Histopathological examination of surgical breast cancer specimens after neoadjuvant chemotherapy using digital radiography

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Abstract

The article provides a literature overview on significance, pathologic assessment of residual disease problems, and digital radiography (DR) potential in breast cancer (BC) after neoadjuvant therapy (NAT). Within the framework of the paper, the authors carry out an analysis of the Russian and English-language publications from PubMed, Google Scholar, ClinicalTrials.gov, eLibrary, and Cyberleninka. The comparison of the Russian clinical guidelines for BC diagnosis and the European and American guidelines revealed a lack of information on DR usage in the morphological assessment. The review showed the international experience in DR usage and demonstrated the relevance of the solution of morphological assessment problems in BC regression degree after NAT due to necessary clinical trial protocol standardization and increased predictive residual tumor class significance. The DR facilitated the morphological identification of metal markers implanted into the tumor bed, microcalcifications, altered foci, and improved tumor bed visibility, which is important for further objective status assessment of the resection margins and residual cancer burden class. The authors consider it necessary to conduct a study to optimize the residual tumor assessment using DR.

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About the authors

Inessa M. Telezhnikova

Loginov Moscow Clinical Scientific Center; Research Center for Obstetrics, Gynecology and Perinatology

Author for correspondence.
Email: i.telezhnikova@inbox.ru
ORCID iD: 0000-0002-1491-2882

Junior Researcher of the Histopathology Laboratory

Russian Federation, 86, Enthusiastov shosse, Moscow, 111123; Moscow

Galiya R. Setdikova

Loginov Moscow Clinical Scientific Center; Vladimirsky Regional Clinical Research Institute

Email: g.setdikova@mknc.ru
ORCID iD: 0000-0002-5262-4953

Doctor of Science, Leading Researcher of the Histopathology Laboratory

Russian Federation, 86, Enthusiastov shosse, Moscow, 111123; Moscow

Sergey G. Khomeriki

Loginov Moscow Clinical Scientific Center

Email: s.khomeriki@mknc.ru
ORCID iD: 0000-0003-4308-8009

Doctor of Science, Professor, Head of the Histopathology Laboratory

Russian Federation, 86, Enthusiastov shosse, Moscow, 111123

Ludmila G. Zhukova

Loginov Moscow Clinical Scientific Center

Email: l.zhukova@mknc.ru
ORCID iD: 0000-0003-4848-6938

Doctor of Science, Professor, Deputy Director for oncology

Russian Federation, 86, Enthusiastov shosse, Moscow, 111123

References

  1. World Health Organisation. Cancer Today [electronic source]. URL: http://gco.iarc.fr/today/home (accessed: 29.10.2020).
  2. Tyulyadin S.A. The value of preoperative chemotherapy in patients with breast cancer. IV Russian oncology conference. М.; 2000. (in Russian)
  3. Wang H., Mao X. Evaluation of the Efficacy of Neoadjuvant Chemotherapy for Breast Cancer. Drug Des Devel Ther. 2020; 14: 2423-2433. doi: 10.2147/DDDT.S253961.
  4. Asaoka M., Gandhi S., Ishikawa T., Takabe K. Neoadjuvant Chemotherapy for Breast Cancer: Past, Present, and Future. Breast Cancer: Basic and Clinical Research. 2020; 14: 1–8. doi: 10.1177/1178223420980377.
  5. Bossuyt V., Provenzano E., Symmans W.F., Boughey J.C., Coles C., Curiglianoet G. et al. Recommendation for standardized pathological characterization of residual disease for neoadjuvant clinical trials of breast cancer by the BIG-NABCG collaboration. Ann.Oncol. 2015; 26(7): 1280-1291.
  6. Gianni L., Eiermann W., Semiglazov V., Lluch A., Tjulandin S., Zambetti M. et al. Neoadjuvant and adjuvant trastuzumab in patients with HER2-positive locally advanced breast cancer (NOAH): follow-up of a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet Oncol. 2014; 15: 640–647. doi: 10.1016/S1470 2045(14)70080-4.
  7. Rapoport B.L., Demetriou G.S., Moodley S.D., Benn C.A. When and How Do I Use Neoadjuvant Chemotherapy for Breast Cancer? // Current Treatment Options in Oncology. 2014; 15: 86-98. doi: 10.1007/s11864-013-0266-0.
  8. Minckwitz G., Untch M., Blohmer J-U., Costa S.D., Eidtmann H., Fasching P.A. et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J. Clin. Oncol. 2012; 30(15): 1796-1804.
  9. Symmans W.F., Wei C., Gould R., Yu X., Zhang Y., Liu M. et al. Long-Term Prognostic Risk After Neoadjuvant Chemotherapy Associated With Residual Cancer Burden and Breast Cancer Subtype. J. Clin. Oncol. 2017; 35(10): 1049–1060. doi: 10.1200/JCO.2016.71.3503.
  10. Semiglazov V.V., Natopkin A.A. Strategy of post-neoadjuvant treatment of patients with residual breast cancer. Opukholi zhenskoy reproduktivnoy sistemy. 2020; 16(1): 43–54. doi: 10.17650/1994-4098-2020-16-1-43-54. (in Russian)
  11. Masuda N., Lee S.-J., Ohtani S., Im Y.-H., Lee E.-S., Yokota I. et al. Adjuvant Capecitabine for Breast Cancer after Preoperative Chemotherapy. N Engl J Med. 2017; 376: 2147-2159. doi: 10.1056/NEJMoa1612645.
  12. Minckwitz G., Huang C.-S., Mano M.S., Loibl S., Mamounas E.P., Minckwitz M. et al. Trastuzumab Emtansine for Residual Invasive HER2-Positive Breast Cancer. N Engl J Med. 2019; 380(7): 617-628. doi: 10.1056/NEJMoa1814017.
  13. Burstein H.J., Curigliano G., Loibl S., Dubsky P., Gnant M., Poortmans P. et al. Estimating the benefits of therapy for early-stage breast cancer: the St. Gallen International Consensus Guidelines for the primary therapy of early breast cancer 2019. Ann Oncol. 2019; 30(10): 1541–57. doi: 10.1093/annonc/mdz235.
  14. Vaidya J.S., Massarut S., Vaidya H.J., Alexander E.C., Richards T., Caris J.A. et al. Rethinking neoadjuvant chemotherapy for breast cancer. BMJ 2018; 360: j5913. doi: 10.1136/bmj.j5913.
  15. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol. 2018; 19(1): 27-39. doi: 10.1016/S1470-2045(17)30777-5.
  16. Esserman L.J., Berry D.A., DeMichele A., Carey L., Davis S.E., Buxton M. et al. Pathologic Complete Response Predicts Recurrence-Free Survival More Effectively by Cancer Subset : Results From the I-SPY 1 TRIAL — CALGB 150007 / 150012, ACRIN 6657. J Clin Oncol 30(26): 3242-3249. doi: 10.1200/JCO.2011.39.2779.
  17. Fisher E.R., Wang J., Bryant J., Fisher B., Mamounas E., Wolmark N. Pathobiology of preoperative chemotherapy: findings from the National Surgical Adjuvant Breast and Bowel (NSABP) protocol B-18. Cancer. 2002; 95(4): 681–695. doi: 10.1002/cncr.10741.
  18. Fayanju O.M., Ren Y., Thomas S.M., Greenup R.A., Plichta J.K., Rosenberger L.H. at el. The Clinical Significance of Breast-only and Node-only Pathologic Complete Response (pCR) After Neoadjuvant Chemotherapy (NACT): A Review of 20,000 Breast Cancer Patients in the National Cancer Data Base (NCDB). Ann Surg. 2018; 268(4): 591-601. doi: 10.1097/SLA.0000000000002953.
  19. Cortazar P., Zhang L., Untch M., Mehta K., Costantino J.P., Wolmark N. at el. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014; 384: 164-172. doi: 10.1016/S0140-6736(13)62422-8.
  20. Andreeva Yu.Yu., Moskvina L.V., Berezina T.A., Podberezina Yu.L., Loktev S.S., Frank G.A. Procedure for intraoperative material examination in breast cancer after neoadjuvant therapy to estimate residual cancer burden using the RCB system. Arkh Patol. 2016; 78(2): 41-46. doi: 10.17116/patol201678241-46 (in Russian)
  21. Campbell J.I., Yau C., Krass P., Moore D., Carey L.A., Au A., et al. Comparison of residual cancer burden, American Joint Committee on Cancer staging and pathologic complete response in breast cancer after neoadjuvant chemotherapy: results from the I-SPY 1 TRIAL (CALGB 150007/150012; ACRIN 6657). Breast Cancer Res. Treat. 2017; 165: 181–191. doi: 10.1007/s10549-017-4303-8.
  22. Symmans W.F., Peintinger F., Hatzis C., Rajan R., Kuerer H., Valero V. et al. Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy. J. Clin. Oncol. 2007; 25(28): 4414-4422. doi: 10.1200/JCO.2007.10.6823.
  23. Cockburn A., Yan J., Rahardja D., Euhus D., Peng Y., Fang Y. et al. Modulatory effect of neoadjuvant chemotherapy on biomarkers expression; assessment by digital image analysis and relationship to residual cancer burden in patients with invasive breast cancer. Human Pathology. 2014; 45(2): 249-251. doi: 10.1016/j.humpath.2013.09.002.
  24. Hamy A.-S., Darrigues L., Laas E., De Croze D., Topciu L., Lam G.-T. et al. Prognostic value of the Residual Cancer Burden index according to breast cancer subtype: Validation on a cohort of BC patients treated by neoadjuvant chemotherapy. PLoS ONE. 2020; 15(6): e0234191. doi: 10.1371/journal.pone.0234191.
  25. Edge S.B., Compton C.C. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann. Surg. Oncol. 2010; 17(6): 1471-1474. doi: 10.1245/s10434-010-0985-4.
  26. Brierley J.D., Greene F.L., Sobin L.H., Wittekind C. The «y» symbol: An important classification tool for neoadjuvant cancer treatment. Cancer. 2006; 106(11): 2526-2527. doi: 10.1002/cncr.21887.
  27. Provenzano E., Bossuyt V., Viale G., Cameron D., Badve S., Denkert C. et al. Standardization of pathologic evaluation and reporting of postneoadjuvant specimens in clinical trials of breast cancer: Recommendations from an international working group. Mod. Pathol. 2015; 28(9): 1185-1201. doi: 10.1038/modpathol.2015.74.
  28. Bashlyk V.O., Semiglazov V.F., Kudaybergenova A.G., Artem’eva A.S., Semiglazova T.Yu., Chirskiy V.S. Evaluation of morphological and immunohistochemical changes of breast carcinomas after neoadjuvant systemic therapy. Opukholi zhenskoy reproduktivnoy sistemy. 2018; 14(1): 12-9. doi: 10.17650/1994-4098-2018-14-1-12-19. (in Russian)
  29. Schott A.F., Roubidoux M.A., Helvie M.A., Hayes D.F., Kleer C.G., Newman L.A. et al. Clinical and radiologic assessments to predict breast cancer pathologic complete response to neoadjuvant chemotherapy. Breast Cancer Res Treat. 2005; 92(3): 231-238. doi: 10.1007/s10549-005-2510-1.
  30. Sethi D., Sen R., Parshad S., Khetarpal S., Garg M., Sen J. Histopathologic changes following neoadjuvant chemotherapy in various malignancies. Int J Appl Basic Med Res. 2012; 2(2): 111-116. doi: 10.4103/2229-516X.106353.
  31. Penault-Llorca F., Radosevic-Robin N. Biomarkers of residual disease after neoadjuvant therapy for breast cancer. Nat Rev Clin Oncol. 2016; 13(8): 487-503. doi: 10.1038/nrclinonc.2016.1.
  32. Malter W., Holtschmidt J., Thangarajah F., Mallmann P., Krug B., Warm M. et al. First Reported Use of the Faxitron LOCalizer™ Radiofrequency Identification (RFID) System in Europe - A Feasibility Trial, Surgical Guide and Review for Non-palpable Breast Lesions. In Vivo. 2019; 33(5): 1559-1564. doi: 10.21873/invivo.11637.
  33. Maloney B.W., McClatchy D.M., Pogue B.W., Paulsen K.D., Wells W.A., Barth R.J. Review of methods for intraoperative margin detection for breast conserving surgery. J Biomed Opt. 2018; 23(10): 1-19. doi: 10.1117/1.JBO.23.10.100901.
  34. Wang Y., Ebuoma L., Saksena M., Liu B., Specht M., Rafferty E. Clinical evaluation of a mobile digital specimen radiography system for intraoperative specimen verification. AJR Am J Roentgenol. 2014; 203(2): 457-462. doi: 10.2214/AJR.13.11408.
  35. Morel J.C., Milnes V., Iqbal A., Michell M.J. Comparison of dedicated digital specimen radiography with direct digital specimen mammography images. Breast Cancer Res. 2011; 13(Suppl 1): 26. doi: 10.1186/bcr2978.
  36. D’Orsi C.J. Management of the breast specimen. Radiology. 1995; 194(2) :297-302. doi: 10.1148/radiology.194.2.7824700.
  37. McCormick J.T., Keleher A.J., Tikhomirov V.B., Budway R.J., Caushaj P.F. Analysis of the use of specimen mammography in breast conservation therapy. Am J Surg. 2004; 188(4): 433-436. doi: 10.1016/j.amjsurg.2004.06.030.
  38. Muttaliba M., Taia C.C., Briant-Evansa T., Maheswarana I., Livnib N., Shoushac S. et al. Intra-operative assessment of excision margins using breast imprint and scrape cytology. The Breast. 2004; 14: 42–50. doi: 10.1016/j.breast.2004.10.002.
  39. Bathla L., Harris A., Davey M., Sharma P., Silva E. High resolution intra-operative two-dimensional specimen mammography and its impact on second operation for re-excision of positive margins at final pathology after breast conservation surgery. The American Journal of Surgery. 2011; 202: 387–394. doi: 10.1016/j.amjsurg.2010.09.031.
  40. Kim S.H.H., Cornacchi S.D., Heller B., Farrokhyar F., Babra M., Lovrics P.J. An evaluation of intraoperative digital specimen mammography versus conventional specimen radiography for the excision of nonpalpable breast lesions. Am J Surg. 2013; 205(6): 703-710. doi: 10.1016/j.amjsurg.2012.08.010.
  41. Niemeier L.A., Angelo R.D., Ormsby A., Raju U., Zarbo R.J. Lean redesign of digital X-ray of breast biopsies for calcifications – Reduction of turn around time and wasteful recuts in the Henry ford production system. Lab. Investig. 2008; 88(1): 2007.
  42. Majdak-Paredes E.J., Schaverien M.V., Szychta P., Raine C., Dixon J.M. Intra-operative digital specimen radiology reduces re-operation rates in therapeutic mammaplasty for breast cancer. Breast. 2015; 24(5): 556-559. doi: 10.1016/j.breast.2015.04.007.

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1. Fig. X-ray imaging system for the Pathology Laboratory

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