Accuracy of Magnetic Resonance Imaging–Guided Biopsy to Verify Breast Cancer Pathologic Complete Response After Neoadjuvant Chemotherapy

Sutton, Elizabeth; Braunstein, Lior Z.; El‐Tamer, Mahmoud; Hughes, Mary; Bryce, Yolanda; Gluskin, Jill S.; Powell, Simon N.; Woosley, Alyssa; Tadros, Audree B; Sevilimedu, Varadan; Martinez, Danny F.; Toni, Larowin; Smelianskaia, Olga; Nyman, C. Gregory; Razavi, Pedram; Norton, Larry; Fung, Maggie; Sedorovich, James D.; Sacchini, Virgilio; Morris, Elizabeth A.

doi:10.1001/jamanetworkopen.2020.34045

Cited by 22 publications

(18 citation statements)

References 28 publications

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“…This was depending on the definition used for pCR. If this was defined as no residual disease including invasive cancer and DCIS, the FNR was 25%, while when pCR was defined as no residual invasive disease, the FNR was 14.2% [ 31 ]. An analysis from MD Anderson Cancer Center showed that stereo-guided compared to ultrasound-guided VAB was associated with the ability to retrieve more cores and had a higher positive predictive value for residual disease, therefore recommending this modality as the preferred method for identification of patients with pCR for trials testing the safety of omission of surgery [ 32 ].…”

Section: De-escalation Of Breast Surgerymentioning

confidence: 99%

De-escalating Surgery Among Patients with HER2 + and Triple Negative Breast Cancer

Tasoulis

Heil

Kuerer

2022

Curr Breast Cancer Rep

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Purpose of Review De-escalation of surgery has been central in the evolution of multidisciplinary management of breast cancer. Advances in oncology and increasing use of neoadjuvant chemotherapy (NACT) have opened opportunities for further surgical de-escalation especially for HER2 + and triple negative (TN) disease. The aim of this review is to discuss the recent data on de-escalation of surgery as well as the future directions. Recent Findings Patients with TN and HER2 + breast cancer with excellent response to NACT would be the ideal candidates for surgical de-escalation. Post-NACT image-guided biopsy, potentially combined with machine learning algorithms, may accurately identify patients achieving pathologic complete response that would be eligible for clinical trials assessing safety of omission of breast and axillary surgery. Summary Multidisciplinary research is required to further support results of preliminary studies. Current data point towards a future when even less or no surgery may be required for exceptional responders.

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Section: De-escalation Of Breast Surgerymentioning

confidence: 99%

De-escalating Surgery Among Patients with HER2 + and Triple Negative Breast Cancer

Tasoulis

Heil

Kuerer

2022

Curr Breast Cancer Rep

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“…This limits the use of MRI as a definitive imaging surrogate for surgical exploration to confirm pCR, although several studies are investigating approaches combining imaging and biopsy to explore the potential to avoid surgery. [12][13][14] Perhaps more relevant to the personalization of treatment is the ability of imaging to predict treatment outcome when measured early in the course of treatment. Early noninvasive indicators of treatment effectiveness could provide a basis for modifying treatment plans, making de-escalation possible for patients showing excellent response and a recommended change in therapy for those with minimal response.…”

Section: Practical Applicationsmentioning

confidence: 99%

The Way of the Future: Personalizing Treatment Plans Through Technology

Liefaard

Lips

Wesseling

et al. 2021

American Society of Clinical Oncology Educational Book

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Advances in tissue analysis methods, image analysis, high-throughput molecular profiling, and computational tools increasingly allow us to capture and quantify patient-to patient variations that impact cancer risk, prognosis, and treatment response. Statistical models that integrate patient-specific information from multiple sources (e.g., family history, demographics, germline variants, imaging features) can provide individualized cancer risk predictions that can guide screening and prevention strategies. The precision, quality, and standardization of diagnostic imaging are improving through computer-aided solutions, and multigene prognostic and predictive tests improved predictions of prognosis and treatment response in various cancer types. A common theme across many of these advances is that individually moderately informative variables are combined into more accurate multivariable prediction models. Advances in machine learning and the availability of large data sets fuel rapid progress in this field. Molecular dissection of the cancer genome has become a reality in the clinic, and molecular target profiling is now routinely used to select patients for various targeted therapies. These technology-driven increasingly more precise and quantitative estimates of benefit versus risk from a given intervention empower patients and physicians to tailor treatment strategies that match patient values and expectations.

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“…As expected, FNR and negative predictive value (NPV) were better in HER2-enriched and TNBC subtypes. Larger gauge needles and multiple biopsy samples also improved the FNR and NPV [60-62]. Some studies included near or partial response to NAC as well as complete response [63].…”

Section: Omission Of Surgery After Nacmentioning

confidence: 99%

Innovative Standards in Surgery of the Breast after Neoadjuvant Systemic Therapy

et al. 2021

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Background: The goal of neoadjuvant systemic therapy (NST) in breast cancer is to downstage tumors and downgrade treatment. Indications are constantly evolving. These changes raise practical questions for planning of surgery after NST. Summary: In this review we discuss current evolving aspects of surgery of the breast after NST. Breast-conserving surgery (BCS) eligibility increases after NST – both neoadjuvant chemotherapy (NAC) and neoadjuvant endocrine therapy. Adequate margin width in NST and upfront surgery are similar – “no tumor on ink” for invasive cancer. Oncoplastic breast surgery after NST is feasible – both for BCS and mastectomy with reconstruction. There is increasing interest in the possibility of omitting surgery in patients with a complete response to NAC. Several trials are being conducted in aim of achieving acceptable prediction of pathological complete response, by combination of imaging and percutaneous biopsy of the tumor bed, as well as assessing the safety of such an approach. Key Messages: Surgery of the breast after NST should be determined not only according to biologic and anatomic parameters at diagnosis, but is dynamic, and must be tailored according to the response to therapy. The omission of surgery in exceptional responders after NAC is being explored.

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Accuracy of Magnetic Resonance Imaging–Guided Biopsy to Verify Breast Cancer Pathologic Complete Response After Neoadjuvant Chemotherapy

Cited by 22 publications

References 28 publications

De-escalating Surgery Among Patients with HER2 + and Triple Negative Breast Cancer

De-escalating Surgery Among Patients with HER2 + and Triple Negative Breast Cancer

The Way of the Future: Personalizing Treatment Plans Through Technology

Innovative Standards in Surgery of the Breast after Neoadjuvant Systemic Therapy

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