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03.01.2021 | Clinical trial

Prediction of axillary nodal burden in patients with invasive lobular carcinoma using MRI

verfasst von: Su Min Ha, Jung Min Chang, Soo-Yeon Kim, Su Hyun Lee, Eun Sil Kim, Yeon Soo Kim, Nariya Cho, Woo Kyung Moon

Erschienen in: Breast Cancer Research and Treatment | Ausgabe 2/2021

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Abstract

Purpose

To investigate clinical and imaging features associated with a high nodal burden (≥ 3 metastatic lymph nodes [LNs]) and compare diagnostic performance of US and MRI in patients with invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC).

Methods

Retrospective search revealed 239 patients with ILC and 999 with IDC who underwent preoperative US and MRI between January 2016 and June 2019. Patients with ILC were propensity-score-matched with patients with IDC. Univariate and multivariate logistic regression analyses were performed to determine factors associated with ≥ 3 metastatic LNs.

Results

412 patients (206 ILC and 206 IDC) were evaluated. Of all patients with ILC, 27.2% (56/206) were node-positive and 7.8% (16/206) showed a high nodal burden. In multivariate analysis, the clinical N stage was the only independent factor associated with a high nodal burden in patients with IDC (odds ratio [OR] 6.24; 95% confidence interval [CI] 1.57–24.73; P = 0.009), but not in patients with ILC. Increased cortical thickness with loss of fatty hilum on US was associated with a high nodal burden in patients with ILC (OR 58.40; 95% CI 5.09–669.71; P = 0.001) and IDC (OR 24.14; 95% CI 3.52–165.37; P = 0.001), while suspicious LN findings at MRI were independently associated with a high nodal burden in ILC only (OR 13.94; 95% CI 2.61–74.39; P = 0.002).

Conclusion

In patients with ILC, MRI findings of suspicious LNs were helpful to predict a high nodal disease burden.

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Caudle AS, Cupp JA, Kuerer HM (2014) Management of axillary disease. Surg Oncol Clin N Am 23:473–486. https://doi.org/10.1016/j.soc.2014.03.007CrossRefPubMed

Ecanow JS, Abe H, Newstead GM, Ecanow DB, Jeske JM (2013) Axillary staging of breast cancer: what the radiologist should know. Radiographics 33:1589–1612. https://doi.org/10.1148/rg.336125060CrossRefPubMed

Montemurro F, Maggiorotto F, Valabrega G, Kubatzki F, Rossi V, Magistris A, Marocco F, Gatti M, Sarotto I, Aglietta M, Ponzone R (2012) Omission of axillary dissection after a positive sentinel node dissection may influence adjuvant chemotherapy indications in operable breast cancer patients. Ann Surg Oncol 19:3755–3761. https://doi.org/10.1245/s10434-012-2505-1CrossRefPubMed

Giuliano AE, Ballman KV, McCall L, Beitsch PD, Brennan MB, Kelemen PR, Ollila DW, Hansen NM, Whitworth PW, Blumencranz PW, Leitch AM, Saha S, Hunt KK, Morrow M (2017) Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (alliance) randomized clinical trial. JAMA 318:918–926. https://doi.org/10.1001/jama.2017.11470CrossRefPubMedPubMedCentral

Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, Leitch AM, Saha S, McCall LM, Morrow M (2011) Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA 305:569–575. https://doi.org/10.1001/jama.2011.90CrossRefPubMedPubMedCentral

Chang JM, Leung JWT, Moy L, Ha SM, Moon WK (2020) Axillary nodal evaluation in breast cancer: state of the art. Radiology 295:500–515. https://doi.org/10.1148/radiol.2020192534CrossRefPubMed

Ahn SK, Kim MK, Kim J, Lee E, Yoo TK, Lee HB, Kang YJ, Kim J, Moon HG, Chang JM, Cho N, Moon WK, Park IA, Noh DY, Han W (2017) Can we skip intraoperative evaluation of sentinel lymph nodes? Nomogram predicting involvement of three or more axillary lymph nodes before breast cancer surgery. Cancer Res Treat 49:1088–1096. https://doi.org/10.4143/crt.2016.473CrossRefPubMedPubMedCentral

Caudle AS, Kuerer HM, Le-Petross HT, Yang W, Yi M, Bedrosian I, Krishnamurthy S, Fornage BD, Hunt KK, Mittendorf EA (2014) Predicting the extent of nodal disease in early-stage breast cancer. Ann Surg Oncol 21:3440–3447. https://doi.org/10.1245/s10434-014-3813-4CrossRefPubMed

Farrell TP, Adams NC, Stenson M, Carroll PA, Griffin M, Connolly EM, O’Keeffe SA (2015) The Z0011 trial: is this the end of axillary ultrasound in the pre-operative assessment of breast cancer patients? Eur Radiol 25:2682–2687. https://doi.org/10.1007/s00330-015-3683-6CrossRefPubMed

10.

Harris CK, Tran HT, Lee K, Mylander C, Pack D, Rosman M, Tafra L, Umbricht CB, Andrade R, Liang W, Jackson RS (2017) Positive ultrasound-guided lymph node needle biopsy in breast cancer may not mandate axillary lymph node dissection. Ann Surg Oncol 24:3004–3010. https://doi.org/10.1245/s10434-017-5935-yCrossRefPubMed

11.

Kim WH, Kim HJ, Lee SM, Cho SH, Shin KM, Lee SY, Lim JK (2019) Prediction of high nodal burden with ultrasound and magnetic resonance imaging in clinically node-negative breast cancer patients. Cancer Imaging 19:4. https://doi.org/10.1186/s40644-019-0191-yCrossRefPubMedPubMedCentral

12.

Lim GH, Upadhyaya VS, Acosta HA, Lim JMA, Allen JC Jr, Leong LCH (2018) Preoperative predictors of high and low axillary nodal burden in Z0011 eligible breast cancer patients with a positive lymph node needle biopsy result. Eur J Surg Oncol 44:945–950. https://doi.org/10.1016/j.ejso.2018.04.003CrossRefPubMed

13.

Moorman AM, Bourez RL, Heijmans HJ, Kouwenhoven EA (2014) Axillary ultrasonography in breast cancer patients helps in identifying patients preoperatively with limited disease of the axilla. Ann Surg Oncol 21:2904–2910. https://doi.org/10.1245/s10434-014-3674-xCrossRefPubMed

14.

Puri S, Sharma N, Newcombe RG, Kaushik M, Al-Attar M, Pascaline S, Hajaj M, Wallis MG, Elsberger B, Goyal A (2018) Axillary tumour burden in women with one abnormal node on ultrasound compared to women with multiple abnormal nodes. Clin Radiol 73:391–395. https://doi.org/10.1016/j.crad.2017.12.014CrossRefPubMed

15.

van Wely BJ, de Wilt JH, Francissen C, Teerenstra S, Strobbe LJ (2015) Meta-analysis of ultrasound-guided biopsy of suspicious axillary lymph nodes in the selection of patients with extensive axillary tumour burden in breast cancer. Br J Surg 102:159–168. https://doi.org/10.1002/bjs.9663CrossRefPubMed

16.

Neal CH, Daly CP, Nees AV, Helvie MA (2010) Can preoperative axillary US help exclude N2 and N3 metastatic breast cancer? Radiology 257:335–341. https://doi.org/10.1148/radiol.10100296CrossRefPubMed

17.

Alvarez S, Anorbe E, Alcorta P, Lopez F, Alonso I, Cortes J (2006) Role of sonography in the diagnosis of axillary lymph node metastases in breast cancer: a systematic review. AJR Am J Roentgenol 186:1342–1348. https://doi.org/10.2214/ajr.05.0936CrossRefPubMed

18.

Fernandez B, Paish EC, Green AR, Lee AH, Macmillan RD, Ellis IO, Rakha EA (2011) Lymph-node metastases in invasive lobular carcinoma are different from those in ductal carcinoma of the breast. J Clin Pathol 64:995–1000. https://doi.org/10.1136/jclinpath-2011-200151CrossRefPubMed

19.

Hackney L, Williams S, Bajwa S, Morley-Davies AJ, Kirby RM, Britton I (2013) Influence of tumor histology on preoperative staging accuracy of breast metastases to the axilla. Breast J 19:49–55. https://doi.org/10.1111/tbj.12042CrossRefPubMed

20.

Morrow E, Lannigan A, Doughty J, Litherland J, Mansell J, Stallard S, Mallon E, Romics L (2018) Population-based study of the sensitivity of axillary ultrasound imaging in the preoperative staging of node-positive invasive lobular carcinoma of the breast. Br J Surg 105:987–995. https://doi.org/10.1002/bjs.10791CrossRefPubMed

21.

Baltzer PA, Dietzel M, Burmeister HP, Zoubi R, Gajda M, Camara O, Kaiser WA (2011) Application of MR mammography beyond local staging: is there a potential to accurately assess axillary lymph nodes? evaluation of an extended protocol in an initial prospective study. AJR Am J Roentgenol 196:W641-647. https://doi.org/10.2214/ajr.10.4889CrossRefPubMed

22.

Fornasa F, Nesoti MV, Bovo C, Bonavina MG (2012) Diffusion-weighted magnetic resonance imaging in the characterization of axillary lymph nodes in patients with breast cancer. J Magn Reson Imaging 36:858–864. https://doi.org/10.1002/jmri.23706CrossRefPubMed

23.

Hyun SJ, Kim EK, Moon HJ, Yoon JH, Kim MJ (2016) Preoperative axillary lymph node evaluation in breast cancer patients by breast magnetic resonance imaging (MRI): can breast MRI exclude advanced nodal disease? Eur Radiol 26:3865–3873. https://doi.org/10.1007/s00330-016-4235-4CrossRefPubMed

24.

Korteweg MA, Zwanenburg JJ, Hoogduin JM, van den Bosch MA, van Diest PJ, van Hillegersberg R, Eijkemans MJ, Mali WP, Luijten PR, Veldhuis WB (2011) Dissected sentinel lymph nodes of breast cancer patients: characterization with high-spatial-resolution 7-T MR imaging. Radiology 261:127–135. https://doi.org/10.1148/radiol.11103535CrossRefPubMed

25.

Kvistad KA, Rydland J, Smethurst HB, Lundgren S, Fjosne HE, Haraldseth O (2000) Axillary lymph node metastases in breast cancer: preoperative detection with dynamic contrast-enhanced MRI. Eur Radiol 10:1464–1471. https://doi.org/10.1007/s003300000370CrossRefPubMed

26.

Mortellaro VE, Marshall J, Singer L, Hochwald SN, Chang M, Copeland EM, Grobmyer SR (2009) Magnetic resonance imaging for axillary staging in patients with breast cancer. J Magn Reson Imaging 30:309–312. https://doi.org/10.1002/jmri.21802CrossRefPubMed

27.

Rahbar H, Conlin JL, Parsian S, DeMartini WB, Peacock S, Lehman CD, Partridge SC (2015) Suspicious axillary lymph nodes identified on clinical breast MRI in patients newly diagnosed with breast cancer: can quantitative features improve discrimination of malignant from benign? Acad Radiol 22:430–438. https://doi.org/10.1016/j.acra.2014.10.010CrossRefPubMed

28.

Scaranelo AM, Eiada R, Jacks LM, Kulkarni SR, Crystal P (2012) Accuracy of unenhanced MR imaging in the detection of axillary lymph node metastasis: study of reproducibility and reliability. Radiology 262:425–434. https://doi.org/10.1148/radiol.11110639CrossRefPubMed

29.

Kuijs VJ, Moossdorff M, Schipper RJ, Beets-Tan RG, Heuts EM, Keymeulen KB, Smidt ML, Lobbes MB (2015) The role of MRI in axillary lymph node imaging in breast cancer patients: a systematic review. Insights Imaging 6:203–215. https://doi.org/10.1007/s13244-015-0404-2CrossRefPubMedPubMedCentral

30.

Zhang X, Liu Y, Luo H, Zhang J (2020) PET/CT and MRI for identifying axillary lymph node metastases in breast cancer patients: systematic review and meta-analysis. J Magn Reson Imaging. https://doi.org/10.1002/jmri.27246CrossRefPubMedPubMedCentral

31.

Jung NY, Kim SH, Kim SH, Seo YY, Oh JK, Choi HS, You WJ (2015) Effectiveness of breast MRI and (18)F-FDG PET/CT for the preoperative staging of invasive lobular carcinoma versus ductal carcinoma. J Breast Cancer 18:63–72. https://doi.org/10.4048/jbc.2015.18.1.63CrossRefPubMedPubMedCentral

32.

Solin LJ, Orel SG, Hwang WT, Harris EE, Schnall MD (2008) Relationship of breast magnetic resonance imaging to outcome after breast-conservation treatment with radiation for women with early-stage invasive breast carcinoma or ductal carcinoma in situ. J Clin Oncol 26:386–391. https://doi.org/10.1200/jco.2006.09.5448CrossRefPubMed

33.

Houssami N, Turner R, Macaskill P, Turnbull LW, McCready DR, Tuttle TM, Vapiwala N, Solin LJ (2014) An individual person data meta-analysis of preoperative magnetic resonance imaging and breast cancer recurrence. J Clin Oncol 32:392–401. https://doi.org/10.1200/jco.2013.52.7515CrossRefPubMed

34.

Mann RM, Hoogeveen YL, Blickman JG, Boetes C (2008) MRI compared to conventional diagnostic work-up in the detection and evaluation of invasive lobular carcinoma of the breast: a review of existing literature. Breast Cancer Res Treat 107:1–14. https://doi.org/10.1007/s10549-007-9528-5CrossRefPubMed

35.

Mann RM, Kuhl CK, Kinkel K, Boetes C (2008) Breast MRI: guidelines from the European Society of breast imaging. Eur Radiol 18:1307–1318. https://doi.org/10.1007/s00330-008-0863-7CrossRefPubMedPubMedCentral

36.

Sung JS, Li J, Da Costa G, Patil S, Van Zee KJ, Dershaw DD, Morris EA (2014) Preoperative breast MRI for early-stage breast cancer: effect on surgical and long-term outcomes. AJR Am J Roentgenol 202:1376–1382. https://doi.org/10.2214/ajr.13.11355CrossRefPubMed

37.

Cho N, Moon WK, Han W, Park IA, Cho J, Noh DY (2009) Preoperative sonographic classification of axillary lymph nodes in patients with breast cancer: node-to-node correlation with surgical histology and sentinel node biopsy results. AJR Am J Roentgenol 193:1731–1737. https://doi.org/10.2214/ajr.09.3122CrossRefPubMed

38.

Valente SA, Levine GM, Silverstein MJ, Rayhanabad JA, Weng-Grumley JG, Ji L, Holmes DR, Sposto R, Sener SF (2012) Accuracy of predicting axillary lymph node positivity by physical examination, mammography, ultrasonography, and magnetic resonance imaging. Ann Surg Oncol 19:1825–1830. https://doi.org/10.1245/s10434-011-2200-7CrossRefPubMed

39.

Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJ, Mansel RE, Cataliotti L, Westenberg AH, Klinkenbijl JH, Orzalesi L, Bouma WH, van der Mijle HC, Nieuwenhuijzen GA, Veltkamp SC, Slaets L, Duez NJ, de Graaf PW, van Dalen T, Marinelli A, Rijna H, Snoj M, Bundred NJ, Merkus JW, Belkacemi Y, Petignat P, Schinagl DA, Coens C, Messina CG, Bogaerts J, Rutgers EJ (2014) Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981–22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol 15:1303–1310. https://doi.org/10.1016/s1470-2045(14)70460-7CrossRefPubMedPubMedCentral

40.

Bae MS, Shin SU, Song SE, Ryu HS, Han W, Moon WK (2018) Association between US features of primary tumor and axillary lymph node metastasis in patients with clinical T1–T2N0 breast cancer. Acta Radiol 59:402–408. https://doi.org/10.1177/0284185117723039CrossRefPubMed

41.

Concato J, Feinstein AR, Holford TR (1993) The risk of determining risk with multivariable models. Ann Intern Med 118:201–210. https://doi.org/10.7326/0003-4819-118-3-199302010-00009CrossRefPubMed

42.

Abe H, Schacht D, Sennett CA, Newstead GM, Schmidt RA (2013) Utility of preoperative ultrasound for predicting pN2 or higher stage axillary lymph node involvement in patients with newly diagnosed breast cancer. AJR Am J Roentgenol 200:696–702. https://doi.org/10.2214/ajr.12.9036CrossRefPubMed

43.

Sankaye P, Chhatani S, Porter G, Steel J, Doyle S (2014) Is axillary sonographic staging less accurate in invasive lobular breast cancer than in ductal breast cancer? J Ultrasound Med 33:1805–1810. https://doi.org/10.7863/ultra.33.10.1805CrossRefPubMed

44.

Cristofanilli M, Gonzalez-Angulo A, Sneige N, Kau SW, Broglio K, Theriault RL, Valero V, Buzdar AU, Kuerer H, Buchholz TA, Hortobagyi GN (2005) Invasive lobular carcinoma classic type: response to primary chemotherapy and survival outcomes. J Clin Oncol 23:41–48. https://doi.org/10.1200/jco.2005.03.111CrossRefPubMed

45.

Korkola JE, DeVries S, Fridlyand J, Hwang ES, Estep AL, Chen YY, Chew KL, Dairkee SH, Jensen RM, Waldman FM (2003) Differentiation of lobular versus ductal breast carcinomas by expression microarray analysis. Cancer Res 63:7167–7175PubMed

46.

ACR Guidelines and Standards Committee ACR practice guideline for the performance of contrast-enhanced magnetic resonance imaging (MRI) of the breast. http://www.acr.org. Accessed 4 May 2020

47.

Sardanelli F, Boetes C, Borisch B, Decker T, Federico M, Gilbert FJ, Helbich T, Heywang-Köbrunner SH, Kaiser WA, Kerin MJ, Mansel RE, Marotti L, Martincich L, Mauriac L, Meijers-Heijboer H, Orecchia R, Panizza P, Ponti A, Purushotham AD, Regitnig P, Del Turco MR, Thibault F, Wilson R (2010) Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group. Eur J Cancer 46:1296–1316. https://doi.org/10.1016/j.ejca.2010.02.015CrossRefPubMed

48.

Galimberti V, Cole BF, Zurrida S, Viale G, Luini A, Veronesi P, Baratella P, Chifu C, Sargenti M, Intra M, Gentilini O, Mastropasqua MG, Mazzarol G, Massarut S, Garbay JR, Zgajnar J, Galatius H, Recalcati A, Littlejohn D, Bamert M, Colleoni M, Price KN, Regan MM, Goldhirsch A, Coates AS, Gelber RD, Veronesi U (2013) Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23–01): a phase 3 randomised controlled trial. Lancet Oncol 14:297–305. https://doi.org/10.1016/S1470-2045(13)70035-4CrossRefPubMedPubMedCentral

Titel: Prediction of axillary nodal burden in patients with invasive lobular carcinoma using MRI
verfasst von: Su Min Ha
Jung Min Chang
Soo-Yeon Kim
Su Hyun Lee
Eun Sil Kim
Yeon Soo Kim
Nariya Cho
Woo Kyung Moon
Publikationsdatum: 03.01.2021
Verlag: Springer US
Erschienen in: Breast Cancer Research and Treatment / Ausgabe 2/2021
Print ISSN: 0167-6806
Elektronische ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-020-06056-9

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Prediction of axillary nodal burden in patients with invasive lobular carcinoma using MRI