期刊
BREAST CANCER RESEARCH AND TREATMENT
卷 182, 期 1, 页码 97-105出版社
SPRINGER
DOI: 10.1007/s10549-020-05678-3
关键词
Breast cancer; Magnetic resonance imaging; Neoadjuvant therapy; Minimally invasive biopsy
类别
资金
- Seoul National University Hospital Research Fund [30-2016-0250]
- Institute for Information and Communications Technology Promotion (IITP) - Korea government (MSIT) [2018-0-00861]
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.
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