Is clinical exam of the axilla sufficient to select node-positive patients who downstage after NAC for SLNB? A comparison of the accuracy of clinical exam versus MRI Journal Article


Authors: Moo, T. A.; Jochelson, M. S.; Zabor, E. C.; Stempel, M.; Raiss, M.; Mamtani, A.; Tadros, A. B.; El-Tamer, M.; Morrow, M.
Article Title: Is clinical exam of the axilla sufficient to select node-positive patients who downstage after NAC for SLNB? A comparison of the accuracy of clinical exam versus MRI
Abstract: Background: The National Comprehensive Cancer Network (NCCN) endorses sentinel lymph node biopsy (SLNB) in patients with clinically positive axillary nodes who downstage after neoadjuvant chemotherapy (NAC). In this study, we compared the accuracy of post-NAC MRI to clinical exam alone in predicting pathologic status of sentinel lymph nodes in cN1 patients. Methods: We identified patients with T0-3, N1 breast cancer who underwent NAC and subsequent SLNB from March 2014 to July 2017. Patients were grouped based on whether a post-NAC MRI was done. MRI accuracy in predicting SLN status was assessed versus clinical exam alone. Results: A total of 450 patients met initial study criteria; 269 were analyzed after excluding patients without biopsy-confirmed nodal disease, palpable disease after NAC, and failed SLN mapping. Median age was 49 years. Post-NAC MRI was done in 68% (182/269). Patients undergoing lumpectomy vs mastectomy more frequently received a post-NAC MRI (88 vs 54%, p < 0.001). All other clinicopathologic parameters were comparable between those who did and did not have a post-NAC MRI. Thirty percent (55/182) had abnormal lymph nodes on MRI. Among these, 58% (32/55) had a positive SLN on final pathology versus 42% (53/127) of patients with no abnormal lymph nodes on MRI and 52% (45/87) of patients who had clinical exam alone (p = 0.09). MRI sensitivity was 38%, specificity was 76%, and overall SLN status prediction accuracy was 58%. Conclusions: Post-NAC MRI is no more accurate than clinical exam alone in predicting SLN pathology in patients presenting with cN1 disease. Abnormal lymph nodes on MRI should not preclude SLNB. © 2019, Society of Surgical Oncology.
Journal Title: Annals of Surgical Oncology
Volume: 26
Issue: 13
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2019-12-01
Start Page: 4238
End Page: 4243
Language: English
DOI: 10.1245/s10434-019-07867-x
PUBMED: 31583546
PROVIDER: scopus
PMCID: PMC6868340
DOI/URL:
Notes: Source: Scopus
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MSK Authors
  1. Monica Morrow
    496 Morrow
  2. Emily Craig Zabor
    156 Zabor
  3. Michelle Moccio Stempel
    147 Stempel
  4. Tracy-Ann Moo
    29 Moo
  5. Anita   Mamtani
    24 Mamtani
  6. Monica E Raiss
    6 Raiss
  7. Audree Blythe Tadros
    11 Tadros