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Correlation Between Preoperative Radiological and Postoperative Pathological Tumor Size in Patients With HER2+ Breast Cancer After Neoadjuvant Chemotherapy Plus Trastuzumab and Pertuzumab

  • Author Footnotes
    † These authors contributed equally to this work.
    Veronica Falcone
    Footnotes
    † These authors contributed equally to this work.
    Affiliations
    Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Austria
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  • Author Footnotes
    † These authors contributed equally to this work.
    Elisabeth Reiser
    Footnotes
    † These authors contributed equally to this work.
    Affiliations
    Department of Obstetrics and Gynecology, Division of Gynecological Endocrinology and Reproductive medicine, Medical University of Innsbruck, Austria
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  • Lenka Grula
    Affiliations
    Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Austria
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  • Zsuzsanna Bago-Horvath
    Affiliations
    Department of Pathology, Division of Gynecopathology and Senology, Medical University of Vienna, Austria
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  • Myriam Stolz
    Affiliations
    Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Austria
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  • Anja Catic
    Affiliations
    Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Austria
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  • Christine Deutschmann
    Affiliations
    Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Austria
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  • Christian Singer
    Affiliations
    Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Austria
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  • Georg Pfeiler
    Correspondence
    Address for correspondence: Georg Pfeiler, MD, Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Wien, Austria
    Affiliations
    Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Austria
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  • Author Footnotes
    † These authors contributed equally to this work.

      Abstract

      Background

      Neoadjuvant chemotherapy (NAC) in combination with anti-HER2 treatment is standard of care in patients with early HER2 positive breast cancer. Preoperative radiological evaluation is mandatory for defining the extent of surgery. In this study, we evaluated the correlation between preoperative radiological and postoperative pathological tumor size in early HER2 positive patients after neoadjuvant chemotherapy in combination with trastuzumab and pertuzumab. In a patient population with HER2 positive breast cancer, who received neoadjuvant chemotherapy and anti-HER2 treatment, the correlation between preoperative radiological and postoperative pathological tumor size was performed. Concordance of radiological and pathological tumor size was found in 55.7%, leading to more extensive breast surgery as required in 7 cases and to the underestimation of 6 neoplastic lesions before surgery, respectively.

      Patients and Methods

      Seventy early HER2 positive breast cancer patients were included and retrospectively analysed. All preoperative radiological assessments as well as the tumor board decision on surgical extent and pathological evaluation were completed at the Medical University of Vienna. Preoperative radiological assessment of tumor size and lymph node status were compared with final histopathological findings. The correlation between different radiological modalities regarding tumor size was investigated.

      Results

      Concordance of radiological and pathological tumor size was found in 55.7 % (50% by sonography and 66.7% by MRI, respectively) of patients with a nonsignificant correlation of r = 0.31 (P = .08). Of the 39 patients with pathologic complete remission (pCR), 16 were also classified as radiological complete response (rCR) while 23 of those showed a radiological stable disease or partial response. In 6 patients, radiological assessment showed a CR but invasive cancer with a tumor size range from 7 to 36 mm was found in histopathological examination. Neither menopausal status (P= .69) nor BMI (P = .60) and age (P = .50) had an impact on the correlation between radiological and histopathological tumor size.
      Regarding lymph node status, a statistically significant association and clinically relevant correlation between radiological and histopathological evaluation was found (r = 0.66, P < .001).

      Conclusion

      Concordance between radiology and histopathology was low regarding tumor size after NAC in combination with trastuzumab and pertuzumab, but significant regarding lymph node status.

      Keywords

      Abbreviations:

      AJCC (American Joint Committee of Cancer), ASCO (American society of clinical oncology), BCT (Breast conserving therapy), BMI (body mass index), CI (confidence interval), ER (estrogen receptor), FEC (fluorouracil, epirubicin and cyclophosphamide), IHC (Immunohistochemical status), LN (lymph node), MRI (magnetic resonance imaging), NAC (neoadjuvant chemotherapy), p (probability value), pCR (pathologic complete response), PgR (progesterone receptor), R (Pearson product-moment correlation coefficient), RECIST (response evaluation criteria in solid tumors), SD (standard deviation), T (Tesla), UICC (Union for international cancer control), US (ultrasound), USCAP (united states and Canadian academy of pathology), vs (versus), WHO (world health organisation)
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