Pattern of Tumor Shrinkage during Neoadjuvant Chemotherapy Is Associated with Prognosis in Low-Grade Luminal Early Breast Cancer

Fukada, Ippei; Araki, Kazuhiro; Kobayashi, Kokoro; Shibayama, Tomoko; Takahashi, Shunji; Gomi, Naoya; Kokubu, Yumi; Oikado, Katsunori; Horii, Rie; Akiyama, Futoshi; Iwase, Takuji; Ohno, Shinji; Hatake, Kiyohiko; Sata, Naohiro; Ito, Yoshiaki

doi:10.1148/radiol.2017161548

Cited by 52 publications

(60 citation statements)

References 29 publications

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“…Limitations of the present study could be the low number of cases and the exclusion of patients receiving primary hormone therapy (PHT). Fukada and coworkers have reported that CS is significantly more frequent in luminal breast cancers following PHT, and these patients had significantly better outcome than patients having other patterns [42]. In contrast, there was no significant correlation between regression patterns and molecular subtypes in present work.…”

Section: Discussioncontrasting

confidence: 74%

Patterns of Regression in Breast Cancer after Primary Systemic Treatment

Zombori

2018

Pathol. Oncol. Res.

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Despite national guidelines, the evaluation of effects of primary systemic treatment (PST) in breast cancer is a complex challenge. Our aims were to evaluate the response patterns focusing on correlations of radiological and pathological tumor size, regression heterogeneity in different molecular subtypes, cellularity changes and the incidence of enlarged, multinucleated neoplastic cells related to therapy.Slides of pretreatment biopsies and resection specimens of consecutive cases were reevaluated focusing on heterogeneity of regression per whole slide, and 40x or 100x magnification fields.Alteration in cellularity and the presence of multinucleated tumor giant cells were noted. The correlation of pathological and radiological sizes and their alterations were analyzed by Spearman rank correlation.The present study included 106 tumors. A decrease in size (84.9%) and cellularity (76.4%) was noted in all molecular subtypes. Inhomogeneous regression was found in 45.3%, with minor inhomogeneity in the majority. Scatter pattern regression was seen only in 8 cases (7.5%). Significant correlations were found between the pathological and radiological sizes (p=0.02), and between the alterations of cellularity and pathological and radiological size (p=0.04; p=0.03, respectively). Multinucleated tumor giant cells were noted in 17.9% (n=19), nearly exclusively in cases treated with PST including taxanes.Regression inhomogeneity following PST is present in about half of the cases, and is not related to molecular subtypes. The evaluation of the maximum area of the tumor bed is recommended for the proper evaluation of regression. Multinucleated tumor giant cells are related to PST including taxane derivate, and may cause upgrading.

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Section: Discussioncontrasting

confidence: 74%

Patterns of Regression in Breast Cancer after Primary Systemic Treatment

Zombori

2018

Pathol. Oncol. Res.

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“…Ninety‐nine percent of respondents performed post‐NACT imaging: MRI‐76%, ultrasound‐41%, and mammography‐29%. Studies have shown that MRI can be useful in predicting pathological response and can be used to differentiate between therapy‐induced nonvasularised fibrosis and residual tumors . One study showed that end‐of‐NACT lesion size measured on MRI did not differ from the histological size with a sensitivity of 87% and accuracy 77%.…”

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confidence: 99%

Neo‐adjuvant chemotherapy and surgical planning: Survey of practice, attitudes, and opinions in the UK

2019

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Neo-adjuvant chemotherapy (NACT) was first used in the treatment of breast cancer to increase the likelihood of surgical resection for locally advanced disease and to assess the sensitivity of tumors to different chemotherapy regimens. Indications have evolved and now relate to a combination of patient and clinical factors, including early eradication of micrometastatic disease, and reducing tumor size to allow breast-conserving surgery (BCS) in patients who would otherwise require mastectomy. The use of NACT is increasing (7%-27% of new cancer diagnoses 1 ), but there is little specific data on its utilization.

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“…Limitations of the present study could be the low number of cases and the exclusion of patients receiving PHT. Fukada and coworkers have reported that CS is significantly more frequent in luminal breast cancers following PHT, and these patients had significantly better outcome than patients having other patterns [127]. In contrast, there was no significant correlation between regression patterns and molecular subtypes in the present work.…”

Section: Evaluation Of Regression Heterogeneity Incontrasting

confidence: 80%

Challenges in the surgical pathological diagnosis of breast cancer

Zombori¹

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Tumor draining sentinel lymph nodes (SLNs) are the sites of selective changes as compared to non-SLNs. They show features of tumor-reactive lymphadenopathy, including increased total number of functional blood vessels, but a relative immunosuppressed status has also been described in them. We explored the hypothesis of a selective regression or non-regression in SLNs versus non-SLNs in 142 patients with 110 estrogen receptor-positive and 32 estrogen receptornegative tumors undergoing both SLN biopsy and axillary lymph node dissection after neoadjuvant therapy by assessing the tumoral (metastatic) and regression statuses of SLNs and non-SLNs separately. Of the 89 cases with signs of nodal regression, 22 cases (25%) were in favor of a selective nonregression in SLNs, 18 cases (20%) were supportive of a selective and more pronounced regression in the SLNs and the remaining showed equal degrees of regression or non-regression in SLNs and non-SLNs. The results indicate that there is no obvious difference in the degree of regressive histological changes shown by SLNs and NSLNs. Therefore, this phenomenon may not be a major contributor to the higher false negative rate of SLN biopsy after neoadjuvant treatment.

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Pattern of Tumor Shrinkage during Neoadjuvant Chemotherapy Is Associated with Prognosis in Low-Grade Luminal Early Breast Cancer

Cited by 52 publications

References 29 publications

Patterns of Regression in Breast Cancer after Primary Systemic Treatment

Patterns of Regression in Breast Cancer after Primary Systemic Treatment

Neo‐adjuvant chemotherapy and surgical planning: Survey of practice, attitudes, and opinions in the UK

Challenges in the surgical pathological diagnosis of breast cancer

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