Axillary staging prior to neoadjuvant chemotherapy for breast cancer: Predictors of recurrence

Kandice Ludwig, M. Catherine Lee, Alexis V. Nees, Vincent M. Cimmino, Kathleen M. Diehl, Michael S. Sabel, Daniel F. Hayes, Anne F. Schott, Celina G. Kleer, Alfred E. Chang, Lisa A. Newman

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background: The value of axillary staging prior to delivery of neoadjuvant chemotherapy (NEO) for breast cancer is controversial. Our goal was to analyze the prognostic and therapeutic impact of axillary staging on recurrence. Methods: The study cohort included 161 patients undergoing comprehensive evaluation by a multidisciplinary approach during the period 1996-2006. Clinicopathologic features were assessed before and after delivery of NEO. Patients with node-positive disease before NEO underwent a post-NEO axillary lymph node dissection at time of definitive breast surgery. Results: At presentation, median age was 49 years; mean tumor size was 45 mm. The axilla was negative in 45 (28.6%) patients. Of the 114 pre-NEO node-positive patients, 65 (57%) were staged histologically. At completion of NEO, partial or complete clinical response was observed in 90.6%; complete pathologic response occurred in 23.6%. Mean residual tumor size was 10.5 mm. Of the 112 initially node-positive patients, 36 (31.6%) had no residual axillary disease post NEO. At median follow-up of 38.1 months, 21.7% patients relapsed. The pre-NEO nodal status was the strongest predictor of treatment failure. A significant risk of distant relapse was based on nodal response to NEO: 8.1% in node-negative patients, 13.9% in the downstaged group, and 22.1% in the persistently positive group (P = 0.047). Delivery of nodal irradiation decreased local recurrence in the downstaged group (12.5% versus 3.7%, P = NS). Conclusion: Our experience suggests that comprehensive axillary staging with ultrasound and fine-needle aspiration (FNA) and sentinel lymph node biopsy prior to NEO is both prognostically and therapeutically important in predicting those patients at higher risk of recurrence.

Original languageEnglish (US)
Pages (from-to)3252-3258
Number of pages7
JournalAnnals of Surgical Oncology
Volume15
Issue number11
DOIs
StatePublished - Nov 2008
Externally publishedYes

Fingerprint

Breast Neoplasms
Recurrence
Drug Therapy
Sentinel Lymph Node Biopsy
Axilla
Residual Neoplasm
Fine Needle Biopsy
Lymph Node Excision
Treatment Failure
Breast
Cohort Studies
Neoplasms

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Ludwig, K., Lee, M. C., Nees, A. V., Cimmino, V. M., Diehl, K. M., Sabel, M. S., ... Newman, L. A. (2008). Axillary staging prior to neoadjuvant chemotherapy for breast cancer: Predictors of recurrence. Annals of Surgical Oncology, 15(11), 3252-3258. https://doi.org/10.1245/s10434-008-0136-3

Axillary staging prior to neoadjuvant chemotherapy for breast cancer : Predictors of recurrence. / Ludwig, Kandice; Lee, M. Catherine; Nees, Alexis V.; Cimmino, Vincent M.; Diehl, Kathleen M.; Sabel, Michael S.; Hayes, Daniel F.; Schott, Anne F.; Kleer, Celina G.; Chang, Alfred E.; Newman, Lisa A.

In: Annals of Surgical Oncology, Vol. 15, No. 11, 11.2008, p. 3252-3258.

Research output: Contribution to journalArticle

Ludwig, K, Lee, MC, Nees, AV, Cimmino, VM, Diehl, KM, Sabel, MS, Hayes, DF, Schott, AF, Kleer, CG, Chang, AE & Newman, LA 2008, 'Axillary staging prior to neoadjuvant chemotherapy for breast cancer: Predictors of recurrence', Annals of Surgical Oncology, vol. 15, no. 11, pp. 3252-3258. https://doi.org/10.1245/s10434-008-0136-3
Ludwig, Kandice ; Lee, M. Catherine ; Nees, Alexis V. ; Cimmino, Vincent M. ; Diehl, Kathleen M. ; Sabel, Michael S. ; Hayes, Daniel F. ; Schott, Anne F. ; Kleer, Celina G. ; Chang, Alfred E. ; Newman, Lisa A. / Axillary staging prior to neoadjuvant chemotherapy for breast cancer : Predictors of recurrence. In: Annals of Surgical Oncology. 2008 ; Vol. 15, No. 11. pp. 3252-3258.
@article{8c986cb2ba4847fcbb87f22a096771bd,
title = "Axillary staging prior to neoadjuvant chemotherapy for breast cancer: Predictors of recurrence",
abstract = "Background: The value of axillary staging prior to delivery of neoadjuvant chemotherapy (NEO) for breast cancer is controversial. Our goal was to analyze the prognostic and therapeutic impact of axillary staging on recurrence. Methods: The study cohort included 161 patients undergoing comprehensive evaluation by a multidisciplinary approach during the period 1996-2006. Clinicopathologic features were assessed before and after delivery of NEO. Patients with node-positive disease before NEO underwent a post-NEO axillary lymph node dissection at time of definitive breast surgery. Results: At presentation, median age was 49 years; mean tumor size was 45 mm. The axilla was negative in 45 (28.6{\%}) patients. Of the 114 pre-NEO node-positive patients, 65 (57{\%}) were staged histologically. At completion of NEO, partial or complete clinical response was observed in 90.6{\%}; complete pathologic response occurred in 23.6{\%}. Mean residual tumor size was 10.5 mm. Of the 112 initially node-positive patients, 36 (31.6{\%}) had no residual axillary disease post NEO. At median follow-up of 38.1 months, 21.7{\%} patients relapsed. The pre-NEO nodal status was the strongest predictor of treatment failure. A significant risk of distant relapse was based on nodal response to NEO: 8.1{\%} in node-negative patients, 13.9{\%} in the downstaged group, and 22.1{\%} in the persistently positive group (P = 0.047). Delivery of nodal irradiation decreased local recurrence in the downstaged group (12.5{\%} versus 3.7{\%}, P = NS). Conclusion: Our experience suggests that comprehensive axillary staging with ultrasound and fine-needle aspiration (FNA) and sentinel lymph node biopsy prior to NEO is both prognostically and therapeutically important in predicting those patients at higher risk of recurrence.",
author = "Kandice Ludwig and Lee, {M. Catherine} and Nees, {Alexis V.} and Cimmino, {Vincent M.} and Diehl, {Kathleen M.} and Sabel, {Michael S.} and Hayes, {Daniel F.} and Schott, {Anne F.} and Kleer, {Celina G.} and Chang, {Alfred E.} and Newman, {Lisa A.}",
year = "2008",
month = "11",
doi = "10.1245/s10434-008-0136-3",
language = "English (US)",
volume = "15",
pages = "3252--3258",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
publisher = "Springer New York",
number = "11",

}

TY - JOUR

T1 - Axillary staging prior to neoadjuvant chemotherapy for breast cancer

T2 - Predictors of recurrence

AU - Ludwig, Kandice

AU - Lee, M. Catherine

AU - Nees, Alexis V.

AU - Cimmino, Vincent M.

AU - Diehl, Kathleen M.

AU - Sabel, Michael S.

AU - Hayes, Daniel F.

AU - Schott, Anne F.

AU - Kleer, Celina G.

AU - Chang, Alfred E.

AU - Newman, Lisa A.

PY - 2008/11

Y1 - 2008/11

N2 - Background: The value of axillary staging prior to delivery of neoadjuvant chemotherapy (NEO) for breast cancer is controversial. Our goal was to analyze the prognostic and therapeutic impact of axillary staging on recurrence. Methods: The study cohort included 161 patients undergoing comprehensive evaluation by a multidisciplinary approach during the period 1996-2006. Clinicopathologic features were assessed before and after delivery of NEO. Patients with node-positive disease before NEO underwent a post-NEO axillary lymph node dissection at time of definitive breast surgery. Results: At presentation, median age was 49 years; mean tumor size was 45 mm. The axilla was negative in 45 (28.6%) patients. Of the 114 pre-NEO node-positive patients, 65 (57%) were staged histologically. At completion of NEO, partial or complete clinical response was observed in 90.6%; complete pathologic response occurred in 23.6%. Mean residual tumor size was 10.5 mm. Of the 112 initially node-positive patients, 36 (31.6%) had no residual axillary disease post NEO. At median follow-up of 38.1 months, 21.7% patients relapsed. The pre-NEO nodal status was the strongest predictor of treatment failure. A significant risk of distant relapse was based on nodal response to NEO: 8.1% in node-negative patients, 13.9% in the downstaged group, and 22.1% in the persistently positive group (P = 0.047). Delivery of nodal irradiation decreased local recurrence in the downstaged group (12.5% versus 3.7%, P = NS). Conclusion: Our experience suggests that comprehensive axillary staging with ultrasound and fine-needle aspiration (FNA) and sentinel lymph node biopsy prior to NEO is both prognostically and therapeutically important in predicting those patients at higher risk of recurrence.

AB - Background: The value of axillary staging prior to delivery of neoadjuvant chemotherapy (NEO) for breast cancer is controversial. Our goal was to analyze the prognostic and therapeutic impact of axillary staging on recurrence. Methods: The study cohort included 161 patients undergoing comprehensive evaluation by a multidisciplinary approach during the period 1996-2006. Clinicopathologic features were assessed before and after delivery of NEO. Patients with node-positive disease before NEO underwent a post-NEO axillary lymph node dissection at time of definitive breast surgery. Results: At presentation, median age was 49 years; mean tumor size was 45 mm. The axilla was negative in 45 (28.6%) patients. Of the 114 pre-NEO node-positive patients, 65 (57%) were staged histologically. At completion of NEO, partial or complete clinical response was observed in 90.6%; complete pathologic response occurred in 23.6%. Mean residual tumor size was 10.5 mm. Of the 112 initially node-positive patients, 36 (31.6%) had no residual axillary disease post NEO. At median follow-up of 38.1 months, 21.7% patients relapsed. The pre-NEO nodal status was the strongest predictor of treatment failure. A significant risk of distant relapse was based on nodal response to NEO: 8.1% in node-negative patients, 13.9% in the downstaged group, and 22.1% in the persistently positive group (P = 0.047). Delivery of nodal irradiation decreased local recurrence in the downstaged group (12.5% versus 3.7%, P = NS). Conclusion: Our experience suggests that comprehensive axillary staging with ultrasound and fine-needle aspiration (FNA) and sentinel lymph node biopsy prior to NEO is both prognostically and therapeutically important in predicting those patients at higher risk of recurrence.

UR - http://www.scopus.com/inward/record.url?scp=55149114863&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=55149114863&partnerID=8YFLogxK

U2 - 10.1245/s10434-008-0136-3

DO - 10.1245/s10434-008-0136-3

M3 - Article

C2 - 18784961

AN - SCOPUS:55149114863

VL - 15

SP - 3252

EP - 3258

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

IS - 11

ER -