Prognostic Ability of the Indication for Adjuvant Systemic Therapy Based on Preoperative Biopsy and the Surgical Excision Specimen in Cases of Small Breast Tumors (CONSCIENCE): A Retrospective Cohort Study.

IF 2.9 3区 医学 Q2 ONCOLOGY
Sophie M Wooldrik, Suzanne Wilhelmus, Thijs van Dalen, Gerson M Struik, Erwin Birnie, Cornelis Verhoef, Taco M A L Klem
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引用次数: 0

Abstract

Purpose: To evaluate the agreement between clinical and pathological assessments of tumor size and grade in patients with small, luminal type breast cancer.

Methods: This retrospective monocenter cohort study included women treated for clinical stage 1, estrogen receptor positive, HER2 negative breast cancer between January 2020 and July 2023. Preoperative and postoperative assessments of tumor size, malignancy grade and lymph node status were compared. The impact on the indication to administer systemic therapy was evaluated. Statistical analyses included agreement estimates expressed as proportions with 95% confidence intervals.

Results: 292 patients were examined preoperatively and postoperatively. Agreement for tumor grade was 81% (95% CI [76-85]) and for tumor size based on ultrasonography (US) 75% (95% CI [70-80]. Tumor size was more likely underestimated than overestimated by US (17% vs 8%). Twelve percent of cN0 patients had a SLN containing metastases. The preoperative assessment for adjuvant chemotherapy aligned with postoperative recommendations in 93% of patients and for adjuvant endocrine therapy in 75%. Preoperative underestimation of the indication to administer chemotherapy and endocrine therapy occurred in 7% and 18% of all patients respectively. A positive SLN contributed to these proportions of underestimated systemic treatment indications in half of these groups.

Conclusion: Our study demonstrates disagreement between preoperative and postoperative assessment of malignancy grade and tumor size in approximately one fifth of the patients. Absence of postoperative information of primary tumor characteristics would have led erroneously to omission of adjuvant chemotherapy in less than 5% of the patients.

基于术前活检和手术切除标本的乳腺小肿瘤辅助全身治疗指征的预后能力(良心):一项回顾性队列研究。
目的:评价小腔型乳腺癌患者肿瘤大小和分级的临床与病理评价的一致性。方法:这项回顾性单中心队列研究纳入了2020年1月至2023年7月期间接受临床1期、雌激素受体阳性、HER2阴性乳腺癌治疗的女性。比较术前和术后肿瘤大小、恶性分级和淋巴结状况的评估。评估对给予全身治疗的适应症的影响。统计分析包括以95%置信区间的比例表示的一致性估计。结果:对292例患者进行了术前、术后检查。肿瘤分级的一致性为81% (95% CI[76-85]),基于超声检查(US)的肿瘤大小一致性为75% (95% CI[70-80])。肿瘤大小更有可能被低估而不是高估(17%比8%)。12%的cN0患者有包含转移的SLN。93%的患者术前评估辅助化疗与术后建议一致,75%的患者辅助内分泌治疗。术前低估化疗和内分泌治疗适应症的发生率分别为7%和18%。在这些组中,有一半的人的SLN阳性导致了这些被低估的全身治疗指征的比例。结论:我们的研究表明,在大约五分之一的患者中,术前和术后对恶性分级和肿瘤大小的评估存在分歧。术后缺乏原发肿瘤特征的信息会导致不到5%的患者错误地遗漏辅助化疗。
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来源期刊
Clinical breast cancer
Clinical breast cancer 医学-肿瘤学
CiteScore
5.40
自引率
3.20%
发文量
174
审稿时长
48 days
期刊介绍: Clinical Breast Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of breast cancer. Clinical Breast Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of breast cancer. The main emphasis is on recent scientific developments in all areas related to breast cancer. Specific areas of interest include clinical research reports from various therapeutic modalities, cancer genetics, drug sensitivity and resistance, novel imaging, tumor genomics, biomarkers, and chemoprevention strategies.
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