Selective Axillary Dissection after Neoadjuvant Chemotherapy in Patients with Lymph-Node-Positive Breast Cancer (CLYP Study): The Radio-Guided Occult Lesion Localization Technique for Biopsy-Proven Metastatic Lymph Nodes
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Pathological Evaluation
2.3. Statistical Analysis
3. Results
3.1. CLN and SLNs and the Prediction of the Nodal Status
3.2. Factors Contributing to Prediction of Nodal Status for CLN and SLNs
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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N° of Patients | 72 |
Mean age, years | 51.4 (28–76) |
Largest tumor diameter on MRI (mm) | 38.3 (12–93) |
Histologic finding | |
Invasive ductal carcinoma | 58/72 (80.6%) |
Invasive lobular carcinoma | 9/72 (12.5%) |
Other invasive carcinoma | 5/72 (6.9%) |
Stage at diagnosis | |
II | 34/72 (47.2%) |
III | 38/72 (72.8%) |
IV | 0/72 (0.0%) |
Phenotype | |
HR-negative/HER2-negative | 17/72 (23.6%) |
HR-positive/HER2-positive | 12/72 (16.7%) |
HR-negative/HER2-positive | 8/72 (11.1%) |
HR-positive/HER2-positive | 35/72 (48.6%) |
Histologic grade | |
Grade I | 3/72 (4.2%) |
Grade II | 30/72 (41.7%) |
Grade III | 39/72 (54.1%) |
Type of surgery | |
Breast-conserving surgery | 39/72 (54.2%) |
Mastectomy | 33/72 (45.8%) |
Neoadjuvant chemotherapy regimen | |
Anthracycline plus taxane | 26/72 (36.1%) |
Anthracycline plus taxane plus anti-HER2 | 43/72 (59.7%) |
Endocrine therapy | 3/72 (4.2%) |
Identification Technique | Identified | Not Identified | Detection Rate (%) |
---|---|---|---|
Blue-dye | 66 | 6 | 91.7 |
ROLL | 70 | 2 | 97.2 |
Blue dye + ROLL | 71 | 1 | 98.6 |
ALND Outcome | |||
---|---|---|---|
Residual Disease (n = 32) | No Residual Disease (n = 28) | False Negative Rate (%) | |
SLN | |||
Positive | 25 | 0 | |
Negative | 6 | 24 | |
Not colored | 1 | 4 | |
6/31 (19.35%) | |||
CLN | |||
Positive | 31 | 0 | |
Negative | 1 | 26 | |
Not identified by ROLL | 0 | 2 | |
1/32 (3.13%) | |||
SNL and CLN | |||
SLN-positive/CLN-positive | 25 | 0 | |
SLN-negative/CLN-positive | 5 | 0 | |
SLN-positive/CLN-negative | 0 | 0 | |
SLN-negative/CLN-negative | 1 | 22 | |
SLN not colored/CLN-positive | 1 | 0 | |
SLN not colored/CLN negative | 0 | 4 | |
SLN-negative/CLN not identified | 0 | 1 | |
SLN not colored/CLN not identified | 0 | 1 | |
1/32 (3.13%) |
Number of Abnormal Nodes on Initial Staging by US | ||||||
<4 Abnormal Nodes | ≥4 Abnormal Nodes | |||||
ALND Outcome | ALND Outcome | |||||
Residual Disease | No Residual Disease | FNR (%) | Residual Disease | No Residual Disease | FNR (%) | |
Outcome CLN | ||||||
Positive | 16 | 0 | 15 | 0 | ||
Negative | 1 | 18 | 0 | 10 | ||
1/17 (5.88%) | 0/15 (0%) | |||||
Outcome SLNs | ||||||
Positive | 11 | 0 | 14 | 0 | ||
Negative | 5 | 17 | 1 | 7 | ||
Not identified | 1 | 1 | 0 | 3 | ||
5/16 (31.25%) | 1/15 (6.67%) | |||||
Ultrasound Evaluation after NACT | ||||||
Normal Lymph Node Status | Suspicious Nodal Status | |||||
Outcome ALND | Outcome ALND | |||||
Residual Disease | No Residual Disease | FNR (%) | Residual Disease | No Residual Disease | FNR (%) | |
Outcome CLN | ||||||
Positive | 10 | 0 | 21 | 0 | ||
Negative | 1 | 24 | 0 | 4 | ||
1/11 (9.09%) | 0/21 (0%) | |||||
Outcome SLNs | ||||||
Positive | 7 | 0 | 18 | 0 | ||
Negative | 3 | 21 | 3 | 3 | ||
Not identified | 1 | 3 | 0 | 1 | ||
3/10 (30.0%) | 3/21 (14.29%) |
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Rella, R.; Conti, M.; Bufi, E.; Trombadori, C.M.L.; Di Leone, A.; Terribile, D.; Masetti, R.; Zagaria, L.; Mulè, A.; Morciano, F.; et al. Selective Axillary Dissection after Neoadjuvant Chemotherapy in Patients with Lymph-Node-Positive Breast Cancer (CLYP Study): The Radio-Guided Occult Lesion Localization Technique for Biopsy-Proven Metastatic Lymph Nodes. Cancers 2023, 15, 2046. https://doi.org/10.3390/cancers15072046
Rella R, Conti M, Bufi E, Trombadori CML, Di Leone A, Terribile D, Masetti R, Zagaria L, Mulè A, Morciano F, et al. Selective Axillary Dissection after Neoadjuvant Chemotherapy in Patients with Lymph-Node-Positive Breast Cancer (CLYP Study): The Radio-Guided Occult Lesion Localization Technique for Biopsy-Proven Metastatic Lymph Nodes. Cancers. 2023; 15(7):2046. https://doi.org/10.3390/cancers15072046
Chicago/Turabian StyleRella, Rossella, Marco Conti, Enida Bufi, Charlotte Marguerite Lucille Trombadori, Alba Di Leone, Daniela Terribile, Riccardo Masetti, Luca Zagaria, Antonino Mulè, Francesca Morciano, and et al. 2023. "Selective Axillary Dissection after Neoadjuvant Chemotherapy in Patients with Lymph-Node-Positive Breast Cancer (CLYP Study): The Radio-Guided Occult Lesion Localization Technique for Biopsy-Proven Metastatic Lymph Nodes" Cancers 15, no. 7: 2046. https://doi.org/10.3390/cancers15072046