Histologische Regression des Mammakarzinoms nach primärer (neoadjuvanter) Chemotherapie

Abstract

Primary (neoadjuvant) chemotherapy of locally advanced breast carcinomas is performed to locally reduce the tumour mass and to improve the operability. Recently, the indication for primary chemotherapy has been extended for preoperative treatment in breast conserving surgery. In an ongoing clinical trial we examined the resection specimens of 51 mammary carcinomas after primary chemotherapy. These patients had received a neoadjuvant therapy with epirubicin/cyclophosphamide for size reduction of large (> 3 cm) but operable tumours (pretreatment median tumour size 4.5 cm by mammography). The tumour response was evaluated pathologically and compared with the clinical tumour regression that was observed in over two-thirds of all cases. We classified the regressive changes using a semiquantitative scoring system from 0 to 4 (0 = no effect, 1 = resorption and tumour sclerosis, 2 = minimal residual invasive tumour [< 0.5 cm], 3 = residual noninvasive tumour only, 4 = no tumour detectable). The aim of this study was to evaluate the improvement of operability objectively and to correlate the histology of the primary tumour with the response to treatment. With invasive lobular carcinomas, the tumour size after therapy was reduced less than average and irrespective of the amount of histological tumour cell reduction, largely due to the stromal content of these neoplasms. Invasive ductal carcinomas with extensive or predominant intraductal component also underwent only a slight decrease in tumour size; this was because of the lack of tumour response with the intraductal component. Well differentiated tubular carcinomas were particularly resistant to primary chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Locally advanced breast carcinoma: computer assisted semiquantitative analysis of color Doppler ultrasonography in the evaluation of tumor response to neoadjuvant chemotherapy (work in progress).

“…These parameters are not concordant, mainly because of the biologic heterogeneity of breast carcinoma, especially the relationship between tumor and stroma, and must be considered separately in the postoperative assessment of the therapeutic effect. 32 A comparison of the histopathologically determined tumor size with the clinical before and after chemotherapy assessment of tumor size demonstrates that clinical and radiologic findings tend to suggest a reduction in tumor volume which, however, is frequently not confirmed by histopathologic examination. Thus in some cases the actual tumor size after neoadjuvant therapy may be substantially underestimated.…”

Tumor Topoisomerase II Alpha Status and Response to Anthracycline-Based Neoadjuvant Chemotherapy in Breast Cancer

“…The tumor characteristics were determined with standardized methods. Tumor regression was graded via the semiquantitative scoring system developed by Sinn et al [23] as follows: 0 = no effect, 1 = resorption and tumor sclerosis; 2 = minimal residual invasive tumor (<0.5 cm); 3 = residual noninvasive tumor only; 4 = no tumor detectable. A pCR was taken as the absence of any invasive or in situ tumor in the breast or the axilla.…”

Prognostic evaluation of VEGFA genotypes and haplotypes in a cohort of Brazilian women with non metastatic breast cancer

“…5,57 Briefly, pathological complete response (pCR) was defined by no microscopic evidence of residual viable tumor cells (invasive or noninvasive) in all resected specimens of the breast and lymph nodes, whereas tumor complete response (tCR) was characterized by no residual tumor or only residual noninvasive (in situ) in breast tissue irrespective of lymph node involvement.…”