Is Routine Axillary Imaging Necessary in Clinically Node-Negative Patients Undergoing Neoadjuvant Chemotherapy?

Area of Science:

• Oncology
• Radiology
• Breast Cancer Management

Background:

• National Comprehensive Cancer Network guidelines suggest axillary imaging before neoadjuvant chemotherapy (NAC) for clinically node-negative (cN0) breast cancer patients.
• The clinical utility of pre-NAC axillary imaging in cN0 patients remains uncertain.

Purpose of the Study:

• To evaluate if abnormal axillary imaging before NAC can predict nodal metastases after NAC (ypN+) in cN0 breast cancer patients.

Main Methods:

• A retrospective review of 402 cN0 breast cancer patients who underwent NAC followed by axillary surgery.
• Comparison of ypN+ rates between patients with abnormal pre-NAC axillary imaging and those with normal or no imaging using Fisher's exact test.

Main Results:

• Of 402 cN0 patients, 52% had abnormal axillary imaging pre-NAC. Overall, 28% were ypN+ post-NAC.
• Patients with abnormal pre-NAC imaging had a significantly higher incidence of ypN+ (p=0.001).
• However, 54% of those with abnormal imaging did not require axillary lymph node dissection (ALND) post-NAC, and 20% of patients with normal pre-NAC imaging were ypN+.

Conclusions:

• Pre-NAC axillary imaging in cN0 patients does not reliably predict the need for post-NAC axillary surgery.
• A significant proportion of patients with abnormal imaging avoided ALND, and some with normal imaging had nodal disease, questioning the clinical utility of this imaging approach.