Our Summary

This research paper discusses a study done on women with non-metastatic breast cancer who were being treated with neoadjuvant chemotherapy. This type of chemotherapy is often used to shrink tumors before they are surgically removed. The researchers were interested in how often these treatments resulted in a complete disappearance of the cancer (known as a pathologic complete response, or pCR).

To figure this out, they recruited a group of women who showed a full or near-full response to the chemotherapy on their mammograms and ultrasound scans. They then performed a magnetic resonance imaging (MRI) for further confirmation, and took small tissue samples (biopsies) from the area where the tumor used to be.

The results showed that 41.5% of the whole group and 53.8% of a subgroup with hormone receptor-negative cancer achieved a pCR. However, the method they used to check for pCR (taking a biopsy with a 14G needle) had a false-negative rate of 42.1% - meaning in many cases, the biopsy suggested there was no cancer left when there actually was.

The study concludes that using this biopsy method may not be a reliable way to check for pCR after chemotherapy. This suggests that more research is needed to find better ways to determine whether surgery is necessary after chemotherapy. The study is registered with the Clinical Trials Registry of India.

FAQs

  1. What is a pathologic complete response (pCR) in the context of breast cancer treatment?
  2. What was the false-negative rate of the biopsy method used in the study to check for pCR?
  3. What are the implications of the study’s findings on the use of biopsy to check for pCR after chemotherapy?

Doctor’s Tip

A doctor might tell a patient undergoing a breast biopsy that it is a common procedure used to collect a small sample of tissue from the breast in order to test for abnormalities or cancer. They may also explain that while a biopsy can provide important information about the presence of cancer, it is not always 100% accurate. In some cases, a biopsy may give a false-negative result, meaning it suggests there is no cancer when there actually is. Therefore, it is important for the patient to follow up with their doctor and discuss the results of the biopsy in detail to determine the best course of action for their treatment.

Suitable For

Patients who are typically recommended for a breast biopsy include those with suspicious findings on a mammogram or ultrasound, such as a lump or mass, abnormal breast changes, or nipple discharge. Additionally, patients with a personal or family history of breast cancer, or those with a genetic predisposition to breast cancer (such as BRCA gene mutations), may also be recommended for a biopsy. Patients who have undergone neoadjuvant chemotherapy for breast cancer may also be recommended for a biopsy to assess the response to treatment and determine the need for further surgical intervention.

Timeline

Before breast biopsy:

  1. Patient undergoes a physical examination and imaging tests such as mammogram and ultrasound to detect any abnormalities in the breast.
  2. If suspicious findings are detected, the patient may be recommended to undergo a breast biopsy to obtain a tissue sample for further analysis.
  3. The patient may undergo additional tests such as MRI to further evaluate the abnormality before the biopsy.

After breast biopsy:

  1. The patient undergoes the biopsy procedure, which involves removing a small tissue sample from the breast using a needle or during a surgical procedure.
  2. The tissue sample is sent to a pathology lab for analysis to determine if there are any cancerous cells present.
  3. The patient may experience some discomfort or pain at the biopsy site after the procedure.
  4. Once the biopsy results are available, the patient meets with their healthcare provider to discuss the findings and determine the appropriate course of treatment, if necessary.

What to Ask Your Doctor

  1. What type of breast biopsy will be performed?
  2. How accurate is the biopsy method in determining if the cancer has completely disappeared?
  3. What are the risks and potential complications associated with the biopsy procedure?
  4. How soon will I receive the results of the biopsy?
  5. If the biopsy results show that there is still cancer present, what are the next steps in my treatment plan?
  6. Are there alternative methods for determining if the cancer has completely disappeared after chemotherapy?
  7. How will the biopsy results impact the decision to proceed with surgery or other treatment options?
  8. What are the potential implications of a false-negative result from the biopsy?
  9. Will I experience any pain or discomfort during or after the biopsy procedure?
  10. Are there any specific instructions I need to follow before or after the biopsy?

Reference

Authors: Hariharan N, Rao TS, Rajappa S, Naidu CCK, Raju KVVN, Koppula V, Sannapareddy K, Sudhir R, Kodandapani S, Fonseca D, Murthy S. Journal: JCO Glob Oncol. 2023 Sep;9:e2300014. doi: 10.1200/GO.23.00014. PMID: 37656945