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Prediction of pathologic complete response using image-guided biopsy after neoadjuvant chemotherapy in breast cancer patients selected based on MRI findings: a prospective feasibility trial.

Published on May 16, 2020in Breast Cancer Research and Treatment3.471
· DOI :10.1007/S10549-020-05678-3
Han-Byoel Lee8
Estimated H-index: 8
,
Wonshik Han44
Estimated H-index: 44
+ 20 AuthorsJung Ho Kim17
Estimated H-index: 17
Abstract
PURPOSE: Accurate prediction of pathologic complete response (pCR) in breast cancer using magnetic resonance imaging (MRI) and ultrasound (US)-guided biopsy may aid in selecting patients who forego surgery for breast cancer. We evaluated the accuracy of US-guided biopsy aided by MRI in predicting pCR in the breast after neoadjuvant chemotherapy (NAC). METHODS: After completion of NAC, 40 patients with near pCR (either tumor size ≤ 0.5 cm or lesion-to-background signal enhancement ratio (L-to-B SER) ≤ 1.6 on MRI) and no diffused residual microcalcifications were prospectively enrolled at a single institution. US-guided multiple core needle biopsy (CNB) or vacuum-assisted biopsy (VAB) of the tumor bed, followed by standard surgical excision, was performed. Matched biopsy and surgical specimens were compared to assess pCR. The negative predictive value (NPV), accuracy, and false-negative rate (FNR) were analyzed. RESULTS: pCR was confirmed in 27 (67.5%) surgical specimens. Preoperative biopsy had an NPV, accuracy, and FNR of 87.1%, 90.0%, and 30.8%, respectively. NPV for hormone receptor-negative and hormone receptor-positive tumors were 83.3% and 100%, respectively. Obtaining at least 5 biopsy cores based on tumor size ≤ 0.5 cm and an L-to-B SER of ≤ 1.6 on MRI (27 patients) resulted in 100% NPV and accuracy. No differences in accuracy were noted between CNB and VAB (90% vs. 90%). CONCLUSIONS: Investigation using stringent MRI criteria and ultrasound-guided biopsy could accurately predict patients with pCR after NAC. A larger prospective clinical trial evaluating the clinical safety of breast surgery omission after NAC in selected patients will be conducted based on these findings.
  • References (31)
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References31
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#1Laura Spring (Harvard University)H-Index: 9
#2Geoffrey Fell (Harvard University)H-Index: 2
Last. Steven J. Isakoff (Harvard University)H-Index: 36
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Purpose: While various studies have highlighted the prognostic significance of pathological complete response (pCR) after neoadjuvant chemotherapy (NAT), the impact of additional adjuvant therapy after pCR is not known. Experimental Design: PubMed was searched for studies with NAT for breast cancer and individual patient-level data was extracted for analysis using plot digitizer software. Hazard ratios (HRs), with 95% probability intervals (PIs), measuring the association between pCR and overall...
5 CitationsSource
#1Susie X. Sun (University of Texas MD Anderson Cancer Center)H-Index: 6
#2Raquel F.D. van la Parra (University of Texas MD Anderson Cancer Center)H-Index: 3
Last. Henry Mark Kuerer (University of Texas MD Anderson Cancer Center)H-Index: 82
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Background Patients with epidermal growth factor receptor 2-positive (HER2+) breast cancer and pathologic complete response (pCR) after neoadjuvant systemic therapy (NST) may be candidates for nonoperative clinical trials if residual invasive and in situ disease are eradicated.
1 CitationsSource
#1Laura SpringH-Index: 9
#2Geoffrey FellH-Index: 2
Last. Aditya BardiaH-Index: 32
view all 11 authors...
Background: While the prognostic significance of pathological complete response (pCR) after neoadjuvant chemotherapy is relatively well established, the impact of adjuvant therapy in modulating relationship between pCR and long term outcomes is less clear. The primary objective of this study was to conduct a systematic review of published neoadjuvant chemotherapy studies to comprehensively evaluate the association between pCR with subsequent breast cancer recurrence and mortality, stratified by ...
9 CitationsSource
#1Gunter von Minckwitz (DKFZ: German Cancer Research Center)H-Index: 74
#2Chiun-Sheng Huang (DKFZ: German Cancer Research Center)H-Index: 1
Last. Charles E. Geyer (DKFZ: German Cancer Research Center)H-Index: 32
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Abstract Background Patients who have residual invasive breast cancer after receiving neoadjuvant chemotherapy plus human epidermal growth factor receptor 2 (HER2)–targeted therapy have a worse prognosis than those who have no residual cancer. Trastuzumab emtansine (T-DM1), an antibody–drug conjugate of trastuzumab and the cytotoxic agent emtansine (DM1), a maytansine derivative and microtubule inhibitor, provides benefit in patients with metastatic breast cancer that was previously treated with...
79 CitationsSource
#1Alison U. Barron (Mayo Clinic)H-Index: 1
#2Tanya L. Hoskin (Mayo Clinic)H-Index: 32
Last. Judy C. Boughey (Mayo Clinic)H-Index: 39
view all 6 authors...
Importance A recent publication reported that of 527 patients with clinically node-negative (cN0) cT1/cT2 triple-negative breast cancer (TNBC) or ERBB2 -positive disease treated with neoadjuvant chemotherapy (NAC), 100% of those who achieved a breast pathologic complete response (pCR) had pathologic node negativity (pN0). Eliminating axillary surgery in these patients has been suggested as safe based on these results. Objective To evaluate nodal positivity rates in patients with cT1/cT2 N0 ERBB2...
5 CitationsSource
#1Soo Yeon Kim (SNU: Seoul National University)H-Index: 11
#2Nariya ChoH-Index: 36
Last. Woo Kyung MoonH-Index: 55
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In women who underwent neoadjuvant chemotherapy for breast cancer, residual tumor size at histopathologic examination showed greater agreement with findings at either conventional or late delayed-p...
2 CitationsSource
#1Joerg Heil (Heidelberg University)H-Index: 18
#2Peter Sinn (Heidelberg University)H-Index: 21
Last. Michael Golatta (Heidelberg University)H-Index: 18
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Background Neoadjuvant chemotherapy (NACT) is a standard approach of the multidisciplinary treatment of breast cancer. Depending on the biological subtype a pathological complete response in the breast (bpCR) can be achieved in up to 60% of the patients. However, only limited accuracy can be reached when using imaging for prediction of bpCR prior to surgery. Due to this diagnostic uncertainty, surgery after NACT is considered to be obligatory for all patients in order to either completely remove...
5 CitationsSource
#1M. E. M. van der Noordaa (NKI-AVL: Netherlands Cancer Institute)H-Index: 4
#2Fh van Duijnhoven (NKI-AVL: Netherlands Cancer Institute)H-Index: 3
Last. M.T.F.D. Vrancken Peeters (NKI-AVL: Netherlands Cancer Institute)H-Index: 11
view all 9 authors...
Abstract Purpose Improvements in neoadjuvant systemic therapy (NST) for breast cancer patients have led to increasing rates of pathologic complete response (pCR). The MICRA trial (NTR6120) aims at identifying pCR with post-NST biopsies. Here, we report the study design and feasibility. Methods The MICRA-trial is a multi-center prospective cohort study. Patients with a pre-NST placed marker and radiologic complete (rCR) or partial response on MRI after NST are eligible for inclusion. Ultrasound g...
5 CitationsSource
#1Mark Basik (JGH: Jewish General Hospital)H-Index: 22
#2Joseph P. Costantino (University of Pittsburgh)H-Index: 68
Last. Norman Wolmark (Allegheny Health Network)H-Index: 6
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TPS604Background: The increased use of neoadjuvant chemotherapy (NCT) has enabled higher rates of breast-conserving surgery (BCS) as well as provided prognostic information for women with breast cancer. High pathological complete response (pCR) rates question the requirement for surgery, with its attendant morbidity. In order to avoid surgery, the ability to predict pCR prior to it must be very high. Trimodality imaging alone is inadequate to predict pCR prior to surgery. We hypothesize that per...
2 CitationsSource
#2Henry Mark KuererH-Index: 82
Last. Wei Tse YangH-Index: 40
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