A Clinical Feasibility Trial for Identification of Exceptional Responders in Whom Breast Cancer Surgery Can Be Eliminated Following Neoadjuvant Systemic Therapy
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- Henry M. Kuerer
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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- Gaiane M. Rauch
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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- Savitri Krishnamurthy
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
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- Beatriz E. Adrada
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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- Abigail S. Caudle
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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- Sarah M. DeSnyder
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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- Dalliah M. Black
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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- Lumarie Santiago
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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- Brian P. Hobbs
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
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- Anthony Lucci
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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- Michael Gilcrease
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
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- Rosa F. Hwang
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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- Rosalind P. Candelaria
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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- Mariana Chavez-MacGregor
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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- Benjamin D. Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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- Elsa Arribas
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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- Tanya Moseley
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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- Mediget Teshome
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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- Makesha V. Miggins
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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- Vicente Valero
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
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- Kelly K. Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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- Wei T. Yang
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
Abstract
<jats:sec> <jats:title>Objective:</jats:title> <jats:p>To determine the accuracy of fine-needle aspiration (FNA) and vacuum-assisted core biopsy (VACB) in assessing the presence of residual cancer in the breast after neoadjuvant systemic therapy (NST).</jats:p> </jats:sec> <jats:sec> <jats:title>Summary Background Data:</jats:title> <jats:p>Pathologic complete response (pCR) rates after NST have improved dramatically, suggesting that surgery might be avoided in some patients. Safe avoidance of surgery would require accurate confirmation of no residual invasive/in situ carcinoma.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>Forty patients with T1-3N0-3 triple-negative or HER2-positive cancer receiving NST were enrolled in this single-center prospective trial. Patients underwent ultrasound-guided or mammography-guided FNA and VACB of the initial breast tumor region before surgery. Findings were compared with findings on pathologic evaluation of surgical specimens to determine the performance of biopsy in predicting residual breast disease after NST.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>Median initial clinical tumor size was 3.3 cm (range, 1.2–7.0 cm); 16 patients (40%) had biopsy-proven nodal metastases. After NST, median clinical tumor size was 1.1 cm (range, 0–4.2 cm). Nineteen patients (47.5%) had a breast pCR and were concordant with pathologic nodal status in 97.5%. Combined FNA/VACB demonstrated an accuracy of 98% (95% CI, 87%–100%), false-negative rate of 5% (95% CI, 0%–24%), and negative predictive value of 95% (95% CI, 75%–100%) in predicting residual breast cancer. VACB alone was more accurate than FNA alone (<jats:italic toggle="yes">P</jats:italic> = 0.011).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>After NST, image-guided FNA/VACB can accurately identify patients with a breast pCR. Based on these results, a prospective clinical trial has commenced in which breast surgery is omitted in patients with a breast pCR after NST according to image-guided biopsy.</jats:p> </jats:sec>
Journal
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- Annals of Surgery
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Annals of Surgery 267 (5), 946-951, 2018-05
Ovid Technologies (Wolters Kluwer Health)
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Details 詳細情報について
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- CRID
- 1360574094085531904
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- ISSN
- 15281140
- 00034932
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- Data Source
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- Crossref