title: [Shrinkage mode of the primary breast tumor after neoadjuvant chemotherapy analyzed with part-mount sub-serial sectioning and three-dimensional reconstruction technique].
abstract: OBJECTIVE
  The aim of this study is to evaluate the shrinkage mode of the primary tumor in women with breast cancer after neoadjuvant chemotherapy (NAC) determined by part-mount sub-serial section (PMSS) and three-dimensional (3D) reconstruction technique.
  
  
  METHODS
  Eighty-six women with pathologically proven solitary invasive ductal carcinoma (ⅡA-ⅢC) were recruited. They were divided into two groups. Group A (n=25) received half cycles of NAC and Group B (n=61) received whole cycles of NAC. Breast specimen was prepared with PMSS, and residual tumors were microscopically outlined, scanned and registered by Photoshop software. The 3D model of residual tumors was reconstructed with 3D-Doctor software to evaluate the shrinkage mode. Further, the clinicpathologic shrinkage modes were divided into 2 categories: concentric shrinkage mode (CSM, the longest diameter of the pathological residual tumors was less than 50% and ≤2 cm in comparison with the primary tumor before NAC), and non-concentric shrinkage mode (NCSM, the longest diameter of the pathological residual tumors was more than 50% and/or >2 cm in comparison with the primary tumor before NAC).
  
  
  RESULTS
  Pathological shrinkage modes: Group A: modes Ⅰ, Ⅱ, and Ⅴ were observed in 1, 1, and 23 cases, respectively; Group B: modesⅠ, Ⅱ, Ⅲ, Ⅳ, and Ⅴwere observed in 18, 3, 12, 21, and 7 cases, respectively (P<0.001). The multivariate analysis showed that patients with lower primary tumor stage, PR(-) or mammographic malignant calcification before NAC(-) and lymph nodes down-staging after NAC were more likely to present with CSM after NAC (P<0.05 for all).
  
  
  CONCLUSIONS
  The pathologic reconstruction of breast residual tumors can fully and three-dimensionally reveal the shrinkage mode of the primary breast tumor in women with breast cancer after NAC. PMSS and 3D reconstruction of pathology provide a new platform in this area. Primary tumor stage, PR expression and mammographic malignant calcification before NAC and lymph node down-staging after NAC are independent predictors of the clinicopathologic shrinkage mode.
authors.affiliation: Breast Cancer Center, Shandong Cancer Hospital & Institute, Shandong Academy of Medical Sciences, Jinan 250117, China(Present Unit: Department of Radiotherapy, the First People's Hospital of Lianyungang, Xuzhou Medical College, Lianyungang 222002, China).
authors.forename: T
authors.initials: T
authors.lastname: Yang
authors.affiliation: Breast Cancer Center, Shandong Cancer Hospital & Institute, Shandong Academy of Medical Sciences, Jinan 250117, China.
authors.forename: Z P
authors.initials: ZP
authors.lastname: Zhang
authors.affiliation: Department of Pathology, Shandong Cancer Hospital & Institute, Shandong Academy of Medical Sciences, Jinan 250117, China.
authors.forename: X Y
authors.initials: XY
authors.lastname: Sun
authors.affiliation: Breast Cancer Center, Shandong Cancer Hospital & Institute, Shandong Academy of Medical Sciences, Jinan 250117, China.
authors.forename: G
authors.initials: G
authors.lastname: Liu
authors.affiliation: Department of Pathology, Shandong Cancer Hospital & Institute, Shandong Academy of Medical Sciences, Jinan 250117, China.
authors.forename: D B
authors.initials: DB
authors.lastname: Mu
authors.affiliation: Breast Cancer Center, Shandong Cancer Hospital & Institute, Shandong Academy of Medical Sciences, Jinan 250117, China.
authors.forename: Y S
authors.initials: YS
authors.lastname: Wang
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy* / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D018365:Neoplasm, Residual; D012984:Software; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden / Q000187:drug effects*