The Diagnostic Performance of Minimally Invasive Biopsy in Predicting Breast Pathological Complete Response After Neoadjuvant Systemic Therapy in Breast Cancer: A Meta-Analysis

Abstract

Background: Neoadjuvant systemic therapy (NST) is commonly used in patients with early stage breast cancer before definitive surgery. The standard diagnostic approach for pathologic complete response (pCR) of the breast is breast surgery and pathologic examination. In recent years, several trials investigated the predictive value of image-guided minimally invasive biopsy (MIB) for breast pCR after NST. This study conducted a meta-analysis to evaluate the diagnostic accuracy of MIB. Materials and Methods: We identified relevant research reports in online databases through February 2020. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to evaluate the quality of included trials. We extracted relevant data and constructed a 2 × 2 contingency table to analyze the predictive accuracy of MIB for breast pCR. Subgroup analyses and meta-regressions were also performed to investigate potential causes of heterogeneity. Results: Nine trials (with 1,030 breast cancer patients) were included in this meta-analysis. The pooled sensitivity and specificity of MIB were 0.72 [95% confidence interval (CI): 0.61-0.81] and 0.99 (95% CI: 0.89-1.00), respectively. By combining relevant data, there were no significant differences in sensitivity or specificity among different molecular subtypes of breast cancer (P > 0.05). Subgroup analyses and meta-regressions implied that trials with responses not limited to clinical complete response (cCR) had a significantly higher accuracy of MIB than those with only cCR (RDOR: 7.65; 95% CI: 1.05-55.46; P = 0.046). Conclusion: Current image-guided MIB methods are not accurate enough in terms of predicting breast pCR after NST. It is of utmost clinical importance to standardize the MIB procedure and incorporate other factors into the evaluation in order to improve the accuracy to an acceptable level.

The use of breast ultrasound for prediction of pathologic complete response in different subtypes of early breast cancer within the WSG-ADAPT subtrials

“…Authors of that study concluded that breast surgery cannot be omitted in cases showing no residual tumor in tissue biopsies and that standardization of the biopsy procedure is required to improve the predictive values of imaging-guided biopsy [23].…”

“…However, the recent meta-analysis on prediction of pCR by imaging-guided biopsy demonstrated that accuracy of such approaches is rather low irrespectively of the BC subtype. Authors of that study concluded that breast surgery cannot be omitted in cases showing no residual tumor in tissue biopsies and that standardization of the biopsy procedure is required to improve the predictive values of imaging-guided biopsy [ 23 ].…”

How will artificial intelligence impact breast cancer research efficiency?

“…In recent years, some trials have failed to demonstrate how current diagnostic tools (such as histological analysis after needle biopsy) can select patients with a 'real' complete response, and who could therefore theoretically avoid surgery [9]. AI could perform a radiomic analysis and allow a better selection, to identify those patients who can be cured with the exclusive administration of drugs.…”

Evaluation of axillary response to neoadjuvant systemic therapy with sentinel node biopsy and axillary wire in node-positive breast cancer

“…Tumor size or the presence of multifocality or multicentricity were not considered among the selection criteria as they are managed independently in breast cancer [7][8][9][10].…”

“…Targeted axillary dissection (TAD) seems to be the best sampling option, even over marked lymph node biopsy (MLNB) [8]. TAD aims to assess the axillary state after NAST through SNB associated with MLNB, marking the affected lymph node at the time of biopsy using a radio-opaque clip, a ferromagnetic seed, radioiodine or carbon tattooing [8,9].…”