Breast MRI and tumour biology predict axillary lymph node response to neoadjuvant chemotherapy for breast cancer

Samia Al-Hattali, Sarah J Vinnicombe, Nazleen Muhammad Gowdh, Andrew Evans, Sharon Armstrong, Douglas Adamson, Colin A Purdie, E Jane Macaskill, Samia Al-Hattali, Sarah J Vinnicombe, Nazleen Muhammad Gowdh, Andrew Evans, Sharon Armstrong, Douglas Adamson, Colin A Purdie, E Jane Macaskill

Abstract

Background: In patients who have had axillary nodal metastasis diagnosed prior to neoadjuvant chemotherapy for breast cancer, there is little consensus on how to manage the axilla subsequently. The aim of this study was to explore whether a combination of breast magnetic resonance imaging (MRI) assessed response and primary tumour pathology factors could identify a subset of patients that might be spared axillary node clearance.

Methods: A retrospective data analysis was performed of patients with core biopsy-proven axillary nodal metastasis prior to commencement of neoadjuvant chemotherapy (NAC) who had subsequent axillary node clearance (ANC) at definitive breast surgery. Breast tumour and axillary response at MRI before, during and on completion of NAC, core biopsy tumour grade, tumour type and immunophenotype were correlated with pathological response in the breast and the number of metastatic nodes in the ANC specimens.

Results: Of 87 consecutive patients with MRI at baseline, interim and after neoadjuvant chemotherapy who underwent ANC at time of breast surgery, 33 (38%) had no residual macrometastatic axillary disease, 28 (32%) had 1-2 metastatic nodes and 26 (30%) had more than 2 metastatic nodes. Factors that predicted axillary nodal complete response were MRI complete response in the breast (p < 0.0001), HER2 positivity (p = 0.02) and non-lobular tumour type (p = 0.015).

Conclusion: MRI assessment of breast tumour response to NAC and core biopsy factors are predictive of response in axillary nodes, and can be used to guide decision making regarding appropriate axillary surgery.

Keywords: Axilla lymph node; Breast cancer; Magnetic resonance imaging; Neoadjuvant chemotherapy; Sentinel node biopsy.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Demonstrates the association of tumour response as predicted on interim-treatment breast MRI and the pathological findings in axillary nodes r = 0.50; p < 0.0001. There were no patients with tumours showing progressive disease at interim MRI. Key: No residual macrometastasis in axillary nodes =0; residual macrometastasis in 1 or 2 nodes =1–2; residual macrometastasis in more than 2 nodes = > 2
Fig. 2
Fig. 2
demonstrates the reported axillary response from MRI assessment post-treatment and the number of positive nodes from the axillary node clearance. There was no statistical correlation

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