ABSTRACT
PURPOSE: Neoadjuvant chemotherapy (NACT) is employed in patients with breast cancer (BC) with the aim of reducing tumor burden and improving surgical outcomes. We evaluated the levels of energy metabolites pre- and post-radiotherapy (RT) in breast cancer (BC) patients who previously received NACT and investigated the alterations of these metabolites in relation to the patient achieving a pathologic complete response to NACT. MATERIALS AND METHODS: We included 37 BC patients who were treated with NACT following surgery and analyzed the concentrations of energy balance-related metabolites using targeted metabolomics before and one month after the end of RT. The control group was composed of 44 healthy women. RESULTS: Pre-radiotherapy, patients had significant decreases in the plasma levels of 12 metabolites. RT corrected these alterations and the improvement was superior in patients with a pathologic complete response. CONCLUSION: Our results highlight the importance of metabolism in the outcomes of patients with BC.
Subject(s)
Breast Neoplasms/metabolism , Carcinoma, Ductal, Breast/metabolism , Carcinoma, Lobular/metabolism , Energy Metabolism , Mastectomy , Radiotherapy, Adjuvant , Radiotherapy, Conformal , Adult , Aged , Antibodies, Monoclonal, Humanized/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/pathology , Breast Neoplasms/radiotherapy , Carcinoma, Ductal, Breast/pathology , Carcinoma, Ductal, Breast/radiotherapy , Carcinoma, Lobular/pathology , Carcinoma, Lobular/radiotherapy , Cyclophosphamide/administration & dosage , Doxorubicin/administration & dosage , Female , Humans , Lymph Node Excision , Mastectomy, Segmental , Metabolomics , Middle Aged , Neoadjuvant Therapy , Neoplasm Staging , Paclitaxel/administration & dosage , Prospective Studies , Sentinel Lymph Node Biopsy , Trastuzumab/administration & dosage , Young AdultABSTRACT
Introducción. El objetivo de nuestro estudio fue evaluar los resultados de los ganglios obtenidos mediante biopsia selectiva del ganglio centinela en mujeres T1-T3/N1-N2 que después de la neoadyuvancia presentaron una axila N0. Material y métodos. Se realizó un estudio multicéntrico de validación diagnóstica en la provincia de Tarragona. Incluimos a mujeres afectadas por cáncer de mama en estadio T1-T3, N1-N2, que presentaron una respuesta axilar completa después de la quimioterapia neoadyuvante. El procedimiento consistió en la realización de la biopsia selectiva del ganglio centinela seguida de la linfadenectomía. El análisis estadístico consistió en la evaluación de la validez de la biopsia selectiva del ganglio centinela mediante la linfadenectomía como gold standard. Resultados. Se incluyeron 53 mujeres. La tasa de detección quirúrgica fue del 90,5% (en 5 pacientes no se encontró el ganglio centinela). El análisis histopatológico de la linfadenectomía mostró remisión completa de los ganglios axilares en el 35,4% (17/48) de las pacientes y enfermedad residual en los ganglios axilares en el 64,6% (31/48) de ellas. En 28 pacientes existía afectación residual en el ganglio centinela, en el 20% (10/48) de las cuales esta se localizaba únicamente en el ganglio centinela, estando el resto de la linfadenectomía libre de enfermedad. En 3 pacientes el ganglio centinela era negativo pero existía enfermedad en la linfadenectomía, resultando falsos negativos. Así, obtenemos una sensibilidad del 93,5%, una tasa de falsos negativos del 9,7% y una eficiencia de prueba global del 93,7%. Conclusiones. La biopsia selectiva del ganglio centinela, después de la quimioterapia en las pacientes que han presentado una respuesta axilar completa, proporciona información válida y confiable sobre el estado axilar después del tratamiento neoadyuvante, y podría evitar la linfadenectomía en casos con ganglio centinela negativo (AU)
Introduction. The aim of our study was to evaluate sentinel lymph node biopsy as a diagnostic test for assessing the presence of residual metastatic axillary lymph nodes after neoadjuvant chemotherapy, replacing the need for a lymphadenectomy in negative selective lymph node biopsy patients. Material and methods. A multicentre, diagnostic validation study was conducted in the province of Tarragona, on women with T1-T3, N1-N2 breast cancer, who presented with a complete axillary response after neoadjuvant chemotherapy. Study procedures consisted of performing an selective lymph node biopsy followed by lymphadenectomy. Results. A total of 53 women were included in the study. Surgical detection rate was 90.5% (no sentinel node found in 5 patients). Histopathological analysis of the lymphadenectomy showed complete disease regression of axillary nodes in 35.4% (17/48) of the patients, and residual axillary node involvement in 64.6% (31/48) of them. In lymphadenectomy positive patients, 28 had a positive selective lymph node biopsy (true positive), while 3 had a negative selective lymph node biopsy (false negative). Of the 28 true selective lymph node biopsy positives, the sentinel node was the only positive node in 10 cases. All lymphadenectomy negative cases were selective lymph node biopsy negative. These data yield a sensitivity of 93.5%, a false negative rate of 9.7%, and a global test efficiency of 93.7%. Conclusions. Selective lymph node biopsy after chemotherapy in patients with a complete axillary response provides valid and reliable information regarding axillary status after neoadjuvant treatment, and might prevent lymphadenectomy in cases with negative selective lymph node biopsy (AU)
Subject(s)
Humans , Female , Sentinel Lymph Node Biopsy/methods , Sentinel Lymph Node Biopsy/statistics & numerical data , Sentinel Lymph Node Biopsy , Neoadjuvant Therapy/methods , Breast Neoplasms/diagnosis , Breast Neoplasms/drug therapy , Lymph Node Excision/methods , Lymph Node Excision , False Negative Reactions , Axilla/anatomy & histology , Axilla/physiology , AxillaABSTRACT
INTRODUCTION: The aim of our study was to evaluate sentinel lymph node biopsy as a diagnostic test for assessing the presence of residual metastatic axillary lymph nodes after neoadjuvant chemotherapy, replacing the need for a lymphadenectomy in negative selective lymph node biopsy patients. MATERIAL AND METHODS: A multicentre, diagnostic validation study was conducted in the province of Tarragona, on women with T1-T3, N1-N2 breast cancer, who presented with a complete axillary response after neoadjuvant chemotherapy. Study procedures consisted of performing an selective lymph node biopsy followed by lymphadenectomy. RESULTS: A total of 53 women were included in the study. Surgical detection rate was 90.5% (no sentinel node found in 5 patients). Histopathological analysis of the lymphadenectomy showed complete disease regression of axillary nodes in 35.4% (17/48) of the patients, and residual axillary node involvement in 64.6% (31/48) of them. In lymphadenectomy positive patients, 28 had a positive selective lymph node biopsy (true positive), while 3 had a negative selective lymph node biopsy (false negative). Of the 28 true selective lymph node biopsy positives, the sentinel node was the only positive node in 10 cases. All lymphadenectomy negative cases were selective lymph node biopsy negative. These data yield a sensitivity of 93.5%, a false negative rate of 9.7%, and a global test efficiency of 93.7%. CONCLUSIONS: Selective lymph node biopsy after chemotherapy in patients with a complete axillary response provides valid and reliable information regarding axillary status after neoadjuvant treatment, and might prevent lymphadenectomy in cases with negative selective lymph node biopsy.
