Disease extent according to baseline [18F]fluorodeoxyglucose PET/CT and molecular subtype: prediction of axillary treatment response after neoadjuvant systemic therapy for breast cancer
van Amstel, Florien J G; de Mooij, Cornelis M; Simons, Janine M; Mitea, Cristina; van Diest, Paul J; Nelemans, Patty J; van der Pol, Carmen C; Luiten, Ernest J T; Koppert, Linetta B; Smidt, Marjolein L; van Nijnatten, Thiemo J A; REFINE Study Group
(2024) The British journal of surgery, volume 111, issue 9
(Article)
Abstract
BACKGROUND: Axillary disease extent according to baseline [18F]fluorodeoxyglucose PET/CT combined with pathological axillary treatment response has been proposed to guide de-escalation of axillary treatment for clinically node-positive breast cancer patients treated with neoadjuvant systemic therapy. The aim of this study was to assess whether axillary disease extent according to baseline
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[18F]fluorodeoxyglucose PET/CT and breast cancer molecular subtype are predictors of axillary pCR. METHODS: This study included clinically node-positive patients treated with neoadjuvant systemic therapy in the prospective Radioactive Iodine Seed placement in the Axilla with Sentinel lymph node biopsy ('RISAS') trial (NCT02800317) with baseline [18F]fluorodeoxyglucose PET/CT imaging available. The predictive value of axillary disease extent according to baseline [18F]fluorodeoxyglucose PET/CT and breast cancer molecular subtype to estimate axillary pCR was evaluated using logistic regression analysis. Discriminative ability is expressed using ORs with 95% confidence intervals. RESULTS: Overall, 185 patients were included, with an axillary pCR rate of 29.7%. The axillary pCR rate for patients with limited versus advanced baseline axillary disease according to [18F]fluorodeoxyglucose PET/CT was 31.9% versus 26.1% respectively. Axillary disease extent was not a significant predictor of axillary pCR (OR 0.75 (95% c.i. 0.38 to 1.46) (P = 0.404)). There were significant differences in axillary pCR rates between breast cancer molecular subtypes. The lowest probability (7%) was found for hormone receptor+/human epidermal growth factor receptor 2- tumours. Using this category as a reference group, significantly increased ORs of 14.82 for hormone receptor+/human epidermal growth factor receptor 2+ tumours, 40 for hormone receptor-/human epidermal growth factor receptor 2+ tumours, and 6.91 for triple-negative tumours were found (P < 0.001). CONCLUSION: Molecular subtype is a significant predictor of axillary pCR after neoadjuvant systemic therapy, whereas axillary disease extent according to baseline [18F]fluorodeoxyglucose PET/CT is not.
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Keywords: Humans, Female, Positron Emission Tomography Computed Tomography/methods, Fluorodeoxyglucose F18, Middle Aged, Neoadjuvant Therapy, Breast Neoplasms/pathology, Axilla, Radiopharmaceuticals, Prospective Studies, Aged, Adult, Sentinel Lymph Node Biopsy, Lymphatic Metastasis/diagnostic imaging, Treatment Outcome, Journal Article
ISSN: 0007-1323
Publisher: John Wiley & Sons Inc.
Note: © The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.
(Peer reviewed)