1. Response in breast vs axilla after neoadjuvant treatment and implications for nonoperative management of invasive breast cancer
- Author
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Christina Weltz, Anupma Nayak, Christopher Valente, Elisa Port, Sarah Weltz, Twisha Oza, Adriana D. Corben, Shruti Zhaveri, Shabnam Jaffer, Eliana Pickholz, Hank Schmidt, and Kereeti Pisapati
- Subjects
medicine.medical_specialty ,Breast surgery ,medicine.medical_treatment ,Physical examination ,Breast Neoplasms ,030218 nuclear medicine & medical imaging ,Metastatic carcinoma ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Biopsy ,Antineoplastic Combined Chemotherapy Protocols ,Internal Medicine ,Medicine ,Humans ,Prospective Studies ,Lymph node ,medicine.diagnostic_test ,business.industry ,Sentinel Lymph Node Biopsy ,medicine.disease ,Neoadjuvant Therapy ,Clinical trial ,Axilla ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Lymphatic Metastasis ,Surgery ,Female ,Radiology ,Lymph Nodes ,business - Abstract
Improved imaging and neoadjuvant chemotherapy (NAT) have led to higher pathologic complete response rates (pCR) in patients with invasive breast cancer. This has questioned the necessity of surgery and axillary lymph node (ALN) dissection in these patients. Prospective clinical trials are implementing extensive core biopsies of the tumor bed of patients with clinical complete response as a means to identify and spare them breast surgery. In addition, it is anticipated that patients with pCR are most likely going to have no or minimal disease in ALN as well. To verify the feasibility of these trials, we performed a pathologic analysis of all our patients who have undergone NAT from 2009 to present. Using pathology data base, we identified 362 patients treated with neoadjuvant chemotherapy followed by surgery. Clinical and pathologic information including gross and microscopic descriptions as well as biomarker status was collected. pCR was 50% for patients with negative ALN pretreatment but only 28% for patients with positive ALN at diagnosis. Despite achieving pCR in the breast, up to 10% of patients with positive ALN and 1% with negative ALN had persistent disease. Eight percent of patients that were presumed to have no ALN disease either clinically and or by imaging were found to have metastatic carcinoma in ALN. The metastases were predominantly (80%)
- Published
- 2020