCR on ANC. Eight patients as described previously had a rCR in their axilla (44%), and 9 patients (53%) had ≥1 positive axillary nodes on MRI following NAC. Discrepancy between radiological response and pathological response was seen in 26 patients (57%). Pathological Response (No. positive axillary nodes)0 (pCR)1-2 3+ TotalMRI Radiological Response (No. positive axillary nodes)0 (rCR)843151-2 536143+ 44816Total17111745ConclusionThere is a clinically significant discrepancy between rCR and pCR in the axilla. This highlights the fact that MRI cannot be relied upon for accurate axillary response to NAC; surgical biopsy and histopathological assessment remains necessary in rCR patients.
Topic: Axilla
Introduction: Neoadjuvant chemotherapy (NAC) can be used to downstage breast cancer and axillary disease to facilitate more conservative surgery. It is important to determine an imaging modality that can accurately determine which patients are appropriate for conservative treatment. This study aims to measure the accuracy of MRI in assessing the radiological response of axillary disease to NAC. MethodsRetrospective data collection from a single institution, including all patients who underwent axillary node clearance (ANC) following NAC between May 2014-November 2017. Results45 patients were included. Radiological complete response (rCR) was seen in 15 patients (33%). Four of these patients (27%) had 1-2 macrometastatic nodes on pathology, and three of these patients had ≥3 macrometastases (20%).17 patients (38%) had pCR on ANC. Eight patients as described previously had a rCR in their axilla (44%), and 9 patients (53%) had ≥1 positive axillary nodes on MRI following NAC. Discrepancy between radiological response and pathological response was seen in 26 patients (57%). Pathological Response (No. positive axillary nodes)0 (pCR)1-2 3+ TotalMRI Radiological Response (No. positive axillary nodes)0 (rCR)843151-2 536143+ 44816Total17111745ConclusionThere is a clinically significant discrepancy between rCR and pCR in the axilla. This highlights the fact that MRI cannot be relied upon for accurate axillary response to NAC; surgical biopsy and histopathological assessment remains necessary in rCR patients.
P007
Topic: Axilla
Introduction: Neoadjuvant chemotherapy (NAC) can be used to downstage breast cancer and axillary disease to facilitate more conservative surgery. It is important to determine an imaging modality that can accurately determine which patients are appropriate for conservative treatment. This study aims to measure the accuracy of MRI in assessing the radiological response of axillary disease to NAC. MethodsRetrospective data collection from a single institution, including all patients who underwent axillary node clearance (ANC) following NAC between May 2014-November 2017. Results45 patients were included. Radiological complete response (rCR) was seen in 15 patients (33%). Four of these patients (27%) had 1-2 macrometastatic nodes on pathology, and three of these patients had ≥3 macrometastases (20%).17 patients (38%) had pCR on ANC. Eight patients as described previously had a rCR in their axilla (44%), and 9 patients (53%) had ≥1 positive axillary nodes on MRI following NAC. Discrepancy between radiological response and pathological response was seen in 26 patients (57%). Pathological Response (No. positive axillary nodes)0 (pCR)1-2 3+ TotalMRI Radiological Response (No. positive axillary nodes)0 (rCR)843151-2 536143+ 44816Total17111745ConclusionThere is a clinically significant discrepancy between rCR and pCR in the axilla. This highlights the fact that MRI cannot be relied upon for accurate axillary response to NAC; surgical biopsy and histopathological assessment remains necessary in rCR patients.
Topic: Axilla
Introduction: Neoadjuvant chemotherapy (NAC) can be used to downstage breast cancer and axillary disease to facilitate more conservative surgery. It is important to determine an imaging modality that can accurately determine which patients are appropriate for conservative treatment. This study aims to measure the accuracy of MRI in assessing the radiological response of axillary disease to NAC. MethodsRetrospective data collection from a single institution, including all patients who underwent axillary node clearance (ANC) following NAC between May 2014-November 2017. Results45 patients were included. Radiological complete response (rCR) was seen in 15 patients (33%). Four of these patients (27%) had 1-2 macrometastatic nodes on pathology, and three of these patients had ≥3 macrometastases (20%).17 patients (38%) had pCR on ANC. Eight patients as described previously had a rCR in their axilla (44%), and 9 patients (53%) had ≥1 positive axillary nodes on MRI following NAC. Discrepancy between radiological response and pathological response was seen in 26 patients (57%). Pathological Response (No. positive axillary nodes)0 (pCR)1-2 3+ TotalMRI Radiological Response (No. positive axillary nodes)0 (rCR)843151-2 536143+ 44816Total17111745ConclusionThere is a clinically significant discrepancy between rCR and pCR in the axilla. This highlights the fact that MRI cannot be relied upon for accurate axillary response to NAC; surgical biopsy and histopathological assessment remains necessary in rCR patients.
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