The rapid advancements in breast cancer treatment have introduced new methods to assess the response of axillary lymph nodes to neoadjuvant chemotherapy, with ultrasonography (US) proving to be more than just a helpful diagnostic tool.
A recent study conducted between February 2022 and September 2023 examined the effectiveness of ultrasonography for evaluating clipped axillary lymph nodes after patients underwent neoadjuvant chemotherapy (NAC). Out of 43 patients who were retrospectively analyzed, the findings indicated promising results, showing ultrasonography could serve as an alternative to more invasive procedures, thereby lowering patient morbidity.
Results revealed ultrasonography showed 70% complete responses and 30% partial responses among the clipped lymph nodes. Conversely, post-surgery pathology indicated 51% complete responses, 9% with micro-metastases, and 40% indicating macro-metastases. The overall diagnostic accuracy of ultrasonography was noted at 81.4%, with significant specificity of 100% and sensitivity of 61.9%.
This study presents important data supporting the increasing role of NAC for reducing tumor sizes and aiding axillary lymph node metastases treatment. By employing ultrasonography, researchers analyzed various parameters including the number, size, shape, cortical thickness, hilum status, and treatment response of the clipped lymph nodes, establishing significant correlations between ultrasound results and pathology findings.
With US being highlighted as the most appropriate imaging method for evaluating lymph nodes, the researchers found characteristics like shape, cortex thickness, and presence of hilum loss provided insights on treatment responses. The technology allows clinicians to not only evaluate the immediate treatment responses but also aids with surgical planning.
A notable aspect of the study was the investigation of how the molecular subtype of breast cancer influenced lymph node responses. Significant correlations were established between the types of breast cancer and the success rate of ultrasonography assessments. The findings indicated particularly high complete response rates among HER2-positive and triple-negative breast cancer patients.
Current practices typically involve placing metallic markers within the breast mass and affected axillary lymph nodes under ultrasound guidance, which helps clinicians adequately plan for subsequent treatments based on the observed responses. The research emphasizes the potential of targeted axillary dissection (TAD) as opposed to extensive axillary surgeries. TAD is shown to minimize complications and improve patients’ quality of life by accurately targeting affected lymph nodes.
Despite these promising results, challenges still exist. The false-negative rates of sentinel lymph node biopsy (SLNB) remain concerning, primarily for patients with larger numbers of pathological lymph nodes. Here, ultrasonography becomes even more valuable, evidencing its versatility and precision as it continues to evolve with technological advancements.
Upon the completion of analyses, the study concluded with recommendations for future research directions focusing on larger patient cohorts and the use of artificial intelligence algorithms for more accurate predictions of lymph node status based on ultrasound images. Overall, these developments bolster the potential of ultrasonography as a transformative element within oncological diagnostics and treatment methodologies.