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新辅助化疗后乳腺癌组织形态学变化的评估

Evaluation of Histomorphological Changes in Breast Cancer Post-Neoadjuvant Chemotherapy.

作者信息

Ahuja Sana, G Kiruthikasri, Zaheer Sufian

机构信息

Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.

出版信息

Indian J Surg Oncol. 2024 Jun;15(2):236-240. doi: 10.1007/s13193-024-01876-3. Epub 2024 Jan 12.

Abstract

Breast cancer, a leading cause of global female mortality, demands comprehensive diagnostic and therapeutic strategies. This study delves into the nuanced realm of post-neoadjuvant chemotherapy breast cancer specimens, emphasizing the imperative need for pathologists to discern stromal and nuclear alterations adeptly. The investigation, encompassing 100 female patients with a mean age of 47.5 years, elucidates the demographic and clinicopathological parameters. Predominantly presenting as palpable lumps (85%), invasive ductal carcinoma emerged as the predominant histological type (98%). The primary focus of the study revolves around the morphological changes post-neoadjuvant chemotherapy, with a meticulous qualitative analysis encompassing stromal elements (fibrosis, elastosis, calcification) and nuclear features (pyknosis, hyperchromasia). Notably, the response to chemotherapy, classified by the International Union against Cancer criteria, delineates a substantial pathological complete response (55%), partial response (35%), and limited non-response (10%). The therapeutic landscape includes a majority of cases undergoing extensive chemotherapy cycles, primarily featuring the cyclophosphamide, doxorubicin, and paclitaxel regimen. Remarkably, this investigation unveils fibrosis (63%) and elastosis/collagenization (51%) as prevalent stromal changes, while pyknosis (58%) and hyperchromasia (48%) dominate nuclear alterations. In conclusion, this retrospective study provides a comprehensive overview of post-neoadjuvant chemotherapy breast cancer specimens, shedding light on the intricate interplay of clinical parameters, treatment responses, and histopathological changes. The findings underscore the pivotal role of pathologists in accurately diagnosing and grading tumors in the evolving landscape of breast cancer management.

摘要

乳腺癌是全球女性死亡的主要原因之一,需要全面的诊断和治疗策略。本研究深入探讨了新辅助化疗后乳腺癌标本的细微领域,强调病理学家必须熟练辨别间质和细胞核的改变。该调查涵盖了100名平均年龄为47.5岁的女性患者,阐明了人口统计学和临床病理参数。主要表现为可触及肿块(85%),浸润性导管癌是主要的组织学类型(98%)。研究的主要重点围绕新辅助化疗后的形态学变化,进行了细致的定性分析,包括间质成分(纤维化、弹性组织变性、钙化)和细胞核特征(核固缩、核染色质增多)。值得注意的是,根据国际抗癌联盟标准分类的化疗反应显示,有大量的病理完全缓解(55%)、部分缓解(35%)和有限的无反应(10%)。治疗方案包括大多数病例接受广泛的化疗周期,主要采用环磷酰胺、多柔比星和紫杉醇方案。值得注意的是,这项调查发现纤维化(63%)和弹性组织变性/胶原化(51%)是常见的间质变化,而核固缩(58%)和核染色质增多(48%)则主导了细胞核的改变。总之,这项回顾性研究全面概述了新辅助化疗后乳腺癌标本,揭示了临床参数、治疗反应和组织病理学变化之间的复杂相互作用。研究结果强调了病理学家在乳腺癌管理不断发展的背景下准确诊断和分级肿瘤方面的关键作用。

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