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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 09, 2021
Accepted:
May 29,
2021
Received:
April 28,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
