Use of Pretreatment Breast MRI to Predict Failed Sentinel Lymph Node Identification after Neoadjuvant Chemotherapy
Menée à partir de données portant sur 276 patientes atteintes d'un cancer du sein et ayant subi entre 2015 et 2019 une biopsie du ganglion sentinelle après une chimiothérapie néoadjuvante (âge moyen : 48 ans), cette étude met en évidence une association entre le nombre de ganglions axillaires suspects déterminé par IRM mammaire avant le traitement et l'échec de l'identification du ganglion sentinelle après la chimiothérapie néoadjuvante
The presence of axillary lymph node (ALN) metastases in primary breast cancer is an important prognostic factor for long-term outcome that is used to guide local-regional and systemic treatment. Patients with breast cancer presenting with nodal metastases are candidates to receive neoadjuvant chemotherapy (NAC), which can eradicate nodal disease in 40%–75% of patients and can play an increasingly key role in the management of locally advanced breast cancer. ALN dissection has been traditionally performed to assess ALN status; however, not all patients should undergo this invasive procedure. Its use has been controversial. ALN dissection is associated with a substantial incidence of comorbidities such as lymphedema, arm pain, nerve damage, and reduced shoulder mobility after surgery (1). Yet, for most patients with biopsy-proven node-positive breast cancer who receive NAC, ALN dissection is recommended regardless of their response to treatment. However, 22%–35% of these patients will have no residual disease in the axilla after NAC (2); therefore, ALN has been progressively replaced by sentinel lymph node biopsy for accurate axillary staging.
Radiology , commentaire, 2019