Assessment of the Effect of Treatment with Neoadjuvant Chemotherapy on Breast Cancer Axillary Lymph Node

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Neoadjuvant chemotherapy is the standard of care for patients with locally advanced breast cancer (LABS). The aim of this study was to determine the effects of neoadjuvant chemotherapy on metastatic and nonmetastatic breast cancer axillary lymph nodes (ALNs). Seventy-seven patients with LABS and cytologically documented ALN metastases were treated in two prospective trials. Patients had breast surgery with level I and level II axillary dissection followed by additional chemotherapy or radiation treatment. Clinical nodal status was determined by physical examination and compared with histological and immunohistochemical findings. The regressive changes in primary tumor and ALNs were achieved using scoring systems. Objective clinical response in primary tumor was seen in 48.05% of patients. Histologic evidence of regression was noted in 46 cases (59.75%), with complete histologic regression achieved in 5 cases (6.49%). The number of cases according to the ALNs regression scoring system was as follows: 0 grade - viable metastases without effect - 21 patients (30%); 1 grade - cytotoxic effect in metastases - 20 patients (28.58%), 2 grade - micrometastasis - only3 patients (4.28%); 3 grade - no residual metastatic disease - 1 patient (1.43%); 4 grade - negative ALNs before and after treatment - 25 patients (35.71%). Nodular fibrotic area and iron-loaded macrophages suggested previous presence of tumor metastasis. There was significant relationship between histologic regression in the primary tumor and the presence of effect of cytotoxic agents on ALNs metastases (r=0.9123; p<0.00001). As chemotherapy is widely used in the treatment of breast carcinoma, pathologists should be aware of chemotherapy-induced changes in metastatic and in non­metastatic ALNs.

1. Bear HD. Indication for neoadjuvant chemotherapy for breast cancer. Semin Oncol. 1998; 25(2 Suppl3):3-12.

2. Botti C,Vici P, Lopez M, Scinto AF, Cognetti F, Cavaliere R. Prognotic value of lymph node metastasis after neoadjuvant chemotherapy for large-sized operable carcinoma of the breast. J Am CollSurg. 1995; 181 (3):202-208.

3. Kuerer HM, Newman LA, Buzdar AU, Hunt KK, Dhingra K, Buchholz TA, et al. Residual metastatic axillary lymph nodes following neoadjuvant chemotherapy predict disease-free survival in patients with locally advanced breast cancer. AmJ Surg. 1998;76:502-506.

4. Kuerer HM, Newman LA, Fomage BD, Dhingra K, Hunt KK, Buzdar AU, et al. Role of axillary lymph node dissection after tumor downstaging with induction chemotherapy for locally advanced breast cancer. Ann Surg Oncol. 1998;5(3):673-80.

5. Machiavelli MR, Romero AO, Perez JE, Lacava JA, Dominguez ME, Rodriguez R, et al. Prognostic significance of pathological response of primary tumour and metastatic axillary lymph nodes after neoadjuvant chemotherapy for locally advanced breast carcinoma. Cancer J Sci Am. 1998 ;4(2):125-31.

6. Feldman LD, Hortobagyi GN, Buzdar AU, Ames FC, Blumenschein GR. Pathological assessment of response to induction chemotherapy in breast cancer.CancerRes. 1986;46(5):2578-81.

7. Gazet J-C,Coombes RC, Ford HT, Griffin M, Coibishley C, Makinde V, et al. Assessment of the effect of pretreatment with neoadjuvant therapy on primary breast cancer. Br J Cancer. 1996; 73(6): 758-762.

8. Kennedy SM, Merino MJ, Swain S, Lippman ME. The effect of hormonal and chemotherapy on tumoral and non-neoplastic breast tissue. Hum Pathol. 1990;21(2): 192 -8.

9. Khanna AK, Saxena SK, Khan a S, Kumar A. Histopathological changes following anterior chemotherapy in advanced breast cancer. Ind J Cancer. 1990;27(2):109-15.

10. Khanna AK, Saxena SK, Khan a S, and Mistra MK:Tumor response to chemotherapy as a primary treatment in advanced breast cancer. Ind J Slug. 1991;53(6):239-45.

11. Mortimer JE, Taylor ME. Can chemotherapy alter the histologic features of breast cancer. Am J Clin PathoL 1994; 102(2): 147-9.

12. Moll UM, Chumas J. Morphologic effects of neoadjuvant chemotherapy in locally advanced breast cancer. Pathol Res Pract. 1997; 193(3): 187-96.

13. Hayward JL, Carbone PP, Heusen JC, Kumaoka S, Segaloff A, Rubens RD. Assessment of response to therapy in advanced breast cancer. Br J Cancer. 1977;35:292-8.

14. WHO Handbook for Reporting Results of Cancer Treatment WHO Offset publication No. 48. Geneva: World Health Organization; 1979.

15. Sinn HP, Schmod H, Junkermann H, Huober J, Leppien G, Kaufmann M, et al. Histologische regression des ma mmac arzino mas nach primarer (neoadjuvanter) chemotherapie. Geburtsh Frauenheilk. 1994;54(10):552-8.

16. Gampenrieder SP, Rinnerthaler G, Greil R. Neoadjuvant chemotherapy and targeted therapy in breast cancer past, present, and future. J Oncol. 2013;2013:732047.

17. Honkoop AH, Pinedo HM, De Jong de JS, Verheul HM, Linn SC, Hoekman K, et al. Effects of chemotherapy on pathologic and biologic characteristics of locally advanced breast cancer. Am J Clin Pathol. 1997; 107(2):211-8.

18. Sharkey FE, Addington SL, Flowerl J, Page CP, Cruz AB. Effects of preoperative chemotherapy on the morphology of resectable breast carcinoma. Mod Pathol. 1996;9(9):893-900.

19. Kuerer HM, Sahin AA, Hunt KK, Newman LA, Breslin TM, Ames FC, et al. Incidence and impact of documented eradication of breast cancer axillary lymph node metastases before surgery in patients treated with neoadjuvant chemotherapy. Ann Surg. 1999;230(l):72-78.

20. Lenert JT, Vlastos G, Mirza NQ, Winchester DJ, Binkley SM, Ames FC, et al. Primary tumor response to induction chemotherapy as a predictor of histological status of axillary nodes in operable breast cancer patients. Ann Surg Oncol. 1999;6(8):762-7.

21. Paradinas FJ. Primary and secondary breast disorders. In: StansfeldAG, d'Ardene AJ, editors. Lymph node biopsy interpretation. 2nd ed. Edinburgh: Churchill Livingstone; 1992. p. 171-86.

22. Sahoo S, Lester SC. Pathology of breast carcinomas after neoadjuvant chemotherapy: an overview with recommendations on specimen processing and reporting. Arch Pathol Lab Med. 2009; 133(4):633-42.

23. Pinder SE, Ptovenzano E, Earl H, Ellis IO. Laboratory handling and histology reporting of breast specimens from patients who have received neoadjuvant chemotherapy. Histopathology. 2007;50(4):409-17.

24. Azzopardi JG, Ahmed A, Millis RR. Problems in breast pathology. Major Probl Pathol. 1979;11:1-466.

25. Misdorp W, Hart G, Delemarre JFM, Voute PA, van der Eijken JW. An analysis of spontaneous and chemotherapy-associated changes in skeletal osteosarcomas. J Pathol. 1988; 156(2): 119-28.

26. Rosen G, Capparos B, Huvos AG, Kosloff C, Nirenbetg A, Cacavio A, et al. Preoperative chemotherapy for osteogenic sarcoma:selection of postoperative chemotherapy based on response of the primary tumor to preoperative chemotherapy. Cancer. 1982;49(6): 1221-30.

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