Department of Breast Surgery, Women's Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan; Department of Breast and Endocrine Surgery, Kumamoto City Hospital, 4-1-60 Higashimachi, Higashi-ku, Kumamoto 862-8505, Japan.
Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
Chin Clin Oncol. 2020 Jun;9(3):31. doi: 10.21037/cco-20-15.
Increased use of cancer screening, improved imaging, and diagnostic intervention techniques has led to the diagnosis of smaller cancers, including breast cancer. Most breast cancer patients receive systemic therapy, and some treatments are given before surgery, such as neoadjuvant therapy, even in an operable setting. Improved neoadjuvant chemotherapy has increased rates of pathological complete response; however, surgery is still required to determine complete tumor remission. Inadequate preoperative evaluations after neoadjuvant therapy can result in excessive surgical stress. Clinical imaging tests such as ultrasound and magnetic resonance imaging of the breast are often performed with neoadjuvant therapy. These clinical imaging techniques, in addition to measuring tumor size, have made it possible to evaluate certain functional aspects of the tumors. Herein, we review the current state of clinical imaging research focused on predicting neoadjuvant chemotherapy response in breast cancer. We also discuss the upfront prediction of treatment response before and during neoadjuvant therapy and the later prediction of pathological residual tumors, including pathological complete response, using ultrasound and magnetic resonance imaging. Upfront prediction can help decision-making and develop new treatment strategies. Predicting the localization of microscopic residual tumors may contribute to disease management without surgery, using radiation or other local treatments. Further larger studies on the prediction of neoadjuvant therapy response using clinical imaging could improve clinical practice and patient benefits.
癌症筛查的广泛应用、成像技术的改进和诊断干预技术的进步，导致了更小的癌症的诊断，包括乳腺癌。大多数乳腺癌患者接受系统治疗，有些治疗在手术前进行，如新辅助治疗，即使在可手术的情况下也是如此。新辅助化疗的改进提高了病理完全缓解率；然而，仍需要手术来确定肿瘤是否完全缓解。新辅助治疗后术前评估不足可能导致手术应激过大。新辅助治疗常结合超声和乳房磁共振成像等临床影像学检查进行。这些临床影像学技术除了测量肿瘤大小外，还可以评估肿瘤的某些功能方面。本文综述了目前针对乳腺癌新辅助化疗反应预测的临床影像学研究现状。我们还讨论了新辅助治疗前和治疗期间治疗反应的即时预测，以及超声和磁共振成像对病理残留肿瘤（包括病理完全缓解）的后期预测。即时预测有助于决策制定和开发新的治疗策略。预测微观残留肿瘤的定位可能有助于在不进行手术的情况下，通过放疗或其他局部治疗来管理疾病。进一步开展关于临床影像学预测新辅助治疗反应的更大规模研究，可能会改善临床实践和患者获益。
