Cross-sectional imaging to evaluate the extent of regional nodal disease in breast cancer patients undergoing neoadjuvant systemic therapy

Tara L. Anderson, Katrina N. Glazebrook, Brittany L. Murphy, Lyndsay D. Viers, Tina J. Hieken

Research output: Contribution to journalArticle

4 Scopus citations


Purpose Cross-sectional imaging often is performed in breast cancer patients undergoing neoadjuvant systemic therapy (NST) and may identify level III axillary and extra-axillary nodal disease. Our aim was to investigate associations of radiologic nodal staging with pathological N (pN) stage at operation and to explore how this might aid surgical and radiotherapy treatment planning. Materials and methods With IRB approval, we reviewed pre-treatment breast MRI, PET/CT, and CT imaging and clinicopathologic data on 348 breast cancer patients with imaging available for review undergoing NST followed by operation at our institution 1/2008-9/2013. We defined abnormal lymph node findings on MRI, CT, and PET/CT to include cortical thickening, FDG-avidity and loss of fatty hilum. Patients were assigned a radiologic nodal (rN) stage based on imaging findings. Statistical analysis was performed using JMP 10.1 software Results Pre-NST imaging included axillary ultrasound in 338 patients (97%), breast MRI in 305 (88%) and PET/CT or CT in 215 (62%). 213 patients (61%) were biopsy-proven axillary lymph node-positive (LN+) pre-treatment. cT stage was T1 in 9%, T2 in 49%, T3 in 29%, T4 in 12%; median tumor size was 4 cm. Pre-treatment rN stage across all the patients was rN0 in 86 (25%), rN1 in 173 (50%), and rN3 in 89 (26%). rN3 disease included level III axillary, supraclavicular and suspicious internal mammary lymph nodes in 47 (53%), 32 (37%) and 45 (52%), respectively. Of patients LN+ at diagnosis, 78 (37%) were rN3. After NST, 162 patients (47%) were node-positive at operation with a median (mean) of 3 (5.9 ± 0.4) positive lymph nodes including 128 of 213 (60%) LN+ at diagnosis. Pre-NST rN stage correlated with the likelihood and extent of axillary disease at operation, p = 0.002. Fifty four of 89 rN3 patients (61%) were node-positive at operation with a median (mean) of 5 (8 ± 1) positive nodes. rN3 patients had larger nodal metastases (median 9 vs 6 mm) and more frequent extranodal extension (61% vs 43%) than rN0/rN1 patients, both p < 0.03. Conclusions Information on rN stage from pre-NST cross-sectional imaging informs the likelihood and extent of axillary nodal disease at operation. This information may be used for surgical and radiotherapy treatment planning and to inform patient expectations.

Original languageEnglish (US)
Pages (from-to)163-168
Number of pages6
JournalEuropean Journal of Radiology
StatePublished - Apr 1 2017



  • Axillary lymph nodes
  • Breast cancer
  • Cross-sectional imaging
  • Neoadjuvant systemic therapy
  • Nodal staging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this