| Breast conservation therapy(BCS) is better than the improved radical correction in aspects of body configuration and upper extremity symptoms improvement, so it improves the life quality of patients. But BCS has a local recurrence rate of 10% in early breast cancer, so how to decrease the local recurrence rate of BCS is always an important focus. So while we pursuit beautiful outlook, the safety should be caution. The studies of MD Anderson Cancer Center showed that tumour changes after neoadjuvant chemotherapy present concentric and patch-like residual tumors, while for BCS the patch-like residual cancer is one of the factors of local recurrence. Besides the two types of residual tumors, whether other types of residuals exist or not is not clear by now. Conventional pathology research can't observe the general state of tumor shrinking for specimen limitation and it has its limitations. So we performed this preliminary study and tried to explore the tumour contraction patterns after chemotherapy and relationship with clinicopathological parameters.Methods & ResultsPartⅠ. Pathological changes of tumor bed and pericancerous tissues after neoadjuvant chemotherapyMethods: 90 women with clinical TNM StageⅡand StageⅢinvasive ductal carcinoma who achieved partial response (PR) after neoadjuvant chemotherapy with Taxol and Epirubicin(TE) were enrolled, in addition all patients had undergone modified radical mastectomy. The surgical specimens were cut apart from the tumor center to the nipple, one half was made into sub-serial section of total breast. Pathological changes of tumor bed and pericancerous tissues were examined with optical microscope.The maximum tumor diameters were detected by ultrasonography and Mammary X-ray.Results: There were three microscopic morphological types of residual breast cancer after neoadjuvant chemotherapy: typeⅠ(centripedally contracted solitary lesion); TypeⅡ(multifocal and patch-like lesions); TypeⅢ(satellite lesions near the main residual tumor) Among the 90 patients, typeⅠwas in 55 (61%), typeⅡin 30 (33%) and typeⅢin 5(6%). Paired t test showed no statistical difference in stageⅠbreast cancer (P>0.05), but significant difference in stageⅡa ndⅢbreast cancer (p<0.05)between the two examination methods. Mammary X-ray examination of the 90 cases after neoadjuvant chemotherapy showed that nine cases were found with calcification and no satellite lesions were found by X-ray examination.PartⅡ. Analysis the relationship of types of residual tumor with clinicopathological parameters.Methods: To add up the patients' data and immunohistochemistry(IHC) was used to measure ER,PR and HER-2, then analyse the correlation between shrink pattern and age, menstrual status, primary tumor T stage, ER, PR and HER-2.Results: There was statistical significance in types of residual tumor and primary tumor T stage(p<0.05), and typeⅡand typeⅢwere easy to find in larger primary tumor; Types of residual tumor were not significant with age and menstrual status(p>0.05), respectively; Types of residual tumor were not significantly related to hormone receptor and HER-2(p>0.05); And expressions of ER, PR and HER-2 after neoadjuvant chemotherapy were descended, but there were no significance(p>0.05).Conclusions1. There were three microscopic morphological types of residual breast cancer after neoadjuvant chemotherapy: typeⅠ(centripedally contracted solitary lesion); typeⅡ(multifocal and patch-like lesions); typeⅢ(satellite lesions near the main residual tumor) Among the 90 patients, typeⅠwas in 55 (61%), typeⅡin 30 (33%) and typeⅢin 5(6%). Among the three types, typeⅠp resented the most proportionality. TypeⅡand typeⅢmay have close relation with local recurrence after BCS, while typeⅢmay be the important factor of local recurrence that patients with negative margin checked by intraoperative frozen section examination.2. There was statistical significance in types of residual tumor and primary tumor T stage and typeⅡand typeⅢwere easy to find in larger primary tumor.3. Expressions of ER,PR and HER-2 after neoadjuvant chemotherapy were descended, but there were no significance. |
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