A study of clinical significance for assessment of nodal status using MRI in advanced breast cancer patients with axillary lymph node metastasis treated with primary chemotherapy

This study aimed to determine the prognostic significance of clinical response of the primary tumor and metastatic axillary lymph nodes in advanced breast cancer patients treated with primary chemotherapy (PCT). Between November 1999 and December 2003, thirty patients of advanced breast cancer with axillary lymph node metastasis received the PCT regimen with weekly docetaxel (25 patients), or weekly paclitaxel (4 patients) or cyclophosphamide, epirubicin and 5-fluorouracil (CEF) (1 patient). We objectively measured dimensions of the primary tumor by mammography, computed tomography, ultrasonography or physical examination, and measured those of the largest metastatic axillary lymph node by magnetic resonance imaging (MRI), before and after PCT. With regard to the primary tumor, twenty three patients had partial response (PR), 6 patients had no change (NC) and 1 patient had progressive disease (PD). Response rate was 76.7%. With regard to the metastatic axillary lymph node, eighteen patients had PR, 11 patients had NC and 1 patient had PD. Response rate was 60%. At a median follow up of 27 months, the 4-year survival rate was 74.8% for the tumor responders and 57.1% for the non-responders. The 4-year survival rate was 83.3% for the nodal responders and 50% for the non-responders. The tumor responders had not improved the overall survival (OS) compared with the non-responders (p=0.46). The nodal responders had improved OS compared with the non-responders (p=0.04). Our results suggest that the axillary lymph node response on MRI is a better prognostic factor than the primary tumor response in breast cancer patients with axillary lymph node metastasis. (author)