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Vacuum-Assisted Breast Biopsy After Neoadjuvant Systemic Treatment for Reliable Exclusion of Residual Cancer in Breast Cancer Patients
- Source :
- Annals of Surgical Oncology
- Publication Year :
- 2021
-
Abstract
- BackgroundAbout 40 % of women with breast cancer achieve a pathologic complete response in the breast after neoadjuvant systemic treatment (NST). To identify these women, vacuum-assisted biopsy (VAB) was evaluated to facilitate risk-adaptive surgery. In confirmatory trials, the rates of missed residual cancer [false-negative rates (FNRs)] were unacceptably high (> 10%). This analysis aimed to improve the ability of VAB to exclude residual cancer in the breast reliably by identifying key characteristics of false-negative cases.MethodsUni- and multivariable logistic regressions were performed using data of a prospective multicenter trial (n= 398) to identify patient and VAB characteristics associated with false-negative cases (no residual cancer in the VAB but in the surgical specimen). Based on these findings FNR was exploratively re-calculated.ResultsIn the multivariable analysis, a false-negative VAB result was significantly associated with accompanying ductal carcinoma in situ (DCIS) in the initial diagnostic biopsy [odds ratio (OR), 3.94;p p = 0.066), and age (OR, 1.03;p = 0.034). Exclusion of women with DCIS or multicentric disease (n = 114) and classication of VABs that did not remove the clip marker as uncertain representative VABs decreased the FNR to 2.9% (3/104).ConclusionFor patients without accompanying DCIS or multicentric disease, performing a distinct representative VAB (i.e., removing a well-placed clip marker) after NST suggests that VAB might reliably exclude residual cancer in the breast without surgery. This evidence will inform the design of future trials evaluating risk-adaptive surgery for exceptional responders to NST.
- Subjects :
- Oncology
Image-Guided Biopsy
medicine.medical_specialty
Neoplasm, Residual
Breast Neoplasms
Disease
Breast Oncology
Breast cancer
Surgical oncology
Internal medicine
Multicenter trial
Biopsy
medicine
Humans
Breast
Prospective Studies
medicine.diagnostic_test
integumentary system
business.industry
Odds ratio
Ductal carcinoma
medicine.disease
Neoadjuvant Therapy
Vacuum-assisted breast biopsy
Surgery
Female
business
Subjects
Details
- ISSN :
- 15344681
- Volume :
- 29
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Annals of surgical oncology
- Accession number :
- edsair.doi.dedup.....722b59ca7ac231933c4f2c13528757a2