RELATIVE VALUE OF PHYSICAL-EXAMINATION, MAMMOGRAPHY, AND BREAST SONOGRAPHY IN EVALUATING THE SIZE OF THE PRIMARY TUMOR AND REGIONAL LYMPH-NODE METASTASES IN WOMEN RECEIVING NEOADJUVANT CHEMOTHERAPY FOR LOCALLYADVANCED BREAST-CARCINOMA

The purpose of this study was to correlate physical examination and so nographic and mammographic measurements of breast tumors and regional lymph nodes with pathological findings and to evaluate the effect of n eoadjuvant chemotherapy on clinical Tumor-Node-Metastasis stage by non invasive methods, This was a retrospective analysis of 100 patients wi th locally advanced breast cancer registered and treated in prospectiv e trials of neoadjuvant chemotherapy, All patients received four cycle s of a doxorubicin-containing regimen and had noninvasive evaluation o f the primary tumor and regional lymph nodes before and after neoadjuv ant chemotherapy by physical examination, sonography? and mammography and underwent breast surgery and axillary dissection within 5 weeks af ter com-pletion of neoadjuvant chemotherapy, The correlations between clinical and pathological measurements mere determined by Spearman ran k correlation analysis, A proportional odds model was used to examine predictive values, Eighty-three patients had both a clinically detecta ble primary tumor and lymph node metastases, Sixty-four patients had a decrease in Tumor-Node-Metastasis stage after chemotherapy, For 54% o f patients, there was concordance in clinical response between the pri mary tumor and lymph node compartment; for the rest, results were disc ordant, Physical examination correlated best with pathological finding s in the measurement of the primary tumor (P = 0.0003), whereas sonogr aphy was the most accurate predictor of size for axillary lymph nodes (P = 0.0005). The combination of physical examination and mammography worked best for assessment of the primary tumor (P = 0.003), whereas c ombining physical examination with sonography gave optimal evaluation of regional lymph nodes (P = 0.0001). In conclusion, physical examinat ion is the best noninvasive predictor of the real size of locally adva nced primary breast cancer, whereas sonography correlates better with the real dimensions of axillary lymph nodes, The combination of physic al examination with either mammography or sonography significantly imp roves the accuracy of noninvasive assessment of tumor dimensions.