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Axillary ultrasound for prediction of response to neoadjuvant therapy in the context of surgical strategies to axillary dissection in primary breast cancer: a systematic review of the current literature

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Abstract

Purpose

Data on the optimal treatment strategy for patients undergoing neoadjuvant therapy (NAT) who initially presented with metastatic nodes and convert to node-negative disease (cN+ → ycN0) are limited. Since NAT leads to axillary downstaging in 20–60% of patients, the question arises whether these patients might be offered less-invasive procedures than axillary dissection, such as sentinel node biopsy or targeted removal of lymph nodes marked before therapy.

Methods

We performed a systematic review of clinical studies on the use of axillary ultrasound for prediction of response to NAT and ultrasound-guided marking of metastatic nodes for targeted axillary dissection.

Results

The sensitivity of ultrasound for prediction of residual node metastasis was higher than that of clinical examination and MRI/PET in most studies; specificity ranged in large trials from 37 to 92%. The diagnostic performance of ultrasound after NAT seems to be associated with tumor subtype: the positive predictive value was highest in luminal, the negative in triple-negative tumors. Several trials evaluated the usefulness of ultrasound for targeted axillary dissection. Before NAT, nodes were most commonly marked using ultrasound-guided clip placement, followed by ultrasound-guided placement of a radioactive seed. After chemotherapy, the clip was detected on ultrasound in 72–83% of patients; a comparison of sonographic visibility of different clips is lacking. Detection rate after radioactive seed placement was ca. 97%.

Conclusion

In conclusion, ultrasound improves prediction of axillary response to treatment in comparison to physical examination and serves as a reliable guiding tool for marking of target lymph nodes before the start of treatment. High quality and standardization of the examination is crucial for selection of patients for less-invasive surgery.

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Funding

Not applicable, no funding received.

Author information

Author notes

  1. Malgorzata Banys-Paluchowski and Ines Verena Gruber contributed equally to this publication.

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Germany

    Malgorzata Banys-Paluchowski

  2. Department for Women’s Health, University of Tübingen, Tübingen, Germany

    Ines Verena Gruber, Andreas Hartkopf, Mario Marx, Sara Brucker & Markus Hahn

  3. Department of Gynecology and Obstetrics, Regio Klinikum Pinneberg, Pinneberg, Germany

    Peter Paluchowski

  4. Department of Obstetrics and Gynecology, University of Düsseldorf, Düsseldorf, Germany

    Natalia Krawczyk

  5. Department of Plastic, Reconstructive and Breast Surgery, Elblandklinikum Radebeul, Radebeul, Germany

    Mario Marx

Authors
  1. Malgorzata Banys-Paluchowski
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  2. Ines Verena Gruber
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  3. Andreas Hartkopf
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  4. Peter Paluchowski
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  5. Natalia Krawczyk
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  6. Mario Marx
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  7. Sara Brucker
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  8. Markus Hahn
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Contributions

MB-P: project development, data collection, data analysis, manuscript writing. IVG: data analysis, manuscript writing. AH: manuscript editing. PP: data collection, data analysis, manuscript writing. NK: data collection, data analysis, manuscript writing. MM: manuscript editing. SB: manuscript editing. MH: project development, data analysis, manuscript writing

Corresponding author

Correspondence to Malgorzata Banys-Paluchowski.

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Not applicable (review article), no human or animal participants involved.

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Banys-Paluchowski, M., Gruber, I.V., Hartkopf, A. et al. Axillary ultrasound for prediction of response to neoadjuvant therapy in the context of surgical strategies to axillary dissection in primary breast cancer: a systematic review of the current literature. Arch Gynecol Obstet 301, 341–353 (2020). https://doi.org/10.1007/s00404-019-05428-x

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  • DOI: https://doi.org/10.1007/s00404-019-05428-x

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