China Oncology ›› 2022, Vol. 32 ›› Issue (4): 335-342.doi: 10.19401/j.cnki.1007-3639.2022.04.006
• Review • Previous Articles Next Articles
XU Bingqi()(), ZHANG Guoqiang()()
Received:
2021-02-25
Revised:
2021-07-25
Online:
2022-04-30
Published:
2022-05-07
Contact:
ZHANG Guoqiang
E-mail:xbq14lc@163.com;zhangguoqiang@hrbmu.edu.cn
CLC Number:
XU Bingqi, ZHANG Guoqiang. Advances in the diagnosis of pathological response by a second biopsy in breast cancer neoadjuvant therapy and their clinical significance[J]. China Oncology, 2022, 32(4): 335-342.
Tab. 1
The advantages and disadvantages of assessment approaches for response to neoadjuvant chemotherapy"
Approach | Clinical examination | Mammography | Ultrasound | MRI | Second biopsy |
---|---|---|---|---|---|
Advantages | Simple and convenient | High sensitivity | Easy to operate and free of radiation; High accuracy; Assessable for axillary response; | High resolution for soft tissue; Non-invasive and free of radiation; Highest accuracy in traditional radiology | Higher accuracy than MRI; Lower false-negative rate |
Disadvantages | Effect by subjective judgement; Lower accuracy than other approaches | Effect by breast density, benign calcification and artifacts etc.; Exposure to radiation; Axillary status cannot be assessed; Difficult to distinguish the residual disease and post-chemotherapy fibrosis | Highly effect by the operator; High false positive rate | Expensive; Risk of contrast agent sensitization | Invasive; Required marker clips; Accuracy depends on the size of needle and number of specimens; Guided by imaging |
Tab. 2
Small prospective trails of pCR prediction by biopsy"
Study | Eligibility criteria | Number of patients | Type of biopsy | Type of guidance | Results |
---|---|---|---|---|---|
Heil, et al.[ | Early breast cancer; cCR after NACT | 164 | 111 by CC and 46 by VAB | 143 by ultrasound; 20 by mammograph; 1 by unknow | NPV=71.3% FNR=49.3% |
Heil, et al.[ | Operable breast cancer; cCR/cPR after NACT; target lesion visible on ultrasound | 50 | VAB | Ultrasound | Entire cohort: NPV=76.7%; FNR=49.3%; Pathologic representative specimens: NPV=94.4%; FNR=4.8% |
MD Anderson Cancer Center[ | TNBC and HER2+ breast caner; Lesion size < 5 cm on imaging after NACT | 40 | VAB and FNA; median sampling number of 12 | 63% by stereotactic techniques; 37% by ultrasound | Accuracy=98%; FNR=5%; NPV=95% |
NOSTRA PRELIM[ | Invasive breast cancer regardless of subtypes; Received NACT | 20 | CNB; median sampling number of 4 | Ultrasound | Cases of false negative of 4/18 |
Lee, et al.[ | Near pCR after NACT (Size of lesion≤0.5 cm or L-to-B SER ≤1.6 on MRI) | 40 | CNB or VAB | MRI assisted ultrasound | NPV=87.1%; FNR=30.8%; Accuracy=90% |
Tab. 3
Large prospective trials of pCR prediction by biopsy"
Study group | Eligibility criteria | Type of biopsy | Number of patients | Unique features | Results |
---|---|---|---|---|---|
MICRA[ | Invasive breast cancer; No metastasis; rPR/rCR by CE-MRI after NACT | Ultrasound-guided 14G biopsies targeted around pre-NACT-placed marker (4 central and 4 peripheral) | 167 (still recruiting) | Included all subtypes; Assessing response by CE-MRI | FNR=37% |
RESPONDER[ | Invasive breast cancer; cCR/PR; Visible targeted lesion on ultrasound/mammography | Ultrasound/mammography guided VAB | 398 | pCR identified by VAB | FNR=17.8% (95% CI: 12.8%-23.7%) |
NRG-BR005[ | Unifocal or multifocal; cCR after NACT; rCR/nearCR by triple- modality radiology; Patients must have a biopsy marker placed within the tumor bed with imaging confirmation of marker placement prior to NST | 6, 8, 11G VAB, stereotactic-guided | 98 (still recruiting) | Multicenter, triple-modality radiology was required | FNR=50% NPV=77.5% (95% CI: 66.8%-86.1%) |
Multicenter pooled analysis[ | Invasive breast cancer; Any subtypes; At least achieved rCR; Marker/residual tumor/microcalcification can be clearly identified within the primary lesion location | VAB/CNB; Ultrasound or stereotactic | 166 | Multicenter pooled data analysis | FNR=18.7% NPV=84.3% |
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