Can a pathological complete response of breast cancer after neoadjuvant chemotherapy be diagnosed by minimal invasive biopsy?
This study aimed to explore the ability of a minimal invasive biopsy to diagnose a pathological complete response (pCR = ypT0) in the breast.



Ultrasound-guided, vacuum-assisted, minimal invasive biopsy (VAB) was performed in 50 patients after neoadjuvant chemotherapy and before breast surgery. Negative predictive values (NPV) and false negative rates (FNR) to predict a pCR in surgical specimen were the main outcome measures. To assess the possible sampling error, the representativeness of the sample was evaluated by the biopsy performing physician (subjectively based on the visibility in ultrasound), by radiography of the biopsy specimen, and by the pathologist (based on histopathology).



The cohort (n = 50) consisted of 15 (30%) triple negative breast cancers, 13 (26%) human epidermal growth factor receptor 2 (HER2) positive and 22 (44%) hormone receptor positive/HER2 negative cancers. ypT0 was diagnosed in 23 (46%) cases. In the overall cohort (n = 50), VAB yielded an NPV of 76.7% and an FNR of 25.9%. Given a representative VAB sample, according to the histopathological evaluation (n = 38), the NPV was 94.4% (95% CI 87.1-100.0) and the FNR 4.8% (95% CI 0.0-11.6). Non-representative VABs were mainly due to bad visibility of the target lesion in ultrasound.



A VAB can accurately diagnose a pCR, given a histopathologically representative sample.
University Breast Unit, Department of Gynecology, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany. Electronic address: joerg.heil@med.uni-heidelberg.de.
Joerg
J
Heil
University Breast Unit, Department of Gynecology, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
Benedikt
B
Schaefgen
Institute of Pathology, Im Neuenheimer Feld 220/221/224, 69120, Heidelberg, Germany.
Peter
P
Sinn
University Breast Unit, Department of Gynecology, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
Hannah
H
Richter
University Breast Unit, Department of Gynecology, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
Aba
A
Harcos
University Breast Unit, Department of Gynecology, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
Christina
C
Gomez
University Breast Unit, Department of Gynecology, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
Anne
A
Stieber
University Breast Unit, Department of Gynecology, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
André
A
Hennigs
Institute of Medical Biometry, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany.
Geraldine
G
Rauch
University Breast Unit, Department of Gynecology, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
Florian
F
Schuetz
University Breast Unit, Department of Gynecology, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
Christof
C
Sohn
National Center of Tumor Disease (NCT), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
Andreas
A
Schneeweiss
University Breast Unit, Department of Gynecology, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
Michael
M
Golatta
D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011300:Preoperative Care; D011446:Prospective Studies; D043823:Taxoids / Q000008:administration & dosage; D000068878:Trastuzumab / Q000008:administration & dosage; D016896:Treatment Outcome; D016217:Ultrasonography, Mammary; D014618:Vacuum
D018943:Anthracyclines; D061067:Antibodies, Monoclonal, Humanized; D043823:Taxoids; C485206:pertuzumab; D000068878:Trastuzumab
Invasive breast cancer; Neoadjuvant chemotherapy; Pathological complete response; Vacuum-assisted biopsy