Axillary ultrasound for prediction of response to neoadjuvant therapy in the context of surgical strategies to axillary dissection in primary breast cancer: a systematic review of the current literature.

Autor: Banys-Paluchowski M; Department of Gynecology and Obstetrics, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Germany. m.banys@outlook.com., Gruber IV; Department for Women's Health, University of Tübingen, Tübingen, Germany., Hartkopf A; Department for Women's Health, University of Tübingen, Tübingen, Germany., Paluchowski P; Department of Gynecology and Obstetrics, Regio Klinikum Pinneberg, Pinneberg, Germany., Krawczyk N; Department of Obstetrics and Gynecology, University of Düsseldorf, Düsseldorf, Germany., Marx M; Department for Women's Health, University of Tübingen, Tübingen, Germany.; Department of Plastic, Reconstructive and Breast Surgery, Elblandklinikum Radebeul, Radebeul, Germany., Brucker S; Department for Women's Health, University of Tübingen, Tübingen, Germany., Hahn M; Department for Women's Health, University of Tübingen, Tübingen, Germany.
Jazyk: angličtina
Zdroj: Archives of gynecology and obstetrics [Arch Gynecol Obstet] 2020 Feb; Vol. 301 (2), pp. 341-353. Date of Electronic Publication: 2020 Jan 02.
DOI: 10.1007/s00404-019-05428-x
Abstrakt: Purpose: Data on the optimal treatment strategy for patients undergoing neoadjuvant therapy (NAT) who initially presented with metastatic nodes and convert to node-negative disease (cN+ → ycN0) are limited. Since NAT leads to axillary downstaging in 20-60% of patients, the question arises whether these patients might be offered less-invasive procedures than axillary dissection, such as sentinel node biopsy or targeted removal of lymph nodes marked before therapy.
Methods: We performed a systematic review of clinical studies on the use of axillary ultrasound for prediction of response to NAT and ultrasound-guided marking of metastatic nodes for targeted axillary dissection.
Results: The sensitivity of ultrasound for prediction of residual node metastasis was higher than that of clinical examination and MRI/PET in most studies; specificity ranged in large trials from 37 to 92%. The diagnostic performance of ultrasound after NAT seems to be associated with tumor subtype: the positive predictive value was highest in luminal, the negative in triple-negative tumors. Several trials evaluated the usefulness of ultrasound for targeted axillary dissection. Before NAT, nodes were most commonly marked using ultrasound-guided clip placement, followed by ultrasound-guided placement of a radioactive seed. After chemotherapy, the clip was detected on ultrasound in 72-83% of patients; a comparison of sonographic visibility of different clips is lacking. Detection rate after radioactive seed placement was ca. 97%.
Conclusion: In conclusion, ultrasound improves prediction of axillary response to treatment in comparison to physical examination and serves as a reliable guiding tool for marking of target lymph nodes before the start of treatment. High quality and standardization of the examination is crucial for selection of patients for less-invasive surgery.
Databáze: MEDLINE
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