乳腺癌新辅助治疗二次活检诊断病理学应答研究进展及临床意义

Advances in the diagnosis of pathological response by a second biopsy in breast cancer neoadjuvant therapy and their clinical significance

随着乳腺癌新辅助治疗的发展,病理学完全缓解率明显提高。对于已经达到病理学完全缓解的患者,使用局域放疗替代手术治疗在理论上可行,因此术前准确判断病理学完全缓解至关重要。新辅助化疗后二次活检因其对病理学完全缓解预测准确率较高而被认为是有希望替代手术诊断病理学完全缓解的方法。最近发表的几项国外的前瞻性临床试验结果表明,新辅助化疗后二次活检具有相对较高的假阴性率,对新辅助化疗反应极好的患者豁免手术仍需要进一步研究。本文首先阐述二次活检的临床应用及其意义,并将国外已发表的临床研究分为小型可行性研究和大型前瞻性研究,对其主要结果及特点进行分析。

With the development of neoadjuvant therapy,the pathological complete response rate has significantly increased for breast cancer patients.Theoretically,the use of locoregional radiotherapy instead of surgery is available for patients with pathological complete response,thus it is essential to predict pathological complete response precisely before surgery.Due to its higher accuracy for assessing the pathological complete response,the second biopsy after neoadjuvant chemotherapy is believed to have potential for diagnosing pathological complete response instead of surgery.Recently several published prospective trials showed the relatively high false negative rates of the second biopsy and omitting surgery for the exceptional responders to neoadjuvant chemotherapy required further investigation.This review elaborated on the clinical utility and significance of the second biopsy firstly and divided these studies into small feasible research and large prospective research in which the results and features were discussed.