Abstract
PurposeIn breast cancer therapy, the indication for systemic therapy is typically based on prognostic markers from the surgical excision specimen. If such is unavailable, for instance prior to tumor ablation therapy, the indication for adjuvant systemic therapy may be assessed from pretreatment biopsies. The effect of differences in tumor characteristics between biopsy and excision specimen on agreement in indication for systemic therapy is, however, largely unknown. The aim of this study is to determine the agreement in eligibility for systemic therapy between preoperative and postoperative assessment. Secondly, to identify which patient-, tumor- or lymph node characteristics may influence this agreement.Materials and MethodsIn this retrospective study, 300 consecutive female patients with primary invasive breast carcinoma on biopsy were included. Indication for systemic therapy was determined separately from biopsied tissue and from excision specimens using national guidelines based on adjuvant! online. Agreement was assessed, and patient-, tumor- and lymph node characteristics affecting agreement analyzed.ResultsAgreement in tumor characteristics between biopsy and excision specimen varied from high (ER-status: 99%), to lower (tumor grade: 62%, tumor size: 59%, and lymph node status: 67%). Without preoperative sentinel node biopsy (SNB), agreement on systemic therapy exists in 77% of patients (kappa = 0,547). Positive pretreatment indication for systemic therapy was highly indicative of the postoperative indication (PPV = 94%). Negative indication was, however, only indicative in 67% of patients. Conversely, with preoperative SNB, agreement on negative indication was raised to 89%. Agreement was especially high for ER-negative status, tumor grade 3, tumor size >2 cm, lymph node positivity at biopsy and a negative preoperative SNB.ConclusionsA positive indication for systemic therapy from biopsy is highly indicative for a positive indication from the excision specimen. When the indication is negative, additional stratification using preoperative SNB raises the agreement. Still, discordance occurs in 1 out of 10 patients.
Highlights
Breast cancer therapy is a combination therapy aiming to balance local control with therapy side effects
Without preoperative sentinel node biopsy (SNB), agreement on systemic therapy exists in 77% of patients
Agreement was especially high for estrogen receptor (ER)-negative status, tumor grade 3, tumor size .2 cm, lymph node positivity at biopsy and a negative preoperative SNB
Summary
Breast cancer therapy is a combination therapy aiming to balance local control with therapy side effects. Pretreatment imaging and biopsy are performed to confirm the diagnosis of breast cancer, followed by surgery, radiotherapy, and systemic therapy in selected patients based on prognostic markers in the excision specimen. For this purpose, a well-established model such as adjuvant! Progression towards more individualized therapy, using minimally-invasive techniques that destroy the tumor in-situ such as high-intensity focused ultrasound, cryoablation, radio-frequency ablation and preoperative radiotherapy [7,8,9,10,11,12,13] has shown to be feasible. To avoid under- or overtreatment, it is essential that the clinical introduction of primary minimally-invasive therapies is accompanied with accurate means to establish indication for systemic therapy in the absence of an excision specimen
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