Diagnosis of pathological complete response to neoadjuvant chemotherapy in breast cancer by minimal invasive biopsy techniques
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Diagnosis of pathological complete response to neoadjuvant chemotherapy in breast cancer by minimal invasive biopsy techniques. / Heil, Joerg; Kümmel, Sherko; Schaefgen, Benedikt; Paepke, Stefan; Thomssen, Christoph; Rauch, Geraldine; Ataseven, Beyhan; Große, Regina; Dreesmann, Volker; Kühn, Thorsten; Loibl, Sibylle; Blohmer, Jens-Uwe; von Minckwitz, Gunter.
in: BRIT J CANCER, Jahrgang 113, Nr. 11, 01.12.2015, S. 1565-1570.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Diagnosis of pathological complete response to neoadjuvant chemotherapy in breast cancer by minimal invasive biopsy techniques
AU - Heil, Joerg
AU - Kümmel, Sherko
AU - Schaefgen, Benedikt
AU - Paepke, Stefan
AU - Thomssen, Christoph
AU - Rauch, Geraldine
AU - Ataseven, Beyhan
AU - Große, Regina
AU - Dreesmann, Volker
AU - Kühn, Thorsten
AU - Loibl, Sibylle
AU - Blohmer, Jens-Uwe
AU - von Minckwitz, Gunter
PY - 2015/12/1
Y1 - 2015/12/1
N2 - BACKGROUND: Neoadjuvant chemotherapy (NACT) is widely used as an efficient breast cancer treatment. Ideally, a pathological complete response (pCR) can be achieved. Up to date, there is no reliable way of predicting a pCR. For the first time, we explore the ability of minimal invasive biopsy (MIB) techniques to diagnose pCR in patients with clinical complete response (cCR) to NACT in this study. This question is of high clinical relevance because a reliable pCR prediction could have direct implications for clinical practice.METHODS: In all, 164 patients were included in this review-board approved, multicenter pooled analysis of prospectively assembled data. Core-cut (CC)-MIB or vacuum-assisted (VAB)-MIB were performed after NACT and before surgery. Negative predictive values (NPV) and false-negative rates (FNR) to predict a pCR in surgical specimen (diagnose pCR through MIB) were the main outcome measures.RESULTS: Pathological complete response in surgical specimen was diagnosed in 93 (56.7%) cases of the whole cohort. The NPV of the MIB diagnosis of pCR was 71.3% (95% CI: (63.3%; 79.3%)). The FNR was 49.3% (95% CI: (40.4%; 58.2%)). Existence of a clip marker tended to improve the NPV (odds ratio 1.98; 95% CI: (0.81; 4.85)). None of the mammographically guided VABs (n=16) was false-negative (FNR 0%, NPV 100%).CONCLUSIONS: Overall accuracy of MIB diagnosis of pCR was insufficient to suggest changing clinical practice. However, subgroup analyses (mammographically guided VABs) suggest a potential capacity of MIB techniques to precisely diagnose pCR after NACT. Representativity of MIB could be a crucial factor to be focused on in further analyses.
AB - BACKGROUND: Neoadjuvant chemotherapy (NACT) is widely used as an efficient breast cancer treatment. Ideally, a pathological complete response (pCR) can be achieved. Up to date, there is no reliable way of predicting a pCR. For the first time, we explore the ability of minimal invasive biopsy (MIB) techniques to diagnose pCR in patients with clinical complete response (cCR) to NACT in this study. This question is of high clinical relevance because a reliable pCR prediction could have direct implications for clinical practice.METHODS: In all, 164 patients were included in this review-board approved, multicenter pooled analysis of prospectively assembled data. Core-cut (CC)-MIB or vacuum-assisted (VAB)-MIB were performed after NACT and before surgery. Negative predictive values (NPV) and false-negative rates (FNR) to predict a pCR in surgical specimen (diagnose pCR through MIB) were the main outcome measures.RESULTS: Pathological complete response in surgical specimen was diagnosed in 93 (56.7%) cases of the whole cohort. The NPV of the MIB diagnosis of pCR was 71.3% (95% CI: (63.3%; 79.3%)). The FNR was 49.3% (95% CI: (40.4%; 58.2%)). Existence of a clip marker tended to improve the NPV (odds ratio 1.98; 95% CI: (0.81; 4.85)). None of the mammographically guided VABs (n=16) was false-negative (FNR 0%, NPV 100%).CONCLUSIONS: Overall accuracy of MIB diagnosis of pCR was insufficient to suggest changing clinical practice. However, subgroup analyses (mammographically guided VABs) suggest a potential capacity of MIB techniques to precisely diagnose pCR after NACT. Representativity of MIB could be a crucial factor to be focused on in further analyses.
KW - Adult
KW - Aged
KW - Breast
KW - Breast Neoplasms
KW - Chemotherapy, Adjuvant
KW - False Negative Reactions
KW - Female
KW - Humans
KW - Image-Guided Biopsy
KW - Middle Aged
KW - Neoadjuvant Therapy
KW - Predictive Value of Tests
KW - Retrospective Studies
KW - Treatment Outcome
KW - Journal Article
KW - Multicenter Study
U2 - 10.1038/bjc.2015.381
DO - 10.1038/bjc.2015.381
M3 - SCORING: Journal article
C2 - 26554654
VL - 113
SP - 1565
EP - 1570
JO - BRIT J CANCER
JF - BRIT J CANCER
SN - 0007-0920
IS - 11
ER -