Buscar en
Revista Española de Medicina Nuclear e Imagen Molecular (English Edition)
Toda la web
Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) Axillary pathologic response after neoadjuvant chemotherapy in locally advanced ...
Journal Information
Vol. 34. Issue 4.
Pages 230-235 (July - August 2015)
Share
Share
Download PDF
More article options
Visits
137
Vol. 34. Issue 4.
Pages 230-235 (July - August 2015)
Original Article
Axillary pathologic response after neoadjuvant chemotherapy in locally advanced breast cancer with axillary involvement
Respuesta patológica en la axila tras quimioterapia neoadyuvante en el cáncer de mama localmente avanzado con afectación axilar
Visits
137
A. Jiménez-Ballvéa,
Corresponding author
anajimenezb@hotmail.com

Corresponding author.
, A. Serrano-Palacioa, J.A. García-Sáenzb, A. Ortega Candila, O. Salsidua-Arroyoa, J.M. Román-Santamaríac, A. Pelayo Alarcónd, M.E. Fuentes Ferrere, J.L. Carreras-Delgadoa
a Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain
b Servicio de Oncología Médica, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain
c Servicio de Ginecología y Obstetricia, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain
d Servicio de Anatomía Patológica, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain
e Unidad de Gestión Clínica de Medicina Preventiva, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain
This item has received
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Tables (3)
Table 1. Clinical-pathological characteristics of the patients.
Table 2. Relationship between the metastatic axillary diagnostic method (N+) and final pathological axillary response.
Table 3. Relationship of final pathological response (tumoral and axillary) according to different histopathological criteria and the p values.
Show moreShow less
Abstract
Aim

To compare axillary involvement (N+) at initial staging in locally advanced breast cancer (LABC) with axillary lymphadenectomy histologic results after neoadjuvant chemotherapy treatment (NeoChemo).

Material and methods

Retrospective study between November 2011 and September 2013 of LABC cases treated with neoadjuvant chemotherapy based on docetaxel (associated with trastuzumab in HER2-positive cases and carboplatin/adriamycin in HER2-negative cases). Those clinically or radiologically suspected cases of axillary involvement were histologically confirmed. When there was no suspicion of axillary involvement, sentinel lymph node radioguided biopsy (SLNRB) was performed using intradermal injection of 99mTc-nanocolloid albumin prior to neoadjuvant treatment. Axillary lymphadenectomy after NeoChemo was undertaken in all cases with positive axilla. Final pathologic response was classified as complete (pCR) when there was no evidence of tumoral disease and as non-pathologic complete response (no pCR) in the opposite case.

Results

A total of 346 patients treated with docetaxel were reviewed, identifying 105 LABC. Axillary involvement at initial staging was detected in 70 (67%) before starting NeoChemo. From these 70, 73% (n=51) were N+ (fine needle biopsy and/or biopsy) and the remaining 19 (27%) were occult N+ detected by SLNRB. Axillary lymphadenectomy detected pCR in 56% (39/70), increasing up to 84% pCR when initial N+ status was reached using SNLB. On the other hand, when N+ was detected using fine needle biopsy/lymph biopsy, pCR was only 45%.

Conclusion

More than 50% of women affected by locally advanced breast cancer with tumoral axillary involvement at initial diagnosis present free metastatic axilla after therapeutic neoadjuvant chemotherapy effect. This increases up to almost 90% in case of occult metastatic axilla detected with sentinel node biopsy prior to starting neoadjuvant chemotherapy.

Keywords:
Locally advanced breast cancer
Neoadjuvant chemotherapy
Pathologic response
Axillary lymphadenectomy
Sentinel lymph node radioguided biopsy
Resumen
Objetivo

Comparar la afectación axilar (N+) al diagnóstico en el cáncer de mama localmente avanzado (CMLA), con el resultado histopatológico en la axila tras el tratamiento quimioterápico neoadyuvante (QTN).

Material y métodos

Estudio retrospectivo entre noviembre de 2011 y septiembre de 2013 de los CMLA tratadas con QTN basada en docetaxel (asociando trastuzumab en los casos HER2 positivos y carboplatino/adriamicina si HER2 negativos). Los casos con sospecha clínica/radiológica de N+ se confirmaron histológicamente. Si no existía sospecha, se estadificó con la técnica de biopsia radioguiada del ganglio centinela (BRGC), mediante la inyección de 99mTc-nanocoloide de albúmina, previa a la QTN. En los casos N+ se realizó linfadenectomía axilar (LA) tras QTN. Clasificamos la respuesta patológica final como completa (RCp) cuando no hubo evidencia de enfermedad tumoral y como no respuesta patológica (NRp) en caso contrario.

Resultados

Revisamos 346 pacientes tratados con docetaxel, donde identificamos 105 CMLA. En 70 (67%) se evidenció infiltración tumoral axilar antes de iniciar la QTN. De estas, el 73% (n=51) presentaban N+ por punción-aspiración con aguja fina (PAAF) y/o biopsia ganglionar, y las restantes 19 (27%) presentaban N+ oculta demostrada por la BRGC. La LA evidenció RCp axilar en el 56% (39/70); aumentando hasta un 84% cuando el estatus inicial N+ se alcanzó por BRGC, frente a un 45% cuando se llegó al diagnóstico de N+ por PAAF/biopsia ganglionar.

Conclusión

Más de la mitad de las mujeres con cáncer de mama localmente avanzado con afectación tumoral axilar al diagnóstico presentan axilas libres de enfermedad metastásica tras el efecto terapéutico de la quimioterapia neoadyuvante. Esto aumenta hasta casi el 90% cuando se trata de axilas metastásicas ocultas detectadas mediante el ganglio centinela antes de iniciar la quimioterapia neoadyuvante.

Palabras clave:
Cáncer de mama localmente avanzado
Quimioterapia neoadyuvante
Respuesta patológica
Linfadenectomía axilar
Biopsia radioguiada del ganglio centinela

Article

These are the options to access the full texts of the publication Revista Española de Medicina Nuclear e Imagen Molecular (English Edition)
Subscriber
Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”
Subscribe
Subscribe to

Revista Española de Medicina Nuclear e Imagen Molecular (English Edition)

Purchase
Purchase article

Purchasing article the PDF version will be downloaded

Price 19.34 €

Purchase now
Contact
Phone for subscriptions and reporting of errors
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
932 415 960
Calls from outside Spain
+34 932 415 960
E-mail
Article options
Tools
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos