Neoadjuvant approach in patients with early breast cancer: patient assessment, staging, and planning

Neoadjuvant treatment (NAT) has become an option in early stage (stage I-II) breast cancer (EBC). New advances in systemic and targeted therapies have increased rates of pathologic complete response increasing the number of patients undergoing NAT. Clear benefits of NAT are downstaging the tumor and...

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Bibliographic Details
Published in:Breast (Edinburgh) 2022-03, Vol.62 (Suppl 1), p.S17-S24
Main Authors: Rubio, Isabel T., Sobrido, Carolina
Format: Article
Language:English
Subjects:
Axilla - pathology
Breast Neoplasms - diagnostic imaging
Breast Neoplasms - pathology
Breast Neoplasms - therapy
COVID-19
Female
Functional imaging
Humans
Lymph Nodes - pathology
Neoadjuvant Therapy - methods
Neoadjuvant treatment
Neoplasm Staging
Selection of patients
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Summary:Neoadjuvant treatment (NAT) has become an option in early stage (stage I-II) breast cancer (EBC). New advances in systemic and targeted therapies have increased rates of pathologic complete response increasing the number of patients undergoing NAT. Clear benefits of NAT are downstaging the tumor and the axillary nodes to de-escalate surgery and to evaluate response to treatment. Selection of patients for NAT in EBC rely in several factors that are related to patient characteristics (i.e, age and comorbidities), to tumor histology, to stage at diagnosis and to the potential changes in surgical or adjuvant treatments when NAT is administered. Imaging and histologic confirmation is performed to assess extent of disease y to confirm diagnosis. Besides mammogram and ultrasound, functional breast imaging MRI has been incorporated to better predict treatment response and residual disease. Contrast enhanced mammogram (CEM), shear wave elastography (SWE), or Dynamic Optical Breast Imaging (DOBI) are emerging techniques under investigation for assessment of response to neoadjuvant therapy as well as for predicting response. Surgical plan should be delineated after NAT taking into account baseline characteristics, tumor response and patient desire. In the COVID era, we have witnessed also the increasing use of NAT in patients who may be directed to surgery, unable to have it performed as surgery has been reserved for emergency cases only.
ISSN:0960-9776
1532-3080
DOI:10.1016/j.breast.2021.12.019