Related Experiment Video
Updated: Aug 6, 2026
03:07
Single-Port Robotic-assisted Transaxillary Breast-conserving Surgery: A Prospective, Single-arm, Non-randomized Phase IIa Clinical Trial
Published on: August 19, 2025
Preoperative Radiologic Assessment of the Axilla in Locally Advanced Breast Cancer After Neoadjuvant Systemic
Andrew Seto1,2, Elisa Port3,4, Stephanie Bernik3,4
1Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA. andrew.seto.md@gmail.com.
Annals of Surgical Oncology
|July 19, 2026
Summary
Ultrasound and PET/CT show promise in assessing axillary response after neoadjuvant systemic therapy (NST) for locally advanced breast cancer (LABC). However, imaging results should not replace surgical staging for accurate treatment evaluation.
Area of Science:
- Oncology
- Radiology
- Breast Cancer Imaging
Background:
- Limited studies compare imaging modalities for axillary response after neoadjuvant systemic therapy (NST) in locally advanced breast cancer (LABC).
- Accurate assessment of residual lymphadenopathy post-NST is crucial for treatment stratification in LABC patients.
Purpose of the Study:
- To evaluate the efficacy of ultrasound (US), MRI, and PET/CT in identifying residual axillary lymphadenopathy after NST in LABC.
- To analyze factors associated with radiologic-pathologic concordance in predicting treatment response.
Main Methods:
- Retrospective review of 101 LABC patients (T3-4, N1-3 or any T with N2-3) who underwent NST and surgical axillary staging (2018-2023).
- Analysis of US, MRI, and PET/CT performance in detecting residual nodal disease.
- Investigation of variables linked to concordance between imaging-based complete imaging response (CIR) and pathologic complete response (pCR).
Main Results:
- Ultrasound demonstrated the highest sensitivity (71%) and positive predictive value (76%).
- PET/CT exhibited the highest specificity (73%) and negative predictive value (70%).
- MRI showed the lowest diagnostic performance across all metrics. Pretreatment nodal status (cN3 vs. cN1) and absence of lymphovascular invasion significantly correlated with CIR-pCR concordance.
Conclusions:
- Post-NST imaging offers valuable insights into treatment response in LABC, with varying performance among modalities.
- Complete imaging response (CIR) should not replace surgical axillary evaluation due to potential discordance with pathologic outcomes.
- Further research is warranted on the relationship between pretreatment nodal status and radiologic-pathologic response in LABC patients undergoing NST.
