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 GS5-03. Issue 3 (9th March 2022)

• Record Type: Journal Article
• Authors: Heil, Joerg; Pfob, André; 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; Rody, Achim; Große, Regina; van Mackelenbergh, Marion; Reinisch, Mattea; Karsten, Maria; Golatta, Michael
• Is Part Of: Annals of surgery. Volume 275:Issue 3(2022)
• Page Start: 576
• Page End: 581
• Publication Date: 2022-03-09
• Subjects: breast cancer surgery -- complete response -- individualized treatment -- neoadjuvant systemic treatment -- surgical de-escalation -- vacuum-assisted biopsy; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000004246
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Supplemental Digital Content is available in the text 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%). 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.