Waldrep Ashley R, Avery Eric J, Rose Ferrill F, Midathada Madhu V, Tilford Joni A, Kolberg Hans-Christian, Hutchins Mark R
Union College Physician Assistant Program, Lincoln, NE, U.S.A.
Nebraska Hematology-Oncology, PC, Lincoln, NE, U.S.A.
Anticancer Res. 2016 Oct;36(10):5389-5395. doi: 10.21873/anticanres.11114.
BACKGROUND/AIM: Clinical response evaluation after neoadjuvant chemotherapy (NACT) for breast cancer could include various imaging methods, as well as clinical breast exam (CBE). We assessed the accuracy of CBE and imaging to predict pathologic response after NACT administration according to breast cancer subtype.
This retrospective cohort study included 84 patients with records of NACT and subsequent primary breast surgery from 2003-2013. Patients were divided into 4 breast cancer subtypes according to hormone receptor (HR) status and human epidermal growth factor receptor-2 (HER2) status. Negative predictive value (NPV), false-negative rate (FNR), false-positive rate (FPR) and positive predictive value (PPV) were calculated for CBE and imaging post-NACT and prior to breast cancer surgery.
NPV, FNR, FPR and PPV varied by breast cancer subtype and clinical response evaluation method. Imaging resulted in a higher NPV and a lower FNR than CBE among the entire cohort. There was a lower FPR with CBE. Clinical response evaluation by CBE was highly accurate for predicting pathologic residual disease in HR+ tumors (CBE PPV: 95.5% in HR+HER2-, 100.0% in HR+HER2+). In triple-negative breast cancer (TNBC), the imaging NPV was 100% and the imaging FNR was 0%.
The use of imaging in HR+ tumors post-NACT may provide little to no additional value that is not already garnered by performance of a CBE. For TNBC, imaging may play a critical role in the prediction of pathologic complete response (pCR) post-NACT.
背景/目的：乳腺癌新辅助化疗（NACT）后的临床反应评估可包括多种影像学方法以及临床乳腺检查（CBE）。我们根据乳腺癌亚型评估了CBE和影像学预测NACT给药后病理反应的准确性。
这项回顾性队列研究纳入了2003年至2013年有NACT记录及后续原发性乳腺癌手术记录的84例患者。根据激素受体（HR）状态和人表皮生长因子受体2（HER2）状态将患者分为4种乳腺癌亚型。计算了NACT后及乳腺癌手术前CBE和影像学检查的阴性预测值（NPV）、假阴性率（FNR）、假阳性率（FPR）和阳性预测值（PPV）。
NPV、FNR、FPR和PPV因乳腺癌亚型和临床反应评估方法而异。在整个队列中，影像学检查的NPV高于CBE，FNR低于CBE。CBE的FPR较低。CBE对HR+肿瘤病理残留疾病的预测具有较高的准确性（HR+HER2-型中CBE的PPV为95.5%，HR+HER2+型中为100.0%）。在三阴性乳腺癌（TNBC）中，影像学检查的NPV为100%，FNR为0%。
NACT后在HR+肿瘤中使用影像学检查可能几乎没有或根本没有提供CBE已经获得的额外价值。对于TNBC，影像学检查可能在预测NACT后的病理完全缓解（pCR）中起关键作用。
