Identification of exceptional responders in whom breast cancer surgery can be eliminated following neoadjuvant systemic therapy


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Henry Kuerer1
1University of Texas MD Anderson Cancer Center

Abstract

Background

Pathologic complete response (pCR) rates after NST have improved dramatically, suggesting that surgery might be avoided in some patients. Safe avoidance of surgery would require accurate confirmation of no residual invasive/in situ carcinoma. A clinical trial to determine the accuracy of fine-needle aspiration (FNA) and vacuum-assisted core biopsy (VACB) in assessing the presence of residual cancer in the breast after neoadjuvant systemic therapy (NST) and updates on other international studies will be presented. In the initial MD Anderson prospective study, patients with triple-negative or HER2-positive cancer receiving NST underwent image-guided biopsy of the initial breast tumor region before surgery. Median initial tumor size was 3.3 cm; 40% had biopsy-proven nodal metastases. After NST, median tumor size was 1.1 cm. 48t% had a breast pCR and was concordant with pathologic nodal status in 98%. Combined FNA/VACB demonstrated an accuracy of 98% (95% CI, 87%-100%), false-negative rate of 5% (95% CI, 0%-24%), and negative predictive value of 95% (95% CI, 75%-100%) in predicting residual breast cancer. After NST, image-guided FNA/VACB can accurately identify patients with a breast pCR. A prospective clinical trial has commenced in which breast surgery is omitted in patients with a breast pCR after NST according to image-guided biopsy.