Richter Hannah, Hennigs André, Schaefgen Benedikt, Hahn Markus, Blohmer Jens Uwe, Kümmel Sherko, Kühn Thorsten, Thill Marc, Friedrichs Kay, Sohn Christof, Golatta Michael, Heil Jörg
Brustzentrum der Universitäts-Frauenklinik Heidelberg, Heidelberg, Germany.
Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Germany.
Geburtshilfe Frauenheilkd. 2018 Jan;78(1):48-53. doi: 10.1055/s-0043-124082. Epub 2018 Jan 22.
The likelihood of pathological complete remission (pCR) of breast cancer following neoadjuvant chemotherapy (NACT) is increasing; most of all in the triple negative and HER2 positive tumour subgroups. The question thus arises whether or not breast surgery is necessary when there is complete remission after NACT, and whether it provides any improvement of the oncological treatment result when tumour is no longer detectable. Avoiding surgery and possibly even radiotherapy would only be conceivable on the basis of a reliable diagnosis of pCR without operating. Current imaging does not achieve the necessary sensitivity and specificity to assure the diagnosis of pathological complete remission. Further studies are therefore required to determine which methods are best able to evaluate tumour response to NACT. Studies on image-guided, minimally invasive biopsies after NACT have delivered first promising results towards diagnosing pCR before surgery and could provide the basis for further studies on the possibility of avoiding surgery in this specific patient collective.
新辅助化疗（NACT）后乳腺癌达到病理完全缓解（pCR）的可能性正在增加，这在三阴性和HER2阳性肿瘤亚组中最为明显。因此出现了一个问题：NACT后若实现完全缓解，是否还需要进行乳腺手术；当肿瘤不再可检测到时，手术是否能改善肿瘤治疗效果。只有在不进行手术就能可靠诊断pCR的基础上，才有可能避免手术甚至放疗。目前的影像学检查无法达到确保病理完全缓解诊断所需的敏感性和特异性。因此，需要进一步研究以确定哪些方法最能评估肿瘤对NACT的反应。关于NACT后影像引导下微创活检的研究已取得了一些初步的有前景的结果，有助于在手术前诊断pCR，并可为进一步研究在这一特定患者群体中避免手术的可能性提供依据。
