scholarly journals Can axillary surgery be omitted in patients with breast pathologic complete response after neoadjuvant systemic therapy for breast cancer? A real-world retrospective study in China

2021 ◽  
Author(s):  
Rui Chen ◽  
Shuo Li ◽  
Yan Li ◽  
Qiannan Zhu ◽  
Xiaoqing Shi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Retrospective Study ◽  
Real World ◽  
Systemic Therapy ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Axillary Surgery ◽  
Neoadjuvant Systemic Therapy

scholarly journals Can axillary surgery be omitted in patients with breast pathologic complete response after neoadjuvant systemic therapy for breast cancer? A real-world retrospective study in China

2021 ◽  
Author(s):  
Rui Chen ◽  
Shuo Li ◽  
Yan Li ◽  
Qiannan Zhu ◽  
Xiaoqing Shi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Real World ◽  
Systemic Therapy ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Axillary Surgery ◽  
Neoadjuvant Systemic Therapy

Abstract Purpose Studies show that axillary surgery can be potentially omitted in certain breast cancer patients who achieve breast pathologic complete response (pCR) after neoadjuvant systemic therapy (NST). However, potential differences between the ypT0 and ypTis subgroups remain to be explored. Furthermore, whether axillary surgery can be omitted in patients with clinically assessed positive axillary lymph nodes (cN+) remains unknown. This study was to evaluate the status of axillary lymph nodes for patients who achieved breast pCR after NST in the real-world study. Methods This retrospective cohort study included 258 patients with early or locally advanced breast cancer who underwent breast and axillary surgery after NST. Clinical and pathologic data were compared between patients with breast pCR (ypT0/is) and those without breast pCR. Results The rate of breast pCR after NST was 27.1% (70/258). Among the patients with initial cN0, the rate of axillary pCR was similar between the breast pCR and breast non-pCR groups (100% vs. 85.7%, P = 0.1543). Among those with breast pCR, the rate of axillary pCR was 100% in both the ypT0 and ypTis subgroups. Furthermore, among those with initial cN+, the rate of axillary pCR was higher in the breast pCR group than in the breast non-pCR group (82.7% vs. 22.9%, P < 0.0001). Among the patients with breast pCR, the rate of axillary pCR was higher in the ypT0 subgroup than in the ypTis subgroup (94.3% vs. 58.8%, P = 0.0034). Conclusion Axillary surgery may potentially be omitted in patients with initial cN0 who achieve breast pCR (ypT0/is), and may also be considered for omission in patients with initial cN + who achieve ypT0 (not ypTis).

scholarly journals Can Axillary Surgery Be Omitted in Patients With Breast Pathologic Complete Response After Neoadjuvant Systemic Therapy for Breast Cancer? A Real-World Re Trospective Study in China

2021 ◽  
Author(s):  
Jue Wang ◽  
Yan Li ◽  
Shuo Li ◽  
Qiannan Zhu ◽  
Xiaoqing Shi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systemic Therapy ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Axillary Surgery ◽  
Neoadjuvant Systemic Therapy

Abstract BackgroundStudies show that axillary surgery can be potentially omitted in certain breast cancer patients who achieve breast pathologic complete response (pCR) after neoadjuvant systemic therapy (NST). However, potential differences between the ypT0 (no residual invasive or in situ carcinoma in the breast) and ypTis (in situ carcinoma in the breast) subgroups remain to be explored. Furthermore, whether axillary surgery can be omitted in patients with clinically assessed positive axillary lymph nodes (cN+) remains unknown.MethodsThis retrospective cohort study included 258 patients with early or locally advanced breast cancer who underwent breast and axillary surgery after NST. Clinical and pathologic data were compared between patients with breast pCR (ypT0/is) and those without breast pCR.ResultsAmong the patients with initial cN0, the rate of axillary pCR was similar between the breast pCR and breast non-pCR groups (P = 0.1543). Among those with breast pCR, the rate of axillary pCR was 100% in both the ypT0 and ypTis subgroups. Furthermore, among those with initial cN+, the rate of axillary pCR was higher in the breast pCR group than in the breast non-pCR group (P < 0.0001). Among the patients with breast pCR, the rate of axillary pCR was higher in the ypT0 subgroup than in the ypTis subgroup (P = 0.0034).ConclusionAxillary surgery may potentially be omitted in patients with initial cN0 who achieve breast pCR (ypT0/is), and may also be considered for omission in patients with initial cN+ who achieve ypT0 (not ypTis).

Towards omitting breast cancer surgery in select patient groups: Assessment of pathologic complete response after neoadjuvant systemic therapy using biopsies—The MICRA trial.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. TPS593-TPS593 ◽  
Author(s):  
Marieke Van Der Noordaa ◽  
Frederieke van Duijnhoven ◽  
Claudette Loo ◽  
Koen van der Vijver ◽  
Gabe S. Sonke ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Systemic Therapy ◽  
Breast Surgery ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Breast Cancer Patients ◽  
Systemic Treatments ◽  
Neoadjuvant Systemic Therapy ◽  
Tumor Area

TPS593 Background: Improvements in systemic treatments for breast cancer patients has led to increasing rates of pathologic complete response (pCR). In addition, the identification of a pCR has been greatly improved with magnetic resonance imaging (MRI). In patients with a pCR, surgical resection of (part of) the original tumor area is performed to confirm the absence or presence of pCR and is not likely to contribute to locoregional control. With the MICRA trial (Minimally Invasive Complete Response Assessment) we aim to omit breast surgery in breast cancer patients achieving pathologic complete response (pCR) after neoadjuvant systemic therapy (NST) using biopsies, thus preventing overtreatment and improving quality of life. Methods: The MICRA trial is a multi-center observational prospective cohort study. In all breast cancer patients receiving NST, a marker is placed in the center of the tumor area before NST. 440 patients with radiologic complete response or partial response (0.1-2.0 cm residual contrast enhancement, ≥30% decrease in tumor size according to RECIST criteria) on contrast enhanced MRI will be included in the MICRA trial. Patients with hormone receptor positive, triple negative and Human Epidermal growth factor Receptor 2 tumors are eligible. After NST, 8 ultrasound-guided biopsies are obtained in the region surrounding the marker, while the patient is under general anesthesia. Immediately hereafter, breast surgery is performed and pathology results of the biopsies and resected specimens are compared. The primary endpoint is specificity of post-NST biopsies. In addition, sensitivity and positive and negative predictive value will be calculated. We will perform a multivariable analysis using data on MRI and ultrasound findings, pre-NST pathology parameters and post-NST biopsy results to determine what the most reliable method is to assess pCR and how many biopsies are needed for this purpose. Conclusion: With the MICRA-trial we aim to select a group of breast cancer patients in whom surgery of the breast after NST can be omitted, by predicting the presence of a pCR on biopsies. Clinical trial information: NTR6120.

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