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Diagnosing Pathologic Complete Response in the Breast After Neoadjuvant Systemic Treatment of Breast Cancer Patients by Minimal Invasive Biopsy: Oral Presentation at the San Antonio Breast Cancer Symposium on Friday, December 13, 2019, Program Number...

Authors :
Heil, Joerg
Pfob, Andre
Sinn, Hans-Peter
Rauch, Geraldine
Bach, Paul
Thomas, Bettina
Schaefgen, Benedikt
Kuemmel, Sherko
Reimer, Toralf
Hahn, Markus
Thill, Marc
Blohmer, Jens-Uwe
Hackmann, John
Malter, Wolfram
Bekes, Inga
Friedrichs, Kay
Wojcinski, Sebastian
Joos, Sylvie
Paepke, Stefan
Ditsch, Nina
Source :
Annals of Surgery; Mar2022, Vol. 275 Issue 3, p576-581, 6p
Publication Year :
2022

Abstract

Objective: We evaluated the ability of minimally invasive, image-guided vacuum-assisted biopsy (VAB) to reliably diagnose a pathologic complete response in the breast (pCR-B). Summary Background Data: Neoadjuvant systemic treatment (NST) elicits a pathologic complete response in up to 80% of women with breast cancer. In such cases, breast surgery, the gold standard for confirming pCR-B, may be considered overtreatment. Methods: This multicenter, prospective trial enrolled 452 women presenting with initial stage 1-3 breast cancer of all biological subtypes. Fifty-four women dropped out; 398 were included in the full analysis. All participants had an imaging-confirmed partial or complete response to NST and underwent study-specific image-guided VAB before guideline-adherent breast surgery. The primary endpoint was the false-negative rate (FNR) of VAB-confirmed pCR-B. Results: Image-guided VAB alone did not detect surgically confirmed residual tumor in 37 of 208 women [FNR, 17.8%; 95% confidence interval (CI), 12.8-23.7%]. Of these 37 women, 12 (32.4%) had residual DCIS only, 20 (54.1%) had minimal residual tumor (<5 mm), and 19 of 25 (76.0%) exhibited invasive cancer cellularity of <=10%. In 19 of the 37 cases (51.4%), the false-negative result was potentially avoidable. Exploratory analysis showed that performing VAB with the largest needle by volume (7-gauge) resulted in no false-negative results and that combining imaging and image-guided VAB into a single diagnostic test lowered the FNR to 6.2% (95% CI, 3.4%-10.5%). /p> Conclusions: Image-guided VAB missed residual disease more often than expected. Refinements in procedure and patient selection seem possible and necessary before omitting breast surgery. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
00034932
Volume :
275
Issue :
3
Database :
Supplemental Index
Journal :
Annals of Surgery
Publication Type :
Academic Journal
Accession number :
155239614
Full Text :
https://doi.org/10.1097/SLA.0000000000004246