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September 1, 2007

Predicting Nodal Status Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Patients With Locally Advanced Breast Cancer Undergoing Neoadjuvant Chemotherapy With and Without Sequential Trastuzumab

Author Affiliations

Author Affiliations: Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange.

Arch Surg. 2007;142(9):855-861. doi:10.1001/archsurg.142.9.855

Hypothesis  Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) is a reliable and accurate method for monitoring primary tumor response in the breast and can be used as a surrogate to predict final axillary nodal status.

Design  Retrospective study (October 1, 2004, through February 28, 2006) of 46 patients with clinically staged locally advanced breast cancer.

Setting  Comprehensive cancer center.

Patients  Forty-six patients with locally advanced breast cancer.

Interventions  Neoadjuvant chemotherapy (NAC), DCE-MRI, mastectomy and lumpectomy, and axillary lymph node dissection.

Main Outcome Measures  The DCE-MRI results and pathologic response of the breast and axillary lymph nodes.

Results  Forty-six patients underwent NAC with doxorubicin hydrochloride and cyclophosphamide, followed by paclitaxel and carboplatin, with or without trastuzumab based on human epidermal growth factor receptor 2 (HER2/neu) status. Twenty-one patients (46%) had a complete pathologic response. For the HER2/neu-positive patients, the complete pathologic response rate was 70% (14/20). The accuracy, sensitivity, and specificity of the primary tumor response in predicting the axillary nodal status were 78%, 88%, and 72%, respectively. The accuracy, sensitivity, and specificity of the DCE-MRI–measured response in the primary tumor in predicting axillary nodal status were 74%, 62%, and 82%, respectively. For the HER2/neu-positive patients, the accuracy, sensitivity, and specificity improved to 80%, 75%, and 82%, respectively.

Conclusions  The results of DCE-MRI of the primary tumor can be predictive of axillary nodal status, especially in patients receiving trastuzumab who are HER2/neu positive. The HER2/neu-positive patients with a complete clinical response on DCE-MRI are highly unlikely to benefit from an axillary lymph node dissection. For HER2/neu-negative patients, sentinel lymph node sampling is warranted.