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Pathologic evaluation of response to neoadjuvant therapy drives treatment changes and improves long-term outcomes for breast cancer patients.
The Breast Journal ( IF 2.1 ) Pub Date : 2020-05-29 , DOI: 10.1111/tbj.13864
Veerle Bossuyt 1 , Laura Spring 1
Affiliation  

Systemic therapy for breast cancer may be given before (neoadjuvant) or after (adjuvant) surgery. When neoadjuvant systemic therapy is given, response to treatment can be evaluated. However, some prognostic information (for example, pathologic tumor size pretreatment) is then lost and pathologic evaluation of breast specimens after neoadjuvant therapy is more difficult. Pathologic complete response (pCR), defined as no invasive disease in the breast (ypT0/is or ypT0) and no disease in all sampled lymph nodes (ypN0), identifies patients with a lower risk of recurrence or death compared to those with residual disease. Multidisciplinary collaboration, marking of the tumor site and any lymph node involvement pretreatment, and access to specimen imaging to facilitate correlation of gross and microscopic findings are critical for accurate determination of pCR. For HER2‐positive and triple negative tumors requiring systemic therapy, giving the treatment before surgery identifies a high‐risk group of patients that can receive additional adjuvant therapy after surgery if a pCR is not achieved. Recent clinical trials have demonstrated that this approach reduced recurrence risk. More than ever, pathologic evaluation of response to neoadjuvant systemic therapy directs treatment received after surgery. Using a single standardized protocol for sampling of the post‐neoadjuvant surgical specimen allows pathologists to ensure accurate determination of pCR or residual disease and quantify residual disease. Residual cancer burden (RCB) and AJCC stage provide complementary quantitative information about residual disease and prognosis.

中文翻译:

对新辅助疗法的反应的病理评估可推动治疗方案的改变并改善乳腺癌患者的长期预后。

乳腺癌的全身治疗可以在(新辅助)手术之前或之后(辅助)进行。给予新辅助全身治疗时,可以评估对治疗的反应。但是,一些预后信息(例如病理性肿瘤大小的预处理)会丢失,新辅助治疗后对乳房标本的病理评估会更加困难。病理完全缓解(pCR)定义为乳房无浸润性疾病(ypT0 / is或ypT0),所有采样淋巴结均无疾病(ypN0),与患有残留疾病的患者相比,其复发或死亡风险较低。多学科协作,标记肿瘤部位和任何淋巴结受累预处理,获得标本成像以促进总体和微观结果的相关性对于准确确定pCR至关重要。对于需要全身治疗的HER2阳性和三阴性肿瘤,在手术前给予治疗可以识别出高危人群,如果未达到pCR,可以在手术后接受其他辅助治疗。最近的临床试验表明,这种方法降低了复发风险。对新辅助全身治疗反应的病理评估比以往任何时候都更能指导手术后的治疗。使用单个标准化方案对新辅助后手术标本进行采样可使病理学家确保准确确定pCR或残留疾病并量化残留疾病。
更新日期:2020-06-23
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