ASO Author Reflections: Elimination of Breast Cancer Surgery in Complete Responders After Neoadjuvant Chemotherapy: Imaging Perspective

Excerpt

Increased use of neoadjuvant chemotherapy (NAC) for breast cancer with the development of new chemotherapy regimens and targeted therapies resulted in a significant increase in pathologic complete response (pCR) rates, especially in triple negative (TN) and human epidermal growth factor receptor 2-positive (HER2 +) tumors. Current imaging modalities have limited accuracy for NAC response evaluation.1 Therefore, image-guided biopsy (IGBx) became an acceptable alternative for pCR detection. Elimination of surgery for invasive breast cancer in exceptional responders with documented pCR after IGBx has become a potential management option. Several clinical trials have been investigating the ability of presurgical IGBx to predict pCR after NAC, with reported high accuracy.2^–4 This led to a need to develop a paradigm for appropriate selection of patients for surgery avoidance. In this study, we reported specific imaging correlates and IGBx characteristics among patients with and without pCR after NAC, and analyzed potential pitfalls of IGBx that need to be considered for future clinical trials on omission of surgery in exceptional responders.5 …