Department of Breast Surgery, Fudan University Shanghai Cancer Center, P.R. China; Department of Oncology, Shanghai Medical College, Fudan University, P.R. China.
Department of Breast Surgery, Fudan University Shanghai Cancer Center, P.R. China; Department of Oncology, Shanghai Medical College, Fudan University, P.R. China.
Surgery. 2020 Dec;168(6):1115-1121. doi: 10.1016/j.surg.2020.06.045. Epub 2020 Sep 8.
Early and accurate assessment of the response to neoadjuvant chemotherapy offers the potential to optimize treatment to obtain improved responses. We aimed to predict the response to neoadjuvant chemotherapy using a second breast core needle biopsy after a median of 2 cycles of neoadjuvant chemotherapy.
We evaluated 805 consecutive patients undergoing neoadjuvant chemotherapy who had a second core needle biopsy between 2013 and 2017. The second core needle biopsy was performed after a median of 2 cycles of neoadjuvant chemotherapy. Pathologic response was evaluated after completion of all the chemotherapy cycles. Diagnostic values were compared and evaluated between the second core needle biopsy and contrast-enhanced magnetic resonance imaging in both the whole and the human epidermal growth factor receptor 2-positive populations.
Overall, 653 patients were eligible and underwent a median of 6 chemotherapy cycles. The second core needle biopsy predicted residual breast cancer earlier than the final contrast-enhanced magnetic resonance imaging, with a greater positive predictive value (positive predictive value: 0.856 vs 0.802, P = .028). Multivariate analysis revealed that a estrogen receptor status, human epidermal growth factor receptor 2 positivity, findings on the final contrast-enhanced magnetic resonance imaging and the pathologic findings of the second core needle biopsy pathology were independent predictive factors for treatment response. The superiority in diagnostic value of a second core needle biopsy pathology in human epidermal growth factor receptor 2-positive patients was consistent with that in the whole population, with a positive predictive value of 0.785 (95% confidence interval: 0.707-0.847). The second core needle biopsy predicted the response to neoadjuvant chemotherapy as early as after 2 cycles, but the accuracy increased from 0.744 to 0.872 if the procedure was performed after more cycles (P = .002).
The second core needle biopsy predicted the response to neoadjuvant chemotherapy after 2 cycles quite well, especially in human epidermal growth factor receptor 2-positive patients. The ability of the prediction of response improved if the second biopsy was performed after 3 or 4 cycles.
早期准确评估新辅助化疗的反应有潜力优化治疗以获得更好的疗效。本研究旨在通过新辅助化疗 2 个周期后的第 2 次乳腺核心针活检来预测新辅助化疗的反应。
我们评估了 2013 年至 2017 年间进行新辅助化疗的 805 例连续患者，他们在新辅助化疗中位 2 个周期后进行了第 2 次核心针活检。所有化疗周期完成后评估病理反应。在整个人群和人表皮生长因子受体 2 阳性人群中，比较并评估了第 2 次核心针活检和对比增强磁共振成像的诊断价值。
共有 653 例患者符合条件，接受了中位数为 6 个化疗周期的治疗。第 2 次核心针活检预测残留乳腺癌的时间早于最终的对比增强磁共振成像，阳性预测值更高（阳性预测值：0.856 比 0.802，P=0.028）。多变量分析显示，雌激素受体状态、人表皮生长因子受体 2 阳性、最终对比增强磁共振成像结果和第 2 次核心针活检的病理结果是治疗反应的独立预测因素。在人表皮生长因子受体 2 阳性患者中，第 2 次核心针活检的病理在诊断价值上的优势与整个人群一致，阳性预测值为 0.785（95%置信区间：0.707-0.847）。第 2 次核心针活检在化疗 2 个周期后即可较早预测新辅助化疗的反应，但如果在更多周期后进行活检，准确性从 0.744 提高到 0.872（P=0.002）。
第 2 次核心针活检在化疗 2 个周期后很好地预测了新辅助化疗的反应，尤其是在人表皮生长因子受体 2 阳性患者中。如果在第 3 或 4 个周期后进行第 2 次活检，预测反应的能力会提高。
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