Is Breast Surgery Necessary for Breast Carcinoma in Complete Remission Following Neoadjuvant Chemotherapy?

Is Breast Surgery Necessary for Breast Carcinoma in Complete Remission Following Neoadjuvant Chemotherapy?
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新辅助化疗后,乳腺癌完全缓解是否需要乳房手术?

DOI:
10.1055/s-0043-124082
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发表时间:
2018-01
影响因子:
2.7
通讯作者:
Heil J
Heil J
中科院分区:
医学4区
文献类型:
--
作者:
Richter H;Hennigs A;Schaefgen B;Hahn M;Blohmer JU;Kümmel S;Kühn T;Thill M;Friedrichs K;Sohn C;Golatta M;Heil J

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新辅助化疗(NACT)后乳腺癌病理学完全缓解(pCR)的可能性正在增加;最常见的是三阴性和HER 2阳性肿瘤亚组。因此,问题是当NACT后完全缓解时是否需要乳房手术,以及当肿瘤不再可检测时,它是否提供肿瘤治疗结果的任何改善。只有在不进行手术的情况下对pCR进行可靠诊断的基础上,才可能避免手术甚至放疗。目前的成像没有达到必要的敏感性和特异性,以确保病理完全缓解的诊断。因此,需要进一步的研究来确定哪些方法能够最好地评估肿瘤对NACT的反应。关于NACT后图像引导微创活检的研究已经为术前诊断pCR提供了第一个有希望的结果,并且可以为进一步研究在这种特定患者群体中避免手术的可能性提供基础。
The likelihood of pathological complete remission (pCR) of breast cancer following neoadjuvant chemotherapy (NACT) is increasing; most of all in the triple negative and HER2 positive tumour subgroups. The question thus arises whether or not breast surgery is necessary when there is complete remission after NACT, and whether it provides any improvement of the oncological treatment result when tumour is no longer detectable. Avoiding surgery and possibly even radiotherapy would only be conceivable on the basis of a reliable diagnosis of pCR without operating. Current imaging does not achieve the necessary sensitivity and specificity to assure the diagnosis of pathological complete remission. Further studies are therefore required to determine which methods are best able to evaluate tumour response to NACT. Studies on image-guided, minimally invasive biopsies after NACT have delivered first promising results towards diagnosing pCR before surgery and could provide the basis for further studies on the possibility of avoiding surgery in this specific patient collective.
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