Enhanced axillary assessment using intradermally injected microbubbles and contrast-enhanced ultrasound (CEUS) before ne
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CLINICAL TRIAL
Enhanced axillary assessment using intradermally injected microbubbles and contrast‑enhanced ultrasound (CEUS) before neoadjuvant systemic therapy (NACT) identifies axillary disease missed by conventional B‑mode ultrasound that may be clinically relevant Karina Cox1 · Nicky Dineen1 · Sian Taylor‑Phillips2 · Nisha Sharma3 · Catherine Harper‑Wynne4 · Deborah Allen1 · Jennifer Weeks1 · Ritchie Chalmers1 · Deepika Akolekar1 · Russell Burcombe4 · Rema Jyothirmayi4 · Ali Sever5 Received: 24 July 2020 / Accepted: 28 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose The purpose of this study is to measure pre-treatment diagnostic yield of malignant lymph nodes (LN) using contrast-enhanced ultrasound (CEUS) in addition to B-mode axillary ultrasound and compare clinicopathological features, response to NACT and long-term outcomes of patients with malignant LN detected with B-mode ultrasound versus CEUS. Methods Between August 2009 and October 2016, NACT patients were identified from a prospective database. Follow-up data were collected until May 2019. Results 288 consecutive NACT patients were identified; 77 were excluded, 110 had malignant LN identified by B-mode ultrasound (Group A) and 101 patients with negative B-mode axillary ultrasound had CEUS with biopsy of sentinel lymph nodes (SLN). In two cases CEUS failed. Malignant SLN were identified in 35/99 (35%) of B-mode ultrasound-negative cases (Group B). Patients in Group A were similar to those in Group B in age, mean diagnostic tumour size, grade and oestrogen receptor status. More Group A patients had a ductal phenotype. In the breast, 34 (31%) Group A patients and 8 (23%) Group B patients achieved a pathological complete response (PCR). In the axilla, 41 (37%) and 13 (37%) Groups A and B patients, respectively, had LN PCR. The systemic relapse rate was not statistically different (5% and 16% for Groups A and B, respectively). Conclusions Enhanced assessment with CEUS before NACT identifies patients with axillary metastases missed by conventional B-mode ultrasound. Without CEUS, 22 (63%) of cases in Group B (negative B-mode ultrasound) may have been erroneously classed as progressive disease by surgical SLN excision after NACT. Keywords Neoadjuvant systemic therapy · Axilla · B-mode ultrasound · Contrast-enhanced ultrasound · Lymph node metastases · Axillary imaging · Sentinel lymph nodes
The abstract of this study has been accepted for poster presentation at the virtual European Breast Cancer Conference (EBCC-12) in October 2020. * Karina Cox [email protected] 1
Peggy Wood Breast Unit, Maidstone Hospital, Hermitage Lane, Maidstone, Kent ME16 9QQ, UK
WMS‑Population Evidence and Technologies, University of Warwick, Coventry CV4 7AL, UK
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Leeds Breast Unit, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK
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Kent Oncology Centre, Maidstone Hospital, Hermitage Lane, Maidstone, Kent ME16 9QQ, UK
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Guy’s Breast Unit, Great Maze Pond, London SE1 9RT, UK
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