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. 2017 May 31;17(1):389.
doi: 10.1186/s12885-017-3380-8.

An objective nodal staging system for breast cancer patients undergoing neoadjuvant systemic treatment

Tae-Kyung Yoo  1   2   3 , Jung Min Chang  4 , Hee-Chul Shin  5 , Wonshik Han  1   2 , Dong-Young Noh  1   2 , Hyeong-Gon Moon  6   7
Affiliations

An objective nodal staging system for breast cancer patients undergoing neoadjuvant systemic treatment

Tae-Kyung Yoo et al. BMC Cancer. .

Abstract

Background: In this study, we aimed to develop an objective staging system to determine the degree of nodal metastasis in breast cancer patients undergoing neoadjuvant systemic treatment (NST).

Methods: We reviewed the pretreatment computed tomography (CT) images of 392 breast cancer patients who received NST. The association between the patterns of the enlarged regional lymph nodes and treatment outcome was analyzed.

Results: In the development cohort of 260 patients, 88 (33.8%) patients experienced tumor recurrence and had a significantly higher number of enlarged lymph nodes on the pretreatment CT compared to patients with no recurrence. When patients were classified according to the numbers and locations of enlarged lymph nodes on pretreatment CT, the number of lymph nodes larger than 1 cm was most significantly associated with tumor recurrence. The accuracy of the CT-based nodal staging system was validated in an independent cohort of 132 patients. The presence of the enlarged supraclavicular nodes was associated with worse outcome, but the effect seemed to originate from the accompanied extensive axillary nodal burden. The prognostic effect of the objectively measured axillary nodal metastasis was more pronounced in hormone receptor-negative tumors.

Conclusions: We have developed and validated an objective method of nodal staging in breast cancer patients who undergo NST based on the number of enlarged axillary lymph nodes. Our system can improve the current subjective approach, which uses physical examination alone.

Keywords: Breast cancer; Chest CT; Neoadjuvant systemic therapy; Nodal staging.

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Figures

Fig. 1
Fig. 1
The representative CT images of the regional lymph node enlargements.Yellow arrows indicate the presence of the enlarged lymph nodes in axillary level I-III (a), a lymph node larger than 2cm in level I (b), enlarged supraclavicular lymph node (c), and an internal mammary node (d)
Fig. 2
Fig. 2
The survival outcome according to the nodal status. The overall disease-free survival in the development cohort of 262 patents (a). The number of CT-based enlarged lymph nodes according to the recurrence status (b). Various nodal enlargement classification method including 1cm-diameter (c), 2 cm-diameter (d), and node locations (e) are shown. The result of independent validation is shown in f
Fig. 3
Fig. 3
The prognostic importance of the extra-axillary lymph node enlargement. The disease-free survival according to the internal mammary node (IMN) enlargement and supraclavicular node (SCN) enlargement are shown in the Figure a and b, respectively. Patients were also stratified by the degree of axillary nodal enlargement
Fig. 4
Fig. 4
Prognostic significance of the CT-based nodal staging system and the pathologic N stages according to the hormonal receptor status. The prognostic significance of the CT-based nodal staging system in patients undergoing neoadjuvant systemic therapy (a) and the significance of the pathologic N stages in patients undergoing primary surgery (b)
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