scholarly journals PET/MRI for Staging the Axilla in Breast Cancer: Current Evidence and the Rationale for SNB vs. PET/MRI Trials

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3571
Author(s):  
Rosa Di Micco ◽  
Letizia Santurro ◽  
Maria Luisa Gasparri ◽  
Veronica Zuber ◽  
Giovanni Cisternino ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Imaging Techniques ◽  
Current Evidence ◽  
Breast Cancer Patients ◽  
Prognostic Information ◽  
Primary Systemic Therapy ◽  
Axillary Surgery ◽  
Imaging Tool ◽  
Positron Emission

Axillary surgery in breast cancer (BC) is no longer a therapeutic procedure but has become a purely staging procedure. The progressive improvement in imaging techniques has paved the way to the hypothesis that prognostic information on nodal status deriving from surgery could be obtained with an accurate diagnostic exam. Positron emission tomography/magnetic resonance imaging (PET/MRI) is a relatively new imaging tool and its role in breast cancer patients is still under investigation. We reviewed the available literature on PET/MRI in BC patients. This overview showed that PET/MRI yields a high diagnostic performance for the primary tumor and distant lesions of liver, brain and bone. In particular, the results of PET/MRI in staging the axilla are promising. This provided the rationale for two prospective comparative trials between axillary surgery and PET/MRI that could lead to a further de-escalation of surgical treatment of BC. • SNB vs. PET/MRI 1 trial compares PET/MRI and axillary surgery in staging the axilla of BC patients undergoing primary systemic therapy (PST). • SNB vs. PET/MRI 2 trial compares PET/MRI and sentinel node biopsy (SNB) in staging the axilla of early BC patients who are candidates for upfront surgery. Finally, these ongoing studies will help clarify the role of PET/MRI in BC and establish whether it represents a useful diagnostic tool that could guide, or ideally replace, axillary surgery in the future.

scholarly journals What Is the Best Management of cN0pN1(sn) Breast Cancer Patients

Breast Care ◽  
2018 ◽  
Vol 13 (5) ◽  
pp. 331-336 ◽  
Author(s):  
Jana de Boniface ◽  
Marcus Schmidt ◽  
Jutta Engel ◽  
Marjolein L. Smidt ◽  
Birgitte Vrou Offersen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
High Volume ◽  
Breast Cancer Patients ◽  
Nodal Disease ◽  
Best Management ◽  
Axillary Surgery ◽  
Individualize Treatment ◽  
Chemotherapy Strategy

Although the majority of breast cancer patients are clinically node-negative (cN0) at diagnosis, 15-20% will have a metastatic sentinel lymph node (SLN, pN1(sn)). While a less radical approach regarding axillary surgery in cN0 patients with a positive SLN biopsy is advocated, the limitations of 5 published trials on axillary management in pN1(sn) are discussed intensely in the literature and support the performance of ongoing validation and extension trials, especially considering the lack of data in the setting of mastectomy. As locoregional radiotherapy has a significant effect on both recurrence and survival, a standardization of locoregional radiotherapy in the situation of SLN biopsy alone in pN1(sn) patients has to be defined in the future, and de-escalation trials should embrace a truly multidisciplinary approach. This is also of utmost importance considering the fact that high-volume nodal disease requires an intensified adjuvant chemotherapy strategy to which patients omitting axillary dissection cannot be stratified. Finally, there is mounting evidence that the therapeutic role of extensive axillary surgery in low-volume nodal disease is negligible, and multidisciplinary and translational efforts must be undertaken to individualize treatment in order to gain a reasonable balance between necessary staging information and unnecessary treatment-related morbidity.

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