Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.
Department of Radiology, St. Luke's International Hospital, Tokyo, Japan.
Clin Breast Cancer. 2018 Apr;18(2):128-134. doi: 10.1016/j.clbc.2017.07.001. Epub 2017 Jul 21.
The influence of breast cancer (BC) subtype in discrepancies between pathologic complete response (pCR) and complete response by magnetic resonance imaging (MRI-CR) after neoadjuvant chemotherapy (NAC) have not been discussed well. We evaluated the association between BC subtype and pCR or only residual in situ lesion without invasive cancer (pCR/in situ) in patients with MRI-CR (positive predictive value [PPV]).
From the data of 716 patients with primary BC who were diagnosed with invasive cancer and treated with NAC and then surgery from January 2009 to May 2014 at St. Luke's International Hospital, 180 patients were determined to have MRI-CR by retrospective chart review. BC subtypes at baseline were classified into 6 subtypes, as strong estrogen receptor (ER), moderately positive ER (ER), negative ER (ER), and HER2 status expression.
Three subtypes had PPV (pCR) ≥ 50%: ER/HER2 (56.3%, 27/48), ER/HER2 (57.6%, 34/59), and ER/HER2 (56.2%, 9/16). However, PPV (pCR) for the ER/HER2 and ER/HER2 subtypes was < 30%; notably, only 12.0% (3/25) for the ER/HER2 subtype, which was significantly low (P < .001) compared with ER/HER2 and other subtypes. PPV (pCR/in situ) was significantly low at 20.0% in the ER/HER2 subtype (P < .001 compared with other subtypes). PPV (pCR/in situ) in other subtypes was collectively greater than 60%, and was 91.7% in the ER/HER2 subtype.
We should interpret carefully MRI-CR of NAC to evaluate residual disease for ER/HER2 BC.
新辅助化疗（NAC）后病理完全缓解（pCR）与磁共振成像（MRI）完全缓解（MRI-CR）之间的差异与乳腺癌（BC）亚型的影响尚未得到充分讨论。我们评估了 MRI-CR 患者中 BC 亚型与 pCR 或仅残留原位病变无浸润性癌（pCR 原位）之间的关系（阳性预测值 [PPV]）。
从 2009 年 1 月至 2014 年 5 月在圣卢克国际医院接受 NAC 治疗后手术的 716 例原发性 BC 患者的数据中，通过回顾性图表审查确定了 180 例患者 MRI-CR。基线时的 BC 亚型分为 6 种亚型，即强雌激素受体（ER）、中度阳性 ER（ER）、阴性 ER（ER）和 HER2 状态表达。
三种亚型的 PPV（pCR）≥50%：ER/HER2（56.3%，27/48）、ER/HER2（57.6%，34/59）和 ER/HER2（56.2%，9/16）。然而，ER/HER2 和 ER/HER2 亚型的 PPV（pCR）<30%；值得注意的是，仅 ER/HER2 亚型为 12.0%（3/25），明显低于 ER/HER2 和其他亚型（P<.001）。ER/HER2 亚型的 PPV（pCR 原位）为 20.0%，明显较低（P<.001 与其他亚型）。其他亚型的 PPV（pCR 原位）均大于 60%，ER/HER2 亚型为 91.7%。
我们应仔细解释 NAC 的 MRI-CR，以评估 ER/HER2 BC 的残留疾病。
