Role of the radiologist during neoadjuvant systemic therapy for breast cancer

2021 ◽  
Vol 100 (6) ◽  
Keyword(s):  
Breast Cancer ◽  
Case Reports ◽  
Treatment Strategies ◽  
Breast Tumour ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Oncological Treatment ◽  
Neoadjuvant Systemic Therapy ◽  
Local Staging

Introduction: Neoadjuvant therapy (NT) is one of the possible oncological treatment strategies for breast cancer. Its aim is to achieve down-staging of the tumour in the breast and axilla and thus the possibility of converting mastectomy to a breast-conserving procedure, and also to allow for a less burdensome and more targeted operation of the axillary lymph nodes. The role of the radiologist is to utilise imaging procedures for precise local staging of the malignancy prior to NT, to evaluate the effect of treatment during its course and upon its completion, and to perform restaging of the cancer in the breast and axilla. Case reports: The authors present three case reports of female patients with breast cancer who underwent neoadjuvant chemotherapy (NCT). They describe the diagnostic procedure and imaging methods used to establish local staging of the cancer prior to treatment, to monitor the disease during the course of treatment, and to perform restaging of the cancer after completing NCT. The radiological response after NCT completion was correlated with the pathological response. Conclusion: Correct determination of the extent of the cancer in the breast and axilla by the radiologist before NT and precise histological analysis of the tumour by the pathologist are fundamental for selecting the appropriate treatment for patients at the multidisciplinary breast tumour board.

scholarly journals Nodal micrometastases in early stage breast cancer: two case reports

2009 ◽  
Vol 12 (3) ◽  
Author(s):  
J. Reeder ◽  
S. Puhalla ◽  
V. Vogel
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Early Stage ◽  
Case Reports ◽  
Early Stage Breast Cancer ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Nodal Disease ◽  
Micrometastatic Disease

AbstractThe most important predictor of outcome for women with early stage breast cancer is the presence or absence of metastases in the axillary lymph nodes. In the era of sentinel lymph node biopsies and improved pathology techniques, micrometastatic disease can be diagnosed. The question of whether or not to treat these women as if they have nodal disease remains in doubt. In order to further explore this topic, we identified two cases of women with nodal micrometastases at our institution. A literature review of PUBMED and SABCS abstracts was then performed. In this article, we discuss our results and the emerging clinical debate about the management of nodal micrometastases.

Role of Sonographic Elastography in the Differential Diagnosis of Axillary Lymph Nodes in Breast Cancer

2011 ◽  
Vol 30 (4) ◽  
pp. 429-436 ◽  
Author(s):  
Jae Jeong Choi ◽  
Bong Joo Kang ◽  
Sung Hun Kim ◽  
Ji Hye Lee ◽  
Seung Hee Jeong ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Differential Diagnosis ◽  
Lymph Nodes ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Sonographic Elastography

scholarly journals Value of Ultrasound in Evaluation of Abnormal Axillary Lymph Node

2021 ◽  
Vol 4 ◽  
pp. 3
Author(s):  
Abdelmohsen Radwan Hussien ◽  
Monaliza El-Quadi ◽  
Avice Oconnell
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cancer Treatment ◽  
Axillary Lymph Node ◽  
Breast Cancer Treatment ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph

Understanding of the various appearances of axillary lymph nodes (LNs) is essential for diagnosing and planning of breast cancer treatment. In this article, the role of ultrasound in detecting abnormal appearing metastatic LNs s is discussed, with emphasis on most of the ultrasonographic features and tools which might help improve detection of axillary LN pathology.

Outcome of patients with locally advanced breast cancer (LABC) followed at the University of Cincinnati (UC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 21160-21160
Author(s):  
R. S. Komrokji ◽  
Z. Nahleh ◽  
S. Dhaliwal ◽  
D. Sivasubramaniam
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Clinical Response ◽  
Locally Advanced Breast Cancer ◽  
Single Agent ◽  
Locally Advanced ◽  
Treatment Strategies ◽  
Pathological Response ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph

21160 Background: LABC poses a difficult clinical challenge . The correlation of complete clinical (cCR) and pathological response rates (pCR) based on molecular tumor characteristics with outcome is of great clinical interest. Methods: We conducted a retrospective chart review on consecutive patients diagnosed with LABC who completed NC between 2001–2006 at UC. Pathological response was classified as pCR (no invasive tumor in breast and axillary lymph nodes), RDLN (disease in lymph nodes), RDB( disease in breast), and RDBLN (disease in both). Overall survival (OS)and event free survival (EFS) were calculated using Kaplan-Meier analysis. Result: We included 45 patients. Median age 51, 40% (n=18) white and 60% (n=27) African American, Stage IIB 9%, IIIA 29%, IIIB 51 % and IIIC 11%. 75 % invasive ductal, 9% invasive lobular and 16% inflammatory breast cancer (IBC). ER+/or PR+ in 47% (18% ER + / PR +, 27% ER +/PR -, 2% ER-/PR+), and 53% ER -/PR-. HER2 neu + ( IHC 3 + or FISH ratio > 2.2) was identified in 27% of patients. NC regimens included: doxorubicin or epirubicine plus taxane (paclitaxel or docetaxel) 80 %, anthracycline only 10%, single agent taxane 4%, and 6% other regimens (2 CMF, 1 capecitabine). One patient received NC with trastuzumab. Response to NC was as follows: Clinically, 55% (n=25) achieved cCR, 38% partial clinical response, 4% stable disease and 2% progressive disease. Pathpogically, pCR was achieved in 22% (n=10) of all patients, 7% pPRLN, 24% pPRB and 47% RDBLN . None of the patients with IBC had pCR. Among ER+ and or PR + tumors , 19% achieved pCR compared to pCR of 25% among ER-/PR-. Among HER2 neu +, 17% achieved pCR compared to 25% in HER2 neu -. Among all patients who achieved cCR, only 36% actually had pCR. For patients who did not achieve pCR, OS and EFS were 5.7 years and 19 months respectively compared to both not yet reached for those with pCR. Conclusion: LABC has poor prognosis overall using standard chemotherapy. Clinical response followingNC was not well predictive of pathological response. ER-/PR - tumors respond better to neoadjuvant chemotherapy compared to ER+/orPR+ tumors. Less than 20% of HER2 neu + tumors achieve pCR before trastuzumab's routine use. More research is urgently needed to optimize treatment strategies and improve outcome of LABC and IBC. No significant financial relationships to disclose.

scholarly journals The usefulness of F-18 FDG PET/CT-mammography for preoperative staging of breast cancer: comparison with conventional PET/CT and MR-mammography

2013 ◽  
Vol 47 (4) ◽  
pp. 390-397 ◽  
Author(s):  
Eun-Ha Moon ◽  
Seok Tae Lim ◽  
Yeon-Hee Han ◽  
Young Jin Jeong ◽  
Yun-Hee Kang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Tumour Size ◽  
Breast Tumour ◽  
Initial Assessment ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Mr Mammography ◽  
T Stage ◽  
Correct Definition ◽  
Pet Ct

AbstractBackground. The objective of the study was to compare the diagnostic efficacy of an integrated Fluorine-18 fluorodeoxyglucose (F-18 FDG) PET/CT-mammography (mammo-PET/CT) with conventional torso PET/CT (supine-PET/CT) and MR-mammography for initial assessment of breast cancer patients.Patients and methods. Forty women (52.0 ± 12.0 years) with breast cancer who underwent supine-PET/CT, mammo- PET/CT, and MR-mammography from April 2009 to August 2009 were enrolled in the study. We compared the size of the tumour, tumour to chest wall distance, tumour to skin distance, volume of axillary fossa, and number of metastatic axillary lymph nodes between supine-PET/CT and mammo-PET/CT. Next, we assessed the difference of focality of primary breast tumour and tumour size in mammo-PET/CT and MR-mammography. Histopathologic findings served as the standard of reference.Results. In the comparison between supine-PET/CT and mammo-PET/CT, significant differences were found in the tumour size (supine-PET/CT: 1.3 ± 0.6 cm, mammo-PET/CT: 1.5 ± 0.6 cm, p < 0.001), tumour to thoracic wall distance (1.8 ± 0.9 cm, 2.2 ± 2.1 cm, p < 0.001), and tumour to skin distance (1.5 ± 0.8 cm, 2.1 ± 1.4 cm, p < 0.001). The volume of axillary fossa was significantly wider in mammo-PET/CT than supine-PET/CT (21.7 ± 8.7 cm3vs. 23.4 ± 10.4 cm3, p = 0.03). Mammo-PET/CT provided more correct definition of the T-stage of the primary tumour than did supine-PET/ CT (72.5% vs. 67.5%). No significant difference was found in the number of metastatic axillary lymph nodes. Compared with MR-mammography, mammo-PET/CT provided more correct classification of the focality of lesion than did MR-mammography (95% vs. 90%). In the T-stage, 72.5% of cases with mammo-PET/CT and 70% of cases with MRmammography showed correspondence with pathologic results.Conclusions. Mammo-PET/CT provided more correct definition of the T-stage and evaluation of axillary fossa may also be delineated more clearly than with supine-PET/CT. The initial assessment of mammo-PET/CT would be more useful than MR-mammography because the mammo-PET/CT indicates similar accuracy with MR-mammography for decision of T-stage of primary breast tumour and more correct than MR-mammography for defining focality of lesion.

scholarly journals Can Axillary Surgery Be Omitted in Patients With Breast Pathologic Complete Response After Neoadjuvant Systemic Therapy for Breast Cancer? A Real-World Re Trospective Study in China

2021 ◽  
Author(s):  
Jue Wang ◽  
Yan Li ◽  
Shuo Li ◽  
Qiannan Zhu ◽  
Xiaoqing Shi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systemic Therapy ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Axillary Surgery ◽  
Neoadjuvant Systemic Therapy

Abstract BackgroundStudies show that axillary surgery can be potentially omitted in certain breast cancer patients who achieve breast pathologic complete response (pCR) after neoadjuvant systemic therapy (NST). However, potential differences between the ypT0 (no residual invasive or in situ carcinoma in the breast) and ypTis (in situ carcinoma in the breast) subgroups remain to be explored. Furthermore, whether axillary surgery can be omitted in patients with clinically assessed positive axillary lymph nodes (cN+) remains unknown.MethodsThis retrospective cohort study included 258 patients with early or locally advanced breast cancer who underwent breast and axillary surgery after NST. Clinical and pathologic data were compared between patients with breast pCR (ypT0/is) and those without breast pCR.ResultsAmong the patients with initial cN0, the rate of axillary pCR was similar between the breast pCR and breast non-pCR groups (P = 0.1543). Among those with breast pCR, the rate of axillary pCR was 100% in both the ypT0 and ypTis subgroups. Furthermore, among those with initial cN+, the rate of axillary pCR was higher in the breast pCR group than in the breast non-pCR group (P < 0.0001). Among the patients with breast pCR, the rate of axillary pCR was higher in the ypT0 subgroup than in the ypTis subgroup (P = 0.0034).ConclusionAxillary surgery may potentially be omitted in patients with initial cN0 who achieve breast pCR (ypT0/is), and may also be considered for omission in patients with initial cN+ who achieve ypT0 (not ypTis).

Sign in / Sign up

Export Citation Format

Share Document