Cytologically proven axillary lymph node metastases are eradicated in patients receiving preoperative chemotherapy with concurrent trastuzumab for HER2‐positive breast cancer
Bibliographic record
Abstract
We read the original article by Dominici et al1 regarding the complete eradication of axillary lymph node metastases in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer who were treated with trastuzumab-containing neoadjuvant chemotherapy. The exquisite sensitivity of breast cancer to this treatment may generate an axillary lymph node complete pathological response that, as a counterpart, causes the stromal and vascular changes that give rise to the appearance of lymphedema before surgery. A patient aged 48 years was diagnosed with an invasive ductal carcinoma of the left breast with positive estrogen receptors, negative progesterone receptors, and positive HER2 in clinical stage IIIB (T4bN2M0). She was treated with four 21-day cycles of doxorubicin at a dose of 60 mg/m2 and cyclophosphamide at a dose of 600 mg/m2, both administered intravenously. After the fourth cycle, the patient developed left arm lymphedema. Venous thrombosis was discounted by Doppler ultrasound. The patient completed the neoadjuvant treatment with four 21-day cycles of docetaxel at a dose of 100 mg/m2 and trastuzumab at a dose of 6 mg/kg (8-mg/kg loading dose), both administered intravenously. During this treatment, the clinical remission of the mammary and axillary disease was maintained, and the edema of the arm increased. The histopathological result of modified radical mastectomy was the total absence of tumor, and marked postchemotherapy changes. During the axillary lymphadenectomy, only 3 lymphatic ganglia were recognized, all of which were free from metastasis, with interstitial fibrosis and lymphoid depletion. Also recognized were several foci of fibrosis with a scarce lymphoid population, suggestive of pre-existing lymphatic ganglia with changes produced by the chemotherapy. To the best of our knowledge, there are no descriptions in the literature of the appearance of lymphedema in this context. The emergence of lymphedema before breast cancer surgery is a rare clinical situation.2 Neoadjuvant chemotherapy results in a decrease in the number of ganglia isolated in the axillary lymphadenectomy, in comparison with patients who have not received neoadjuvant therapy.3 Jose M. Baena-Canada MD, PhD*, Sara Estalella MD*, Petra Rosado MD*, * Medical Oncology Unit, Puerta del Mar University Hospital, Cadiz, Spain.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".