Rationale and Objectives
To develop and validate a simplified scoring system by integrating MRI and clinicopathologic
features for preoperative prediction of axillary pathologic complete response (pCR)
to neoadjuvant chemotherapy (NAC) in clinically node-positive breast cancer.
Materials and Methods
A total of 389 patients from three hospitals were retrospectively analyzed. To identify
independent predictors for axillary pCR, univariable and multivariable logistic regression
analyses were performed on pre- and post-NAC MRI and clinicopathologic features. Then,
a simplified scoring system was constructed based on regression coefficients of predictors
in the multivariable model, and its predictive performance was assessed with the receiver
operating characteristic curve and calibration curve. The added value of the scoring
system for reducing false-negative rate (FNR) of the sentinel lymph node biopsy (SLNB)
was also evaluated.
Results
The simplified scoring system including seven predictors: progesterone receptor-negative
(Three points), HER2-positive (Two points), post-NAC clinical T0-1 stage (Two points),
pre-NAC higher ADC value of breast tumor (One point), absence of perinodal infiltration
at pre-NAC (One point) and post-NAC MRI (Two points), and absence of enhancement in
the tumor bed at post-NAC MRI (Two points), showed good calibration and discrimination,
with AUCs of 0.835, 0.828 and 0.798 in the training, internal and external validation
cohorts, respectively. The axillary pCR rates were increased with the total points
of the scoring system, and patients with a score of ≥11 points had a pCR rate of 86%-100%.
In test cohorts for simulating clinical application, the diagnostic accuracy for axillary
pCR was 80%-90% among four different radiologists. Compared to standalone SLNB, combining
the scoring system with SLNB reduced the FNR from 14.5% to 4.8%.
Conclusion
The clinicopathologic-image scoring system with good predictive performance for axillary
pCR in clinically node-positive breast cancer, may guide axillary management after
NAC and improve patient selection for de-escalating axillary surgery to reduce morbidity.
Key Words
Abbreviations:
ALND (Axillary lymph node dissection), AUC (Area under the receiver operating characteristic curve), CI (Confidence interval), ER (Estrogen receptor), FNR (False-negative rate), HER2 (Human epidermal growth factor receptor 2), NAC (Neoadjuvant chemotherapy), OR (Odds ratio), pCR (Pathologic complete response), PR (Progesterone receptor), SLNB (Sentinel lymph node biopsy)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 21, 2022
Accepted:
September 26,
2022
Received in revised form:
September 17,
2022
Received:
July 14,
2022
Publication stage
In Press Corrected ProofFootnotes
Xiaomei Huang and Zhenwei Shi contributed equally to this work.
Identification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
