• Elisabetta M C Rossi, Alessandra Invento, Filippo Pesapane, Eleonora Pagan, Vincenzo Bagnardi, Nicola Fusco, Konstantinos Venetis, Valeria Dominelli, Chiara Trentin, Enrico Cassano, Laura Gilardi, Manuelita Mazza, Matteo Lazzeroni, Francesca De Lorenzi, Pietro Caldarella, Alessandra De Scalzi, Antonia Girardi, Claudia Sangalli, Luca Alberti, Virgilio Sacchini, Viviana Galimberti, and Paolo Veronesi.
• Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy.
• Br J Surg. 2023 Jan 10; 110 (2): 217224217-224.

BackgroundImage-guided vacuum-assisted breast biopsy (VABB) of the tumour bed, performed after neoadjuvant therapy, is increasingly being used to assess residual cancer and to potentially identify to identify pathological complete response (pCR). In this study, the accuracy of preoperative VABB specimens was assessed and compared with surgical specimens in patients with triple-negative or human epidermal growth factor receptor 2 (HER2)-positive invasive ductal breast cancer after neoadjuvant therapy. As a secondary endpoint, the performance of contrast-enhanced MRI of the breast and PET-CT for response prediction was assessed.MethodsThis single-institution prospective pilot study enrolled patients from April 2018 to April 2021 with a complete response on imaging (iCR) who subsequently underwent VABB before surgery. Those with a pCR at VABB were included in the primary analysis of the accuracy of VABB. The performance of imaging (MRI and PET-CT) was analysed for prediction of a pCR considering both patients with an iCR and those with residual disease at postneoadjuvant therapy imaging.ResultsTwenty patients were included in the primary analysis. The median age was 44 (range 35-51) years. At surgery, 18 of 20 patients showed a complete response (accuracy 90 (95 per cent exact c.i. 68 to 99) per cent). Only two patients showed residual ductal intraepithelial neoplasia of grade 2 and 3 respectively. In the secondary analysis, accuracy was similar for MRI and PET-CT (77 versus 78 per cent; P = 0.76).ConclusionVABB in patients with an iCR might be a promising method to select patients for de-escalation of surgical treatment in triple-negative or HER2-positive breast cancer. The present results support such an approach and should inform the design of future trials on de-escalation of surgery.© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.

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