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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAxillary ultrasound (after neoadjuvant chemo-therapy can help to restage axillary nodal basins for patients with clinical node-positive (cN1) breast cancer, sparing many from the morbidity associated with axillary lymph node dissection. This article reports on the results of a secondary end point of the American College of Surgeons Oncology Group (ACOSOG) Z1071 trial.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ebreast cancer\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eradiology clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eultrasonography\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eadjuvant\/neoadjuvant therapy\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EAxillary ultrasound (AUS) after neoadjuvant chemotherapy (NAC) can help to restage axillary nodal basins for patients with clinical node-positive (cN1) breast cancer, sparing many from the morbidity associated with axillary lymph node dissection (ALND). H. Carisa Le-Petross, MD, University of Texas MD Anderson Cancer Center, Houston, Texas, USA, reported the results of a secondary end point of the American College of Surgeons Oncology Group (ACOSOG) Z1071 trial [Boughey JC et al. \u003Cem\u003EJAMA.\u003C\/em\u003E 2013].\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EThe prospective, multicenter ACOSOG Z1071 trial evaluated the false-negative rate (FNR) for nodal staging with sentinel lymph node (SLN) surgery performed after NAC in women initially presenting with biopsy-proven cN1 disease. The study evaluated the likelihood that the FNR in patients with \u2265 2 SLNs examined was \u0026lt; 10%, the rate reported from many studies for women undergoing SLN surgery who present with clinically node-negative (cN0) disease.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EACOSOG Z1071 enrolled 756 women with breast cancer (clinical T0 to T4, N1 to N2, M0) who received NAC and then underwent SLN surgery with ALND. SLN surgery correctly identified the axillary nodal status in 91.2% of patients. The FNR was 12.6% (39 of 310) in patients with cN1 breast cancer with \u2265 2 SLNs resected (90% Bayesian credible interval, 9.85% to 16.05%).\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe objective of the secondary end point was to evaluate the correlation between lymph node (LN) features on AUS after NAC with the final nodal pathology at surgery.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EStudy enrollment could occur prior to, during, or after chemotherapy. All patients were required to have a physical examination and AUS. AUS was performed after completion of NAC, within 4 weeks prior to surgery. This was followed by SLN surgery and ALND.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EThe study classified the LN morphology as normal or abnormal. AUS images were read locally and reviewed centrally to determine nodal cortical thickness (in millimeters), nodal size, and cortical morphologic features. Dr Le-Petross referenced a previous study in which the cortical morphologic features were used as predictors of metastasis in breast cancer [Bedi DG. \u003Cem\u003EAJR Am J Roentgenol.\u003C\/em\u003E 2008].\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EOf the 756 women enrolled in ACOSOG Z1071, 611 had AUS images available for central review; 370 (60.6%) had residual nodal disease (N+) on final pathology, while 241 (39.4%) had no residual nodal disease (N0).\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EThe analysis of the secondary end point found that of the AUS findings for LNs, the features that significantly predicted residual nodal disease were cortical thickness \u0026gt; 3 mm for N+ (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .0001) and lack of fatty hilum visibility (48 patients [81.4% N+] vs 11 patients [18.6% N0]). LN size was not significant (long axis to short axis ratio, \u003Cem\u003EP\u003C\/em\u003E = .28).\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003ETo conclude, LN status is an important prognostic factor used to guide local, regional, and systemic treatment decisions. It is important to restage breast cancer and nodal status after NAC and prior to surgery. In N+ patients, AUS performed after NAC can provide information to help determine what type of axillary surgery is indicated after NAC. This could help ensure that only those individuals who may benefit from ALND would be exposed to the potential morbidity of the procedure. Nodal morphology, such as cortical thickness and presence or absence of fatty hilum, should be used to predict the presence of residual nodal disease.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/53\/9.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzls81\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}