Accuracy of core biopsy image-guided post-neoadjuvant chemotherapy breast to predict pathologic complete response

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Abstract

Background. Achieving a pathologic complete response (pCR) after neoadjuvant systemic therapy (NST) is a predictive factor for improving disease free and overall survival. In triple negative (TN) and HER2-positive breast cancer (BC), the pCR rate exceeds 60 %. Patients with TN and HER2-positive BC who demonstrate an excellent response to NST are like­ly ideal candidates for downsizing surgery. The condition for reducing the volume of surgical intervention is a reliable determination of pathologic complete response using instrumental imaging and biopsy methods.

Aim. To further assess the accuracy of post-NST image-guided biopsy to predict pCR.

Materials and methods. Sixty one patients with T1-3N0-3 triple negative or HER2-positive BC receiving NST in the Department of Breast Tumors of the NMRC of Oncology named after N.N. Petrov in the period from 2017 to 2019 were enrolled in this single-center retrospective trial. Patients underwent ultrasound-guided core-biopsy of the initial breast tumor region before surgery. Findings were compared with findings on pathologic evaluation of surgical specimens to determine the performance of biopsy in predicting pCR after NST.

Results. After neoadjuvant systemic therapy, clinical partial response (cPR) was diagnosed in 47 (77 %) patients, clinical complete response (cCR) in 14 (23 %) patients. pCR in the core-biopsy tissue and surgical material was achieved in 46 (75.4 %) and 37 (60.7 %), respectively. Performance of image-guided core-biopsy: sensitivity 100 % (95 % confldence interval (CI) 90.51-100), specificity 62.5 % (95 % CI 40.59-81.20), false-negative rate (FNR) 0 %, positive-pre­dictive value (PPV) 75.00 % (95 % CI 59.46-85.99), negative predictive value (NPV) 100.00 %.

Conclusion. This retrospective trial showed that ultrasound-guided core biopsies are accurate enough to identify breast pCR in patients with triple-negative or HER2-positive BC with good response after NST (FNR 0 %). Based on these results, 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.

About the authors

P. V. Krivorotko

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia

Author for correspondence.
ORCID iD: 0000-0002-4898-9159

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

Russian Federation

V. V. Mortada

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia

Email: vika-gukova@mail.ru
ORCID iD: 0000-0002-1982-5710

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

Russian Federation

R. S. Pesotskiy

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia

ORCID iD: 0000-0002-2573-2211

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

Russian Federation

A. S. Artemyeva

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia

ORCID iD: 0000-0002-2948-397X

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

Russian Federation

A. S. Emelyanov

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia

ORCID iD: 0000-0002-0528-9937

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

Russian Federation

S. S. Ereshchenko

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia

ORCID iD: 0000-0002-5090-7001

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

Russian Federation

G. A. Dashyan

D.D. Pletnev City Clinical Hospital, Moscow Healthcare Department

ORCID iD: 0000-0001-6183-9764

32 11-ya Parkovaya St., Moscow 105077

Russian Federation

N. S. Amirov

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia

ORCID iD: 0000-0002-2421-3284

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

Russian Federation

T. T. Tabagua

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia; I.P. Pavlov First Saint Petersburg State Medical University

ORCID iD: 0000-0003-1471-9473

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

6—8 Lva Tolstogo St., Saint Petersburg 197022

Russian Federation

L. P. Gigolaeva

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia

ORCID iD: 0000-0001-7654-4336

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

Russian Federation

A. V. Komyakhov

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia

ORCID iD: 0000-0002-6598-1669

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

Russian Federation

K. S. Nikolaev

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia

ORCID iD: 0000-0003-3377-6369

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

Russian Federation

M. M. Mortada

Saint Petersburg Research Institute of Phthisiopulmonology, Ministry of Health of Russia

ORCID iD: 0000-0002-5838-6861

2—4 Ligovskiy Prospekt, Saint Petersburg 191036

Russian Federation

K. Yu. Zernov

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia

ORCID iD: 0000-0002-2138-3982

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

Russian Federation

E. K. Zhiltsova

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia

ORCID iD: 0000-0002-2029-4582

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

Russian Federation

V. O. Smirnova

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

Russian Federation

Ya. I. Bondarchuk

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia

ORCID iD: 0000-0002-6442-0106

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

Russian Federation

D. A. Enaldieva

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia

ORCID iD: 0000-0002-2773-3111

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

Russian Federation

S. N. Novikov

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia

ORCID iD: 0000-0002-7185-1967

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

Russian Federation

E. A. Busko

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia; Saint Petersburg State University

ORCID iD: 0000-0002-0940-6491

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

7—9 Universitetskaya Naberezhnaya, Saint Petersburg 199034

Russian Federation

A. V. Chernaya

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia

ORCID iD: 0000-0002-7975-3165

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

Russian Federation

P. I. Krzhivitskiy

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia

ORCID iD: 0000-0002-6864-6348

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

Russian Federation

R. M. Paltuev

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia

ORCID iD: 0000-0002-0871-9453

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

Russian Federation

T. Yu. Semiglazova

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia

ORCID iD: 0000-0002-4305-6691

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

Russian Federation

V. F. Semiglazov

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia

ORCID iD: 0000-0003-0077-9619

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

Russian Federation

A. M. Belyaev

N.N. Petrov Research Institute of Oncology, Ministry of Health of Russia

ORCID iD: 0000-0001-5580-4821

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

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