Abstract
BackgroundBreast 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.MethodsNinety 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.ResultsThe 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.ConclusionThree 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.
Highlights
Breast conservation therapy (BCS) after neoadjuvant chemotherapy (NCT) can improve patients’ quality of life
[3] reported a local recurrence rate of 10.7% in postchemotherapy patients treated with BCS, 7.6% in patients with primary tumors fit for BCS and 15.9% in patients with primary breast cancer unfit for BCS through downstaging by chemotherapy
We have shown that the larger the primary tumors, the more types II and III residual tumors occurred, which may be due to vascular distribution and avascular necrosis
Summary
Breast conservation therapy (BCS) after neoadjuvant chemotherapy (NCT) can improve patients’ quality of life. This study was conducted to investigate the shrinking pattern of breast cancer and residual tumors as a risk factor for BCS after NCT. Breast conservation therapy (BCS) can improve patients’ quality of life. Neoadjuvant chemotherapy (NCT) can make more patients suitable for BCS by downstaging primary tumors [2,3]. NCT-downstaged tumors have a higher local recurrence rate than the primary tumors suitable for BCS, which may be a result of incomplete removal of cancer tissues [4]. The patchlike residual cancer is one of the major factors underlying local recurrence after BCS [5]. Subserial sectioning was used to check the shrinking pattern and identify residual tumors after NCT.
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