Shrink pattern of breast cancer after neoadjuvant chemotherapy and its correlation with clinical pathological factors

World Journal of Surgical Oncology

Jun Jiang¹  Qingqiu Chen¹  Xiaowei Qi¹  Linjun Fan¹  Xinhua Yang¹  Yi Zhang¹  Shushu Wang¹ 

[1] Breast Disease Center, Southwest Hospital, Third Military Medical University, 29 Gaotanyan Street, Chongqing 400038, China

关键词: Subserial section;    Residual tumor;    Neoadjuvant chemotherapy;    Breast conservation surgery;    Breast cancer;   

Others  :  1209013
DOI  :  10.1186/1477-7819-11-166

 received in 2013-03-22, accepted in 2013-07-08,  发布年份 2013

【 摘 要 】

Background

Breast conservation therapy (BCS) after neoadjuvant chemotherapy (NCT) can improve patients’ quality of life. Currently used intraoperative examination for negative margins may not be sufficient to detect microresidual foci, which are a risk factor for local recurrence. This study was conducted to investigate the shrinking pattern of breast cancer and residual tumors as a risk factor for BCS after NCT.

Methods

Ninety women with stage II or III invasive ductal carcinoma who achieved partial response after NCT with paclitaxel and epirubicin were enrolled. All patients had undergone modified radical mastectomy. One-half of the surgical specimens were subjected to subserial sectioning. Pathological changes of tumor bed and pericancerous tissues were examined with an optical microscope. The levels of estrogen receptors, progesterone receptors and HER2 were analyzed by immnohistochemical staining.

Results

The residual tumors were classified into three types according to their microscopic morphology: solitary lesion, multifocal and patchlike lesions, and main residual tumor with satellite lesions. Type I residual tumors were found in 55 patients (61%), type II in 30 patients (33%) and type III in 5 patients (6%). Types II and III were often associated with larger primary tumors. The types of residual tumors were not correlated with the status of hormone receptors or HER2.

Conclusion

Three types of residual tumors were observed after NCT. The solitary residual tumor is most common, but main residual tumors with satellite lesions are most likely to cause local recurrence after BCS. Subserial sectioning would improve the identification of microfoci and patient survival after BCS.

【 授权许可】

   
2013 Wang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Poggi MM, Danforth DN, Sciuto LC, Smith SL, Steinberg SM, Liewehr DJ, Menard C, Lippman ME, Lichter AS, Altemus RM: Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the national cancer institute randomized trial. Cancer 2003, 98:697-702.
• [2]Fisher B, Brown A, Mamounas E, Wieand S, Robidoux A, Margolese RG, Cruz AB Jr, Fisher ER, Wickerham DL, Wolmark N, DeCillis A, Hoehn JL, Lees AW, Dimitrov NV: Effect of preoperative chemotherapy on local-regional disease in women with operable breast carcinoma: findings from national surgical adjuvant breast and bowel project B-18. J Clin Oncol 1997, 15:2483-2493.
• [3]Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B: Preoperative chemotherapy in patients with operable breast cancer: nine-year results from the national surgical adjuvant breast and bowel project B-18. J Natl Cancer Inst Monogr 2001, 30:96-102.
• [4]van der Hage JA, van de Velde CJ, Julien JP, Tubiana-Hulin M, Vandervelden C, Duchateau L: Preoperative chemotherapy in primary operable breast cancer: results from the European organization for research and treatment of cancer Trial 10902. J Clin Oncol 2001, 19:4224-4237.
• [5]Chen AM, Meric-Bernstam F, Hunt KK, Thames HD, Oswald MJ, Outlaw ED, Strom EA, McNeese MD, Kuerer HM, Ross MI, Singletary SE, Ames FC, Feig BW, Sahin AA, Perkins GH, Schechter NR, Hortobagyi GN, Buchholz TA: Breast conservation after neoadjuvant chemotherapy: the MD Anderson cancer center experience. J Clin Oncol 2004, 22:2303-2312.
• [6]Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J: New response evaluation criteria in solid tumors: revised RECIST guideline (version 1.1). Eur J Cancer 2009, 45:228-247.
• [7]Ogston KN, Miller ID, Payne S, Hutcheon AW, Sarkar TK, Smith I, Schofield A, Heys SD: A new histological grading system to assess response of breast cancers to primary chemotherapy: prognostic significance and survival. Breast 2003, 12:320-327.
• [8]Harvey JM, Clark GM, Osborne CK, Allred DC: Estrogen receptor status by immunohistochemistry is superior to the ligand-binding assay for predicting response to adjuvant endocrine therapy in breast cancer. J Clin Oncol 1999, 17:1474-1481.
• [9]Group of guideline of HER2 detection in breast cancer: Guideline of HER2 detection in breast cancer [in Chinese]. Zhonghua Bing Li Xue Za Zhi 2006, 35:631-633.
• [10]Bodian CA, Perzin KH, Lattes R: Lobular neoplasia: long-term risk of breast cancer and relation to other factors. Cancer 1996, 78:1024-1034.
• [11]Fisher ER, Costantino J, Fisher B, Palekar AS, Paik SM, Suarez CM, Wolmark N: Pathologic findings from the national surgical adjuvant breast project (NSABP) protocol B-17: five-year observations concerning lobular carcinoma in situ. Cancer 1996, 78:1403-1416.
• [12]Pendas S, Dauway E, Giuliano R, Ku N, Cox CE, Reintgen DS: Sentinel node biopsy in ductal carcinoma in situ patients. Ann Surg Oncol 2000, 7:15-20.
• [13]Kestin LL, Goldstein NS, Martinez AA, Rebner M, Balasubramaniam M, Frazier RC, Register JT, Pettinga J, Vicini FA: Mammographically detected ductal carcinoma in situ treated with conservative surgery with or without radiation therapy: patterns of failure and 10-year results. Ann Surg 2000, 231:235-245.
• [14]Buchholz TA, Hunt KK, Whitman GJ, Sahin AA, Hortobagyi GN: Neoadjuvant chemotherapy for breast carcinoma: multidisciplinary considerations of benefits and risks. Cancer 2003, 98:1150-1160.
• [15]Peintinger F, Kuerer HM, McGuire SE, Bassett R, Pusztai L, Symmans WF: Residual specimen cellularity after neoadjuvant chemotherapy for breast cancer. Br J Surg 2008, 95:433-437.
• [16]Zhong L, He G, Chen Q, Fan L, Jiang J, Zhang Y: Exploration on the technique and application of whole breast serial subsection [in Chinese]. Chin J Breast Dis 2009, 5:564-567.
• [17]Zhang W, Ma R, Zhang Y, Fu J, Yao Y, Xu J: Clinicopathological study of the nipple-areolar complex involvement in breast cancer [in Chinese]. Chin J Pract Surg 2003, 10:35-36.
• [18]Zhang Y, Zhou Y, Guo M, Guo D, Feng C, Jiang J: Infiltrating characteristics of breast cancer after neoadjuvant chemotherapy: whole breast serial subsection observation [in Chinese]. Di 3 Jun Yi Da Xue Xue Bao 2007, 21:2083-2085.
• [19]Veronesi U, Bonadonna G, Zurrida S, Galimberti V, Greco M, Brambilla C, Luini A, Andreola S, Rilke F, Raselli R: Conservation surgery after primary chemotherapy in large carcinomas of the breast. Ann Surg 1995, 222:612-618.
• [20]Chagpar AB, Middleton LP, Sahin AA, Dempsey P, Buzdar AU, Mirza AN, Ames FC, Babiera GV, Feig BW, Hunt KK, Kuerer HM, Meric-Bernstam F, Ross MI, Singletary SE: Accuracy of physical examination, ultrasonography, and mammography in predicting residual pathologic tumor size in patients treated with neoadjuvant chemotherapy. Ann Surg 2006, 243:257-264.
• [21]Kasami M, Uematsu T, Honda M, Yabuzaki T, Sanuki J, Uchida Y, Sugimura H: Comparison of estrogen receptor, progesterone receptor and Her-2 status in breast cancer pre- and post-neoadjuvant chemotherapy. Breast 2008, 17:523-527.
• [22]Hannemann J, Oosterkamp HM, Bosch CA, Velds A, Wessels LF, Loo C, Rutgers EJ, Rodenhuis S, van de Vijver MJ: Changes in gene expression associated with response to neoadjuvant chemotherapy in breast cancer. J Clin Oncol 2005, 23:3331-3342.
• [23]Learn PA, Yeh IT, McNutt M, Chisholm GB, Pollock BH, Rousseau DL Jr, Sharkey FE, Cruz AB, Kahlenberg MS: HER-2/neu expression as a predictor of response to neoadjuvant docetaxel in patients with operable breast carcinoma. Cancer 2005, 103:2252-2260.