Diagnostic Performance of Noninvasive Imaging for Assessment of Axillary Response After Neoadjuvant Systemic Therapy in Clinically Node-positive Breast Cancer: A Systematic Review and Meta-analysis

S. Samiei*, C.M. de Mooij, M.B.I. Lobbes, K.B.M.I. Keymeulen, T.J.A. van Nijnatten, M.L. Smidt

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

11 Citations (Web of Science)

Abstract

Objective: The purpose of this study was to perform a systematic review and meta-analysis to determine the diagnostic performance of current noninvasive imaging modalities for assessment of axillary response after neoadjuvant systemic therapy (NST) in clinically node-positive breast cancer patients. Summary of Background Data: NST can lead to downstaging of axillary lymph node disease. Imaging can potentially provide information about the axillary response to NST and, consequently, tailor the surgical management. Methods: PubMed and Embase were searched for studies that compared noninvasive imaging after NST with axillary surgery outcome to identify axillary response in patients with initial pathologically proven axillary lymph node metastasis. Two reviewers independently screened the studies and extracted the data. A meta-analysis was performed by computing the pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: Thirteen studies describing 2380 patients were included for final analysis. Of these patients, 1322 had undergone axillary ultrasound, 849 breast MRI, and 209 whole-body F-18-FDG PET-CT. The overall axillary pathologic complete response rate was 39.5% (941/2380). For axillary ultrasound, the pooled sensitivity, specificity, PPV, and NPV were 65%, 69%, 77%, 50%, respectively. For breast MRI, the pooled sensitivity, specificity, PPV, and NPV were 60%, 76%, 78%, 58%, respectively. For whole-body F-18-FDG PET-CT, the pooled sensitivity, specificity, PPV, and NPV were 38%, 86%, 78%, 49%, respectively. Conclusions: The diagnostic performance of current noninvasive imaging modalities is limited to accurately assess axillary response after NST in clinically node-positive breast cancer patients.
Original languageEnglish
Pages (from-to)694-700
Number of pages7
JournalAnnals of Surgery
Volume273
Issue number4
DOIs
Publication statusPublished - 1 Apr 2021

Keywords

  • axillary response
  • breast cancer
  • imaging
  • neoadjuvant systemic therapy
  • node-positive
  • PATHOLOGICAL COMPLETE RESPONSE
  • PREOPERATIVE CHEMOTHERAPY
  • F-18-FDG PET/CT
  • ULTRASOUND
  • MRI
  • DISEASE
  • METASTASES
  • PREDICTION
  • MANAGEMENT
  • BIOPSY

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