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Hua Y, Peng Q, Han J, Fei J, Sun A. A two-center study of a combined nomogram based on mammography and MRI to predict ALN metastasis in breast cancer. Magn Reson Imaging 2024; 110:128-137. [PMID: 38631535 DOI: 10.1016/j.mri.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/05/2024] [Accepted: 04/13/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES To develop and validate a predictive method for axillary lymph node (ALN) metastasis of breast cancer by using radiomics based on mammography and MRI. MATERIALS AND METHODS A retrospective analysis of 492 women from center 1 (The affiliated Hospital of Qingdao University) and center 2 (Yantai Yuhuangding Hospital) with primary breast cancer from August 2013 to May 2021 was carried out. The radscore was calculated using the features screened based on preoperative mammography and MRI from the training cohort of Center 1 (n = 231), then tested in the validation cohort (n = 99), an internal test cohort (n = 90) from Center 1, and an external test cohort (n = 72) from Center 2. Univariate and multivariate analyses were used to screen for the clinical and radiological characteristics most associated with ALN metastasis. A combined nomogram was established in combination with radscore that predicted the clinicopathological and radiological characteristics. Calibration curves were used to test the effectiveness of the combined nomogram. The receiver operating characteristic (ROC) curve was used to evaluate the performance of the combined nomogram and then compare with the clinical and radiomic models. The decision curve analysis (DCA) value was used to evaluate the combined nomogram for clinical applications. RESULTS The constructed combined nomogram incorporating the radscore and MRI-reported ALN metastasis status exhibited good calibration and outperformed the radiomics signatures in predicting ALN metastasis (area under the curve [AUC]: 0.886 vs. 0.846 in the training cohort; 0.826 vs. 0.762 in the validation cohort; 0.925 vs. 0.899 in the internal test cohort; and 0.902 vs. 0.793 in the external test cohort). The combination nomogram achieved a higher AUC in the training cohort (0.886 vs. 0.786) and the internal test cohort (0.925 vs. 0.780) and similar AUCs in the validation (0.826 vs. 0.811) and external test (0.902 vs. 0.837) cohorts than the clinical model. CONCLUSION A combined nomogram based on mammography and MRI can be used for preoperative prediction of ALN metastasis in primary breast cancer.
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Affiliation(s)
- Yuchen Hua
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Qiqi Peng
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Junqi Han
- Department of Breast Imaging, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jie Fei
- Department of Breast Imaging, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Aimin Sun
- Nanfang Hospital Southern Medical University, Guangzhou, Guangdong, China.
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Wintraecken VM, Boersma LJ, van Roozendaal LM, de Vries J, van Kuijk SMJ, Vane MLG, van Dalen T, van der Hage JA, Strobbe LJA, Linn SC, Lobbes MBI, Poortmans PMP, Tjan-Heijnen VCG, van de Vijver KKBT, Westenberg AH, de Wilt JHW, Smidt ML, Simons JM. Quality assurance of radiation therapy after breast-conserving surgery among patients in the BOOG 2013-08 trial. Radiother Oncol 2024; 191:110069. [PMID: 38141879 DOI: 10.1016/j.radonc.2023.110069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/11/2023] [Accepted: 12/17/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND AND PURPOSE In the BOOG 2013-08 trial (NCT02271828), cT1-2N0 breast cancer patients were randomized between breast conserving surgery with or without sentinel lymph node biopsy (SLNB) followed by whole breast radiotherapy (WBRT). While awaiting primary endpoint results (axillary recurrence rate), this study aims to perform a quality assurance analysis on protocol adherence and (incidental) axillary radiation therapy (RT) dose. MATERIALS AND METHODS Patients were enrolled between 2015 and 2022. Data on prescribed RT and (in 25% of included patients) planning target volumes (PTV) parameters were recorded for axillary levels I-IV and compared between treatment arms. Multivariable linear regression analysis was performed to determine prognostic variables for incidental axillary RT dose. RESULTS 1,439/1,461 included patients (98.5%) were treated according to protocol and 87 patients (5.9%) received regional RT (SLNB 10.9%, no-SLNB 1.5 %). In 326 patients included in the subgroup analysis, the mean incidental PTV dose at axilla level I was 59.5% of the prescribed breast RT dose. In 5 patients (1.5%) the mean PTV dose at level I was ≥95% of the prescribed breast dose. No statistically or clinically significant differences regarding incidental axillary RT dose were found between treatment arms. Tumour bed boost (yes/no) was associated with a higher incidental mean dose in level I (R2 = 0.035, F(6, 263) = 1.532, p 0.168). CONCLUSION The results indicate that RT-protocol adherence was high, and that incidental axillary RT dose was low in the BOOG 2013-08 trial. Potential differences between treatmentarms regarding the primary endpoint can thus not be attributed to different axillary radiation doses.
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Affiliation(s)
- V M Wintraecken
- GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - L J Boersma
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - L M van Roozendaal
- Department of Surgical Oncology, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
| | - J de Vries
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands; Board member Adrz, Goes, the Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - M L G Vane
- GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - T van Dalen
- Division of Surgical Oncology, Diakonessenhuis Hospital, Utrecht, the Netherlands; Department of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - J A van der Hage
- Division of Surgical Oncology, Leids University Medical Center, Leiden, the Netherlands
| | - L J A Strobbe
- Division of Surgical Oncology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - S C Linn
- Division of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - M B I Lobbes
- GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
| | - P M P Poortmans
- Department of Radiation Oncology, Iridium Network, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - V C G Tjan-Heijnen
- GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Division of Medical Oncology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - K K B T van de Vijver
- Department of Pathology, Ghent University Hospital, Ghent, Belgium; Department of Diagnostic Sciences, Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium; Center for Gynecological Oncology Amsterdam (CGOA), Department of Gynecology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - A H Westenberg
- Radiation Oncology, Radiotherapiegroep location Arnhem, Arnhem, the Netherlands
| | - J H W de Wilt
- Division of Surgical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - M L Smidt
- GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - J M Simons
- GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Radiotherapy, Erasmus Medical Centre, Rotterdam, the Netherlands
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van Roozendaal LM, Vane MLG, Colier E, Strobbe LJA, de Boer M, Sonke G, Van Maaren MC, Smidt ML. Gene expression profiles in clinically T1-2N0 ER+HER2- breast cancer patients treated with breast-conserving therapy: their added value in case sentinel lymph node biopsy is not performed. Breast Cancer Res Treat 2024; 203:103-110. [PMID: 37794289 PMCID: PMC10771349 DOI: 10.1007/s10549-023-07128-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE Omitting sentinel lymph node biopsy (SLNB) in breast cancer treatment results in patients with unknown positive nodal status and potential risk for systemic undertreatment. This study aimed to investigate whether gene expression profiles (GEPs) can lower this risk in cT1-2N0 ER+ HER2- breast cancer patients treated with BCT. METHODS Patients were included if diagnosed between 2011 and 2017 with cT1-2N0 ER+ HER2- breast cancer, treated with BCT and SLNB, and in whom GEP was applied. Adjuvant chemotherapy recommendations based on clinical risk status (Dutch breast cancer guideline of 2020 versus PREDICT v2.1) with and without knowledge on SLNB outcome were compared to GEP outcome. We examined missing adjuvant chemotherapy indications, and the number of GEPs needed to identify one patient at risk for systemic undertreatment. RESULTS Of 3585 patients, 2863 (79.9%) had pN0 and 722 (20.1%) pN + disease. Chemotherapy was recommended in 1354 (37.8% guideline-2020) and 1888 patients (52.7% PREDICT). Eliminating SLNB outcome (n = 722) resulted in omission of chemotherapy recommendation in 475 (35.1% guideline-2020) and 412 patients (21.8% PREDICT). GEP revealed genomic high risk in 126 (26.5% guideline-2020) and 82 patients (19.9% PREDICT) in case of omitted chemotherapy recommendation in the absence of SLNB. Extrapolated to the whole group, this concerns 3.5% and 2.3%, respectively, resulting in the need for 28-44 GEPs to identify one patient at risk for systemic undertreatment. CONCLUSION If no SLNB is performed, clinical risk status according to the guideline of 2020 and PREDICT predicts a very low risk for systemic undertreatment. The number of GEPs needed to identify one patient at risk for undertreatment does not justify its standard use.
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Affiliation(s)
- L M van Roozendaal
- Department of Surgical Oncology, Zuyderland Medical Center, Heerlen - Sittard, The Netherlands.
| | - M L G Vane
- Department of Surgical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - E Colier
- Department of Surgical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - L J A Strobbe
- Department of Surgical Oncology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - M de Boer
- Department of Medical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - G Sonke
- Department of Medical Oncology, Netherlands-Cancer Institute, Amsterdam, The Netherlands
| | - M C Van Maaren
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - M L Smidt
- Department of Surgical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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Houvenaeghel G, Cohen M, Martino M, Reyal F, Classe JM, Chauvet MP, Colombo PE, Heinemann M, Jouve E, Gimbergues P, Azuar AS, Coutant C, Gonçalves A, de Nonneville A. Negative Survival Impact of Occult Lymph Node Involvement in Small HER2-Positive Early Breast Cancer Treated by Up-Front Surgery. Cancers (Basel) 2023; 15:4567. [PMID: 37760536 PMCID: PMC10526175 DOI: 10.3390/cancers15184567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: The independent negative prognostic value of isolated tumor cells or micro-metastases in axillary lymph nodes has been established in triple-negative breast cancers (BC). However, the prognostic significance of pN0(i+) or pN1mi in HER2-positive BCs treated by primary surgery remains unexplored. Therefore, our objective was to investigate the impact of pN0(i+) or pN1mi in HER2-positive BC patients undergoing up-front surgery on their outcomes. (2) Methods: We retrospectively analyzed 23,650 patients treated in 13 French cancer centers from 1991 to 2013. pN status was categorized as pN0, pN0(i+), pN1mi, and pNmacro. The effect of pN0(i+) or pN1mi on outcomes was investigated both in the entire cohort of patients and in pT1a-b tumors. (3) Results: Of 1771 HER2-positive BC patients included, pN status distributed as follows: 1047 pN0 (59.1%), 60 pN0(i+) (3.4%), 118 pN1mi (6.7%), and 546 pN1 macro-metastases (30.8%). pN status was significantly associated with sentinel lymph node biopsy, axillary lymph node dissection, age, ER status, tumor grade, and size, lymphovascular invasion, adjuvant systemic therapy (ACt), and radiation therapy. With 61 months median follow-up (mean 63.2; CI 95% 61.5-64.9), only pN1 with macro-metastases was independently associated with a negative impact on overall, disease-free, recurrence-free, and metastasis-free survivals in multivariate analysis. In the pT1a-b subgroup including 474 patients, RFS was significantly decreased in multivariate analysis for pT1b BC without ACt (HR 2.365, 1.04-5.36, p = 0.039) and for pN0(i+)/pN1mi patients (HR 2.518, 1.03-6.14, p = 0.042). (4) Conclusions: Survival outcomes were not adversely affected by pN0(i+) and pN1mi in patients with HER2-positive BC. However, in the case of pT1a-b HER2-positive BC, a negative impact on RFS was observed specifically for patients with pN0(i+) and pN1mi diseases, particularly among those with pT1b tumors without ACt. Our findings highlight the importance of considering the pN0(i+) and pN1mi status in the decision-making process when discussing trastuzumab-based ACt for these patients.
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Affiliation(s)
- Gilles Houvenaeghel
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, INSERM, 232 Bd de Sainte Marguerite, 13009 Marseille, France; (M.C.); (M.M.)
| | - Monique Cohen
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, INSERM, 232 Bd de Sainte Marguerite, 13009 Marseille, France; (M.C.); (M.M.)
| | - Marc Martino
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, INSERM, 232 Bd de Sainte Marguerite, 13009 Marseille, France; (M.C.); (M.M.)
| | - Fabien Reyal
- Institut Curie, 26 Rue d’Ulm, 75248 Paris, France;
| | - Jean-Marc Classe
- Institut René Gauducheau, Site Hospitalier Nord, Boulevard Jacques Monod, 44800 St. Herblain, France;
| | | | | | | | - Eva Jouve
- Centre Claudius Regaud, 20-24 Rue du Pont St. Pierre, 31300 Toulouse, France;
| | - Pierre Gimbergues
- Centre Jean Perrin, 58 Rue Montalembert, 63011 Clermont-Ferrand, France;
| | | | - Charles Coutant
- Centre Georges François Leclerc, 1 Rue du Professeur Marion, 21000 Dijon, France;
| | - Anthony Gonçalves
- Department of Medical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, INSERM, 232 Bd de Sainte Marguerite, 13009 Marseille, France;
| | - Alexandre de Nonneville
- Department of Medical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, INSERM, 232 Bd de Sainte Marguerite, 13009 Marseille, France;
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Niu Z, Gao Y, Xiao M, Mao F, Zhou Y, Zhu Q, Jiang Y. Contrast-enhanced lymphatic US can improve the preoperative diagnostic performance for sentinel lymph nodes in early breast cancer. Eur Radiol 2023; 33:1593-1602. [PMID: 36152038 PMCID: PMC9510155 DOI: 10.1007/s00330-022-09139-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/20/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the preoperative diagnostic value of contrast-enhanced lymphatic ultrasound (CEUS) for the sentinel lymph node (SLN) status in early breast cancer. MATERIALS AND METHODS We prospectively recruited 102 consecutive patients with clinically node-negative early breast cancer from July 2021 to October 2021. All patients underwent conventional US and percutaneous CEUS examinations. The CEUS of SLNs were classified into four enhancement patterns: homogeneous (I), featured inhomogeneous (II), focal defect (III), and no enhancement (IV). The diagnostic performance of conventional US and CEUS for SLN metastasis was assessed by receiver operating characteristic (ROC) curves and decision curves. RESULTS A total of 78 women were enrolled in this study, including 55, 18, and 5 patients with negative axilla, 1-2, and ≥ 3 metastastic SLNs pathologically, respectively. The identification rate of SLNs by CEUS was 100%. Patterns I and II can select 91.7% (44/48) of patients with disease-free axilla, while patterns III and IV had higher percentages of metastasis (65.2%, p < 0.001 and 57.1%, p < 0.002, respectively). For the SLN metastatic burden, 100% (48/48) of patients with pattern I/II had ≤ 2 metastatic SLNs. Compared with conventional US, the CEUS enhancement patterns showed significant improvement in diagnosing metastatic SLNs (0.813 vs 0.601, p < 0.001). CEUS had greater clinical benefits and correctly reclassified 48% of metastatic SLNs (p < 0.001) without sacrificing the classification accuracy of negative SLNs (p = 0.25), and could improve prediction accuracy by 0.42 (p < 0.001). CONCLUSIONS CEUS demonstrated better diagnostic performance and greater clinical benefits than conventional US for the preoperative diagnosis of SLNs, showing its potential to select candidates for precluding axillary surgery in early breast cancer. KEY POINTS • The homogeneous and featured inhomogeneous enhancement of SLNs are highly suggestive of negative LNs, while focal defect (p < 0.001) and no enhancement (p < 0.002) patterns had higher percentages of metastasis. • The proportion of SLNs with highly suspicious signs on conventional US increases as the type of enhancement pattern increases (no suspicious signs in pattern I/II, 34.8% in pattern III, and 85.7% in pattern IV). • Compared with conventional US, CEUS improved the area under the receiver operating characteristic curve (0.813 vs. 0.601, p < 0.001) and had greater clinical benefits (IDI = 0.42, p < 0.001) for the diagnosis of axillary metastasis.
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Affiliation(s)
- Zihan Niu
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Yuanjing Gao
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Mengsu Xiao
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Yidong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Qingli Zhu
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China.
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The NILS Study Protocol: A Retrospective Validation Study of an Artificial Neural Network Based Preoperative Decision-Making Tool for Noninvasive Lymph Node Staging in Women with Primary Breast Cancer (ISRCTN14341750). Diagnostics (Basel) 2022; 12:diagnostics12030582. [PMID: 35328135 PMCID: PMC8947586 DOI: 10.3390/diagnostics12030582] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 11/16/2022] Open
Abstract
Newly diagnosed breast cancer (BC) patients with clinical T1–T2 N0 disease undergo sentinel-lymph-node (SLN) biopsy, although most of them have a benign SLN. The pilot noninvasive lymph node staging (NILS) artificial neural network (ANN) model to predict nodal status was published in 2019, showing the potential to identify patients with a low risk of SLN metastasis. The aim of this study is to assess the performance measures of the model after a web-based implementation for the prediction of a healthy SLN in clinically N0 BC patients. This retrospective study was designed to validate the NILS prediction model for SLN status using preoperatively available clinicopathological and radiological data. The model results in an estimated probability of a healthy SLN for each study participant. Our primary endpoint is to report on the performance of the NILS prediction model to distinguish between healthy and metastatic SLNs (N0 vs. N+) and compare the observed and predicted event rates of benign SLNs. After validation, the prediction model may assist medical professionals and BC patients in shared decision making on omitting SLN biopsies in patients predicted to be node-negative by the NILS model. This study was prospectively registered in the ISRCTN registry (identification number: 14341750).
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Zhang J, Li L, Zhe X, Tang M, Zhang X, Lei X, Zhang L. The Diagnostic Performance of Machine Learning-Based Radiomics of DCE-MRI in Predicting Axillary Lymph Node Metastasis in Breast Cancer: A Meta-Analysis. Front Oncol 2022; 12:799209. [PMID: 35186739 PMCID: PMC8854258 DOI: 10.3389/fonc.2022.799209] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/14/2022] [Indexed: 12/23/2022] Open
Abstract
Objective The aim of this study was to perform a meta‐analysis to evaluate the diagnostic performance of machine learning(ML)-based radiomics of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) DCE-MRI in predicting axillary lymph node metastasis (ALNM) and sentinel lymph node metastasis(SLNM) in breast cancer. Methods English and Chinese databases were searched for original studies. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and Radiomics Quality Score (RQS) were used to assess the methodological quality of the included studies. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) were used to summarize the diagnostic accuracy. Spearman’s correlation coefficient and subgroup analysis were performed to investigate the cause of the heterogeneity. Results Thirteen studies (1618 participants) were included in this meta-analysis. The pooled sensitivity, specificity, DOR, and AUC with 95% confidence intervals were 0.82 (0.75, 0.87), 0.83 (0.74, 0.89), 21.56 (10.60, 43.85), and 0.89 (0.86, 0.91), respectively. The meta-analysis showed significant heterogeneity among the included studies. There was no threshold effect in the test. The result of subgroup analysis showed that ML, 3.0 T, area of interest comprising the ALN, being manually drawn, and including ALNs and combined sentinel lymph node (SLN)s and ALNs groups could slightly improve diagnostic performance compared to deep learning, 1.5 T, area of interest comprising the breast tumor, semiautomatic scanning, and the SLN, respectively. Conclusions ML-based radiomics of DCE-MRI has the potential to predict ALNM and SLNM accurately. The heterogeneity of the ALNM and SLNM diagnoses included between the studies is a major limitation.
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Houvenaeghel G, de Nonneville A, Cohen M, Chopin N, Coutant C, Reyal F, Mazouni C, Gimbergues P, Azuar AS, Chauvet MP, Classe JM, Daraï E, Martinez A, Rouzier R, de Lara CT, Lambaudie E, Barrou J, Goncalves A. Lack of prognostic impact of sentinel node micro-metastases in endocrine receptor-positive early breast cancer: results from a large multicenter cohort ☆. ESMO Open 2021; 6:100151. [PMID: 33984674 PMCID: PMC8314870 DOI: 10.1016/j.esmoop.2021.100151] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/07/2021] [Accepted: 04/15/2021] [Indexed: 01/15/2023] Open
Abstract
Background Prognostic impact of lymph node micro-metastases (pN1mi) has been discordantly reported in the literature. The need to clarify this point for decision-making regarding adjuvant therapy, particularly for patients with endocrine receptor (ER)-positive status and HER2-negative tumors, is further reinforced by the generalization of gene expression signatures using pN status in their recommendation algorithm. Patients and methods We retrospectively analyzed 13 773 patients treated for ER-positive breast cancer in 13 French cancer centers from 1999 to 2014. Five categories of axillary lymph node (LN) status were defined: negative LN (pN0i−), isolated tumor cells [pN0(i+)], pN1mi, and pN1 divided into single (pN1 = 1) and multiple (pN1 > 1) macro-metastases (>2 mm). The effect of LN micro-metastases on outcomes was investigated both in the entire cohort of patients and in clinically relevant subgroups according to tumor subtypes. Propensity-score-based matching was used to balance differences in known prognostic variables associated with pN status. Results As determined by sentinel LN biopsy, 9427 patients were pN0 (68.4%), 546 pN0(i+) (4.0%), 1446 pN1mi (10.5%) and 2354 pN1 with macro-metastases (17.1%). With a median follow-up of 61.25 months, pN1 status, but not pN1mi, significantly impacted overall survival (OS), disease-free survival (DFS), metastasis-free survival (MFS), and breast-cancer-specific survival. In the subgroup of patients with known tumor subtype, pN1 = 1, as pN1 > 1, but not pN1mi, had a significant prognostic impact on OS. DFS and MFS were only impacted by pN1 > 1. Similar results were observed in the subgroup of patients with luminal A-like tumors (n = 7101). In the matched population analysis, pN1macro, but not pN1mi, had a statistically significant negative impact on MFS and OS. Conclusion LN micro-metastases have no detectable prognostic impact and should not be considered as a determining factor in indicating adjuvant chemotherapy. The evaluation of the risk of recurrence using second-generation signatures should be calculated considering micro-metastases as pN0. LN micro-metastases have no detectable prognostic impact. pN1 status, but not pN1mi, significantly impacted overall survival, disease-free survival, metastasis-free survival. In the subgroup of patients with known tumor subtype, pN1=1, as pN1>1, but not pN1mi, had a significant prognostic impact on OS. LN micro-metastases should not be considered as a determining factor in indicating adjuvant chemotherapy.
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Affiliation(s)
- G Houvenaeghel
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France.
| | - A de Nonneville
- Department of Medical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - M Cohen
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - N Chopin
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - C Coutant
- Department of Surgical Oncology, Centre Georges François Leclerc, Dijon, France
| | - F Reyal
- Department of Surgical Oncology, Institut Curie, Paris Cedex 05, Paris, France
| | - C Mazouni
- Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France
| | - P Gimbergues
- Department of Surgical Oncology, Centre Jean Perrin, Clermont Ferrand, France
| | - A-S Azuar
- Department of Surgical Oncology, Hôpital de Grasse, Grasse, France
| | - M-P Chauvet
- Department of Surgical Oncology, Centre Oscar Lambret, Lille, France
| | - J-M Classe
- Department of Surgical Oncology, Institut René Gauducheau, St Herblain, France
| | - E Daraï
- Department of Surgical Oncology, Hôpital Tenon, Paris, France
| | - A Martinez
- Department of Surgical Oncology, Centre Claudius Regaud, Toulouse, France
| | - R Rouzier
- Department of Surgical Oncology, Hôpital René Huguenin, Saint Cloud, France
| | - C T de Lara
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - E Lambaudie
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - J Barrou
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - A Goncalves
- Department of Medical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
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9
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van den Hoven I, van Klaveren D, Verheuvel NC, van la Parra RFD, Voogd AC, de Roos WK, Bosscha K, Heuts EM, Tjan-Heijnen VCG, Roumen RMH, Steyerberg EW. Predicting the extent of nodal involvement for node positive breast cancer patients: Development and validation of a novel tool. J Surg Oncol 2019; 120:578-586. [PMID: 31338839 PMCID: PMC6771524 DOI: 10.1002/jso.25644] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 07/10/2019] [Indexed: 12/22/2022]
Abstract
Background This study aimed to develop an easy to use prediction model to predict the risk of having a total of 1 to 2, ≥3, or ≥4 positive axillary lymph nodes (LNs), for patients with sentinel lymph node (SLN) positive breast cancer. Methods Data of 911 SLN positive breast cancer patients were used for model development. The model was validated externally in an independent population of 180 patients with SLN positive breast cancer. Results Final pathology after ALND showed additional positive LN for 259 (28%) of the patients. A total of 726 (81%) out of 911 patients had a total of 1 to 2 positive nodes, whereas 175 (19%) had ≥3 positive LNs. The model included three predictors: the tumor size (in mm), the presence of a negative SLN, and the size of the SLN metastases (in mm). At external validation, the model showed a good discriminative ability (area under the curve = 0.82; 95% confidence interval = 0.74‐0.90) and good calibration over the full range of predicted probabilities. Conclusion This new and validated model predicts the extent of nodal involvement in node‐positive breast cancer and will be useful for counseling patients regarding their personalized axillary treatment.
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Affiliation(s)
| | - David van Klaveren
- Department of Public Health, Center for Medical Decision Sciences, Erasmus MC, Rotterdam, The Netherlands
| | - Nicole C Verheuvel
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Raquel F D van la Parra
- Division of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adri C Voogd
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Department of Epidemiology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Wilfred K de Roos
- Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Koop Bosscha
- Department of Surgery, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Esther M Heuts
- Department of Surgery, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rudi M H Roumen
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Center for Medical Decision Sciences, Erasmus MC, Rotterdam, The Netherlands
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10
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Chai R, Ma H, Xu M, Arefan D, Cui X, Liu Y, Zhang L, Wu S, Xu K. Differentiating axillary lymph node metastasis in invasive breast cancer patients: A comparison of radiomic signatures from multiparametric breast MR sequences. J Magn Reson Imaging 2019; 50:1125-1132. [PMID: 30848041 DOI: 10.1002/jmri.26701] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/20/2019] [Indexed: 01/01/2023] Open
Affiliation(s)
- Ruimei Chai
- Department of RadiologyFirst Hospital of China Medical University Shenyang Liaoning Province China
| | - He Ma
- Sino‐Dutch Biomedical and Infornation Engineering SchoolNortheastern University Shenyang Liaoning Province China
| | - Mingjie Xu
- Sino‐Dutch Biomedical and Infornation Engineering SchoolNortheastern University Shenyang Liaoning Province China
| | - Dooman Arefan
- Imaging Research Division, Department of RadiologyUniversity of Pittsburgh Pittsburgh Pennsylvania USA
| | - Xiaoyu Cui
- Sino‐Dutch Biomedical and Infornation Engineering SchoolNortheastern University Shenyang Liaoning Province China
| | - Yi Liu
- Department of RadiologyFirst Hospital of China Medical University Shenyang Liaoning Province China
| | - Lina Zhang
- Department of RadiologyFirst Hospital of China Medical University Shenyang Liaoning Province China
| | - Shandong Wu
- Imaging Research Division, Department of RadiologyUniversity of Pittsburgh Pittsburgh Pennsylvania USA
| | - Ke Xu
- Department of RadiologyFirst Hospital of China Medical University Shenyang Liaoning Province China
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11
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Roux P, Knight S, Cohen M, Classe JM, Mazouni C, Chauvet MP, Reyal F, Colombo PE, Jouve E, Chopin N, Daraï E, Coutant C, Lambaudie E, Houvenaeghel G. Tubular and mucinous breast cancer: results of a cohort of 917 patients. TUMORI JOURNAL 2018; 105:55-62. [DOI: 10.1177/0300891618811282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objectives: To analyze axillary lymph node involvement (ALNI) rate and survival for mucinous (MC) and tubular (TC) breast carcinomas considered being of very good prognosis and for which an axillary surgical exploration could be questioned. Methods: Our multicentric cohort consisted of 21,135 patients with clinically node-negative invasive breast cancer, without neoadjuvant therapy, between 1999 and 2013 in 10 French centers. ALNI rate and survival were analyzed according to patient and tumor characteristics. Results: Our cohort consisted of 672 TC and 245 MC. Patients were older and tumor size greater for MC and pathologic factors were more pejorative. The rate of mastectomies and adjuvant chemotherapy was higher in the MC group. Axillary lymph node status was determined by SLNB alone in 71.2% of patients. ALNI rates were 17.9% and 18% for TC and MC, respectively. ALNI rate was lesser for MC (OR 0.503, p = 0.024) and greater in case of lympho-vascular invasion (OR 5.0, p < 0.0001) and for tumors >10 mm (OR 2.17, p = 0.042). Median follow-up was 58 months. The 5- and 7-year overall survival rates were 97.1% and 95% for TC, respectively; 92.3% and 91.2% for MC ( p = 0.043); 5- and 7-year disease-free survival rates were 97.9% and 97.2% versus 95.2 and 93.6% ( p = 0.041). Lympho-vascular invasion was the only predictive factor for overall survival (hazard ratio [HR] = 2.70)’ grade 2 (HR = 10) and HR-negative (HR = 4.9) were the two predictive factors for disease-free survival. Conclusion: This study confirms the need for an axillary exploration for these tumors even for a tumor size <10 mm and a favorable prognosis.
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Affiliation(s)
- Pauline Roux
- Institut Paoli Calmettes and CRCM, Surgical Oncology Department, Marseille, France
| | - Sophie Knight
- Institut Paoli Calmettes and CRCM, Surgical Oncology Department, Marseille, France
| | - Monique Cohen
- Institut Paoli Calmettes and CRCM, Surgical Oncology Department, Marseille, France
| | - Jean Marc Classe
- Institut René Gauducheau, Surgical Oncology Department, St Herblain, France
| | - Chafika Mazouni
- Institut Gustave Roussy, Surgical Oncology Department, Villejuif, France
| | | | - Fabien Reyal
- Institut Curie, Surgical Oncology Department, Paris, France
| | | | - Eva Jouve
- Centre Claudius Regaud, Surgical Oncology Department, Toulouse, France
| | - Nicolas Chopin
- Centre Léon Bérard, Surgical Oncology Department, Lyon, France
| | - Emile Daraï
- Hôpital Tenon, Surgical Oncology Department, Paris, France
| | - Charles Coutant
- Centre Georges François Leclerc, Surgical Oncology Department, Dijon, France
| | - Eric Lambaudie
- Institut Paoli Calmettes and CRCM, Surgical Oncology Department, Marseille, France
- Aix Marseille Université, Marseille, France
| | - Gilles Houvenaeghel
- Institut Paoli Calmettes and CRCM, Surgical Oncology Department, Marseille, France
- Aix Marseille Université, Marseille, France
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12
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Blair SL, Tsai C, Tafra L. ASBRS Great Debate: Sentinel Node Biopsy in Patients Over 70 Years of Age. Ann Surg Oncol 2018; 25:2813-2817. [PMID: 29987610 DOI: 10.1245/s10434-018-6617-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Controversy over the need for sentinel node biopsy (SNB) continues to exist for the optimal treatment of breast cancer in patients ≥ 70 years of age, especially in those with lower-risk disease. Clinicians must balance competing risks to give the best individualized care. METHODS The American Society of Breast Surgeons (ASBrS) conducted a debate discussing the pros and cons of routinely performing SNB in this age group. Small, randomized studies have been conducted that show no overall survival benefit to axillary intervention (either axillary dissection or SNB) in patients with clinically T1N0 estrogen receptor (ER)- and progesterone receptor (PR)-positive, HER2/neu-negative tumors. There may be a small local recurrence benefit to axillary staging in patients who do not undergo radiation. Alternatively, axillary ultrasound, which carries a low false-negative rate for heavy disease burden, can be used to select patients who can avoid SNB. CONCLUSION Surgeons must continue to individualize care of breast cancer patients over 70 years of age in whom competing comorbidities may dictate care. No randomized clinical trials (RCTs) have found a survival benefit to axillary staging in this low-risk population. However, in healthy patients, axillary staging may improve local control, provide prognostic information, and help guide decisions regarding adjuvant therapy such as chemotherapy and radiation. Ongoing RCTs are evaluating the benefit of SNB in patients with a negative axillary ultrasound. Until those results are available, clinicians and patients must balance the risk and benefits to determine if SNB adds significant value to their overall care.
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Affiliation(s)
- Sarah L Blair
- University of California San Diego, La Jolla, CA, USA.
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13
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Andersson Y, Bergkvist L, Frisell J, de Boniface J. Long-term breast cancer survival in relation to the metastatic tumor burden in axillary lymph nodes. Breast Cancer Res Treat 2018; 171:359-369. [DOI: 10.1007/s10549-018-4820-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/03/2018] [Indexed: 10/16/2022]
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14
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Zhu Y, Li X, Wang F, Zhang J, Li W, Ma Y, Qi J, Ren S, Ye Z. Intravoxel incoherent motion diffusion-weighted magnetic resonance imaging in characterization of axillary lymph nodes: Preliminary animal experience. Magn Reson Imaging 2018; 52:46-52. [PMID: 29852212 DOI: 10.1016/j.mri.2018.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 05/27/2018] [Accepted: 05/27/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate the diagnostic value of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) for discriminating axillary metastatic from non-metastatic lymph nodes (LNs) in rabbit models. MATERIALS AND METHODS The institutional animal care and use committee approved this study. Forty New Zealand white rabbits were randomly divided into two groups. The axillary LN models were created by inoculating VX2 cell suspension and complete Freund's adjuvant in the mammary glands of 20 female rabbits of each group, respectively. Conventional MRI and IVIM DWI were performed after animal models successfully established. Images of axillary LNs were analyzed with regard to long-axis diameter (L), short-axis diameter (S), apparent diffusion coefficient (ADC) and IVIM parameters (D, D*, f). Receiver operating characteristic analyses were conducted to determine the diagnostic performance of aforementioned criteria. RESULTS A total of 42 metastatic and 30 non-metastatic LNs were successfully isolated. ADC and D of metastatic LNs were significantly lower than those of non-metastatic ones (all P < 0.001), whereas D* was statistically higher (P = 0.033). L, S, and f showed no significant difference between the two groups (P = 0.089, 0.058, 0.054, respectively). Optimal cutoff values, area under the curve, sensitivity, and specificity for differentiation were as follows: ADC = 1.101 × 10-3 mm2/s, 0.886, 78.6%, 90.0%; D = 0.938 × 10-3 mm2/s, 0.927, 83.3%, 93.3%; and D* = 12.635 × 10-3 mm2/s, 0.657, 52.4%, 80.0%. CONCLUSION IVIM DWI is useful to distinguish metastatic from non-metastatic LNs in axilla. D was the most discriminative variable for predicting metastatic LNs.
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Affiliation(s)
- Yueqiang Zhu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Xubin Li
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Fengkui Wang
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Jun Zhang
- Department of Breast Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Wei Li
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Yan Ma
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Jin Qi
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Song Ren
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.
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15
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van Nijnatten T, Schipper R, Lobbes M, van Roozendaal L, Vöö S, Moossdorff M, Paiman ML, de Vries B, Keymeulen K, Wildberger J, Smidt M, Beets-Tan R. Diagnostic performance of gadofosveset-enhanced axillary MRI for nodal (re)staging in breast cancer patients: results of a validation study. Clin Radiol 2018; 73:168-175. [DOI: 10.1016/j.crad.2017.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/05/2017] [Accepted: 09/11/2017] [Indexed: 11/16/2022]
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16
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van Roozendaal LM, Vane MLG, van Dalen T, van der Hage JA, Strobbe LJA, Boersma LJ, Linn SC, Lobbes MBI, Poortmans PMP, Tjan-Heijnen VCG, Van de Vijver KKBT, de Vries J, Westenberg AH, Kessels AGH, de Wilt JHW, Smidt ML. Clinically node negative breast cancer patients undergoing breast conserving therapy, sentinel lymph node procedure versus follow-up: a Dutch randomized controlled multicentre trial (BOOG 2013-08). BMC Cancer 2017; 17:459. [PMID: 28668073 PMCID: PMC5494134 DOI: 10.1186/s12885-017-3443-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 06/22/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Studies showed that axillary lymph node dissection can be safely omitted in presence of positive sentinel lymph node(s) in breast cancer patients treated with breast conserving therapy. Since the outcome of the sentinel lymph node biopsy has no clinical consequence, the value of the procedure itself is being questioned. The aim of the BOOG 2013-08 trial is to investigate whether the sentinel lymph node biopsy can be safely omitted in clinically node negative breast cancer patients treated with breast conserving therapy. METHODS The BOOG 2013-08 is a Dutch prospective non-inferiority randomized multicentre trial. Women with pathologically confirmed clinically node negative T1-2 invasive breast cancer undergoing breast conserving therapy will be randomized for sentinel lymph node biopsy versus no sentinel lymph node biopsy. Endpoints include regional recurrence after 5 (primary endpoint) and 10 years of follow-up, distant-disease free and overall survival, quality of life, morbidity and cost-effectiveness. Previous data indicate a 5-year regional recurrence free survival rate of 99% for the control arm and 96% for the study arm. In combination with a non-inferiority limit of 5% and probability of 0.8, this result in a sample size of 1.644 patients including a lost to follow-up rate of 10%. Primary and secondary endpoints will be reported after 5 and 10 years of follow-up. DISCUSSION If the sentinel lymph node biopsy can be safely omitted in clinically node negative breast cancer patients undergoing breast conserving therapy, this study will cost-effectively lead to a decreased axillary morbidity rate and thereby improved quality of life with non-inferior regional control, distant-disease free survival and overall survival. TRIAL REGISTRATION The BOOG 2013-08 study is registered in ClinicalTrials.gov since October 20, 2014, Identifier: NCT02271828. https://clinicaltrials.gov/ct2/show/NCT02271828.
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Affiliation(s)
- L M van Roozendaal
- Division of Surgical Oncology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - M L G Vane
- Division of Surgical Oncology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. .,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - T van Dalen
- Division of Surgical Oncology, Diakonessenhuis Hospital, Utrecht, the Netherlands
| | - J A van der Hage
- Division of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - L J A Strobbe
- Division of Surgical Oncology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - L J Boersma
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Radiation Oncology, Maastricht University Medical Centre (MAASTRO clinic), Maastricht, the Netherlands
| | - S C Linn
- Division of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - M B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - P M P Poortmans
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - V C G Tjan-Heijnen
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Division of Medical Oncology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - K K B T Van de Vijver
- Department of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - J de Vries
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - A H Westenberg
- Radiation Oncology, Radiotherapy group, Arnhem, the Netherlands
| | - A G H Kessels
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J H W de Wilt
- Division of Surgical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - M L Smidt
- Division of Surgical Oncology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
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17
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Kim SH, Shin HJ, Shin KC, Chae EY, Choi WJ, Cha JH, Kim HH. Diagnostic Performance of Fused Diffusion-Weighted Imaging Using T1-Weighted Imaging for Axillary Nodal Staging in Patients With Early Breast Cancer. Clin Breast Cancer 2017; 17:154-163. [DOI: 10.1016/j.clbc.2016.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/12/2016] [Indexed: 01/17/2023]
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18
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Heymans C, van Bastelaar J, Visschers RGJ, Vissers YLJ. Sentinel Node Procedure Obsolete in Lumpectomy for Ductal Carcinoma In Situ. Clin Breast Cancer 2016; 17:e87-e93. [PMID: 28162949 DOI: 10.1016/j.clbc.2016.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/08/2016] [Accepted: 10/12/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with a preoperative needle-biopsy diagnosis of ductal carcinoma in situ (DCIS) may have an indication for a sentinel lymph node biopsy if invasive carcinoma is found. We investigated how often a positive sentinel node and invasive carcinoma occurred in patients with a preoperative diagnosis of DCIS and whether this influenced the adjuvant regime. MATERIALS AND METHODS From 2005 to 2014, the records of 240 patients with needle-biopsy diagnosis of DCIS were retrospectively reviewed for postoperative pathology outcomes of the sentinel node and breast, and decisions on adjuvant treatment. Descriptive statistics and univariable and multivariable analysis were used. RESULTS A total of 160 of 240 patients underwent a sentinel node biopsy. Sixteen of 85 patients undergoing lumpectomy had occult invasive cancer. One patient had a micrometastasis. In patients undergoing mastectomy, 30 of 155 patients had occult invasive cancer. One patient had a micrometastasis, and 3 had a macrometastases. Eleven patients received adjuvant treatment as a result of invasive cancer. Three patients received adjuvant treatment (radiotherapy of the axilla or axillary dissection) because of node positivity. These patients underwent a primary mastectomy. CONCLUSION A positive sentinel lymph node biopsy in patients with needle-biopsy diagnosis of ductal DCIS is rare and rarely changes adjuvant regimes. Current Dutch guidelines should be updated.
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Affiliation(s)
- Cathelijne Heymans
- Department of Surgery, Zuyderland Medical Center, Sittard, The Netherlands
| | | | | | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Center, Sittard, The Netherlands.
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19
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Kramer GM, Leenders MWH, Schijf LJ, Go HLS, van der Ploeg T, van den Tol MP, Schreurs WH. Is ultrasound-guided fine-needle aspiration cytology of adequate value in detecting breast cancer patients with three or more positive axillary lymph nodes? Breast Cancer Res Treat 2016; 156:271-8. [PMID: 26995283 DOI: 10.1007/s10549-016-3755-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 03/14/2016] [Indexed: 12/30/2022]
Abstract
This study evaluated the accuracy of ultrasound-guided fine-needle aspiration cytology of the sonographically most suspicious axillary lymph node (US/FNAC) to select early breast cancer patients with three or more tumour-positive axillary lymph nodes. Between 2004 and 2014, a total of 2130 patients with histologically proven early breast cancer were evaluated and treated in the Noordwest Clinics Alkmaar. US/FNAC was performed preoperatively in all these patients. We analysed the results of US/FNAC retrospectively. Pathological axillary node status (sentinel node biopsy and/or axillary lymph node dissection) was used as reference standard. A total of 634 (29.8 %) of 2130 patients had axillary lymph node metastases on final histology. 248 node positive patients (11.6 %) had three or more positive lymph nodes. The accuracy of US/FNAC to detect three or more positive lymph nodes was 89.8 %, sensitivity was 44.8 %, specificity was 95.7 %, PPV was 58.1 %, and NPV was 92.9 %. This study shows a more than adequate accuracy of preoperative US/FNAC to detect three or more positive lymph nodes (89.8 %). However, when US/FNAC was chosen as the only axillary staging method, 6.4 % of all patients (false negative group) would have been undertreated and 3.8 % of all patients (false positive group) would have been overtreated according to the ACOSOG Z0011 criteria.
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Affiliation(s)
- G M Kramer
- Department of Surgery, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815JD, Alkmaar, The Netherlands.
| | - M W H Leenders
- Department of Surgery, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815JD, Alkmaar, The Netherlands
| | - L J Schijf
- Department of Radiology, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815JD, Alkmaar, The Netherlands
| | - H L S Go
- Department of Radiology, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815JD, Alkmaar, The Netherlands
| | - T van der Ploeg
- Department of Statistics, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815JD, Alkmaar, The Netherlands
| | - M P van den Tol
- Department of Surgery, VU Medical Centre, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
| | - W H Schreurs
- Department of Surgery, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815JD, Alkmaar, The Netherlands
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20
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Schipper RJ, Paiman ML, Beets-Tan RGH, Nelemans PJ, de Vries B, Heuts EM, van de Vijver KK, Keymeulen KB, Brans B, Smidt ML, Lobbes MBI. Diagnostic Performance of Dedicated Axillary T2- and Diffusion-weighted MR Imaging for Nodal Staging in Breast Cancer. Radiology 2015; 275:345-55. [DOI: 10.1148/radiol.14141167] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kuijs VJL, Moossdorff M, Schipper RJ, Beets-Tan RGH, Heuts EM, Keymeulen KBMI, Smidt ML, Lobbes MBI. The role of MRI in axillary lymph node imaging in breast cancer patients: a systematic review. Insights Imaging 2015; 6:203-15. [PMID: 25800994 PMCID: PMC4376816 DOI: 10.1007/s13244-015-0404-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/25/2015] [Accepted: 02/25/2015] [Indexed: 12/12/2022] Open
Abstract
Objectives To assess whether MRI can exclude axillary lymph node metastasis, potentially replacing sentinel lymph node biopsy (SLNB), and consequently eliminating the risk of SLNB-associated morbidity. Methods PubMed, Cochrane, Medline and Embase databases were searched for relevant publications up to July 2014. Studies were selected based on predefined inclusion and exclusion criteria and independently assessed by two reviewers using a standardised extraction form. Results Sixteen eligible studies were selected from 1,372 publications identified by the search. A dedicated axillary protocol [sensitivity 84.7 %, negative predictive value (NPV) 95.0 %] was superior to a standard protocol covering both the breast and axilla simultaneously (sensitivity 82.0 %, NPV 82.6 %). Dynamic, contrast-enhanced MRI had a lower median sensitivity (60.0 %) and NPV (80.0 %) compared to non-enhanced T1w/T2w sequences (88.4, 94.7 %), diffusion-weighted imaging (84.2, 90.6 %) and ultrasmall superparamagnetic iron oxide (USPIO)- enhanced T2*w sequences (83.0, 95.9 %). The most promising results seem to be achievable when using non-enhanced T1w/T2w and USPIO-enhanced T2*w sequences in combination with a dedicated axillary protocol (sensitivity 84.7 % and NPV 95.0 %). Conclusions The diagnostic performance of some MRI protocols for excluding axillary lymph node metastases approaches the NPV needed to replace SLNB. However, current observations are based on studies with heterogeneous study designs and limited populations. Main Messages • Some axillary MRI protocols approach the NPV of an SLNB procedure. • Dedicated axillary MRI is more accurate than protocols also covering the breast. • T1w/T2w protocols combined with USPIO-enhanced sequences are the most promising sequences.
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Affiliation(s)
- V J L Kuijs
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
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