新辅助全身治疗后进行微创乳腺活检，以确定有残留疾病的乳腺癌患者，以进行延长新辅助治疗：一个新概念。
Minimally Invasive Breast Biopsy After Neoadjuvant Systemic Treatment to Identify Breast Cancer Patients with Residual Disease for Extended Neoadjuvant Treatment: A New Concept.
发表日期：2023 Nov 10
作者：
André Pfob, Lie Cai, Andreas Schneeweiss, Geraldine Rauch, Bettina Thomas, Benedikt Schaefgen, Sherko Kuemmel, Toralf Reimer, Markus Hahn, Marc Thill, Jens-Uwe Blohmer, John Hackmann, Wolfram Malter, Inga Bekes, Kay Friedrichs, Sebastian Wojcinski, Sylvie Joos, Stefan Paepke, Tom Degenhardt, Joachim Rom, Achim Rody, Marion van Mackelenbergh, Maggie Banys-Paluchowski, Regina Große, Mattea Reinisch, Maria Margarete Karsten, Chris Sidey-Gibbons, Markus Wallwiener, Michael Golatta, Joerg Heil
来源：
ANNALS OF SURGICAL ONCOLOGY
摘要：
与达到病理完全缓解（pCR）的乳腺癌患者相比，新辅助全身治疗（NAST）后仍有残留病灶的乳腺癌患者预后较差。及早识别这些患者可能有助于及时、扩展新辅助治疗策略。我们探讨了 NAST 后进行真空辅助活检 (VAB) 的可行性，以在手术前识别残留病变 (ypT 或 ypN) 的患者。我们使用在 21 个研究中心收集的多中心试验数据 (NCT02948764)。该试验包括患有 cT1-3、cN0/ 乳腺癌的女性，她们在手术前接受了常规新辅助成像（超声、MRI、乳房 X 光检查）和 VAB。我们将 VAB 和常规影像学检查结果与手术标本的组织病理学评估进行了比较。在 398 名患者中，排除了 34 名 ypN 状态缺失的患者和 127 名患有管腔肿瘤的患者。在其余 237 例患者中，VAB 中的肿瘤细胞表明所有患者均达到手术非 pCR（73/73，阳性预测值 [PPV] 100%），而 NAST 后常规影像学的 PPV 为 56.0%（75/134） 。 VAB 的敏感性为 72.3% (73/101)，成像敏感性为 74.3% (75/101)。 NAST 后在 VAB 标本中发现的残留癌症始终对应于非 pCR。 NAST 后常规成像中假定的残留癌症与大约一半患者的实际残留癌症相对应。 VAB 的疗效评估对于排除残留癌症并不安全。 NAST 后活检的反应评估可能允许在未来的试验中研究对残留疾病患者进行延长新辅助治疗的新概念。© 2023。作者。
Breast cancer patients with residual disease after neoadjuvant systemic treatment (NAST) have a worse prognosis compared with those achieving a pathologic complete response (pCR). Earlier identification of these patients might allow timely, extended neoadjuvant treatment strategies. We explored the feasibility of a vacuum-assisted biopsy (VAB) after NAST to identify patients with residual disease (ypT+ or ypN+) prior to surgery.We used data from a multicenter trial, collected at 21 study sites (NCT02948764). The trial included women with cT1-3, cN0/+ breast cancer undergoing routine post-neoadjuvant imaging (ultrasound, MRI, mammography) and VAB prior to surgery. We compared the findings of VAB and routine imaging with the histopathologic evaluation of the surgical specimen.Of 398 patients, 34 patients with missing ypN status and 127 patients with luminal tumors were excluded. Among the remaining 237 patients, tumor cells in the VAB indicated a surgical non-pCR in all patients (73/73, positive predictive value [PPV] 100%), whereas PPV of routine imaging after NAST was 56.0% (75/134). Sensitivity of the VAB was 72.3% (73/101), and 74.3% for sensitivity of imaging (75/101).Residual cancer found in a VAB specimen after NAST always corresponds to non-pCR. Residual cancer assumed on routine imaging after NAST corresponds to actual residual cancer in about half of patients. Response assessment by VAB is not safe for the exclusion of residual cancer. Response assessment by biopsies after NAST may allow studying the new concept of extended neoadjuvant treatment for patients with residual disease in future trials.© 2023. The Author(s).