Accuracy of physical examination, ultrasonography, and mammography in predicting residual pathologic tumor size in patients treated with neoadjuvant chemotherapy

被引:191
作者
Chagpar, AB
Middleton, LP
Sahin, AA
Dempsey, P
Buzdar, AU
Mirza, AN
Ames, FC
Babiera, GV
Feig, BW
Hunt, KK
Kuerer, HM
Meric-Bernstam, F
Ross, MI
Singletary, SE
机构
[1] Univ Texas, MD Anderson Canc Ctr, Dept Surg Oncol, Houston, TX 77030 USA
[2] Univ Texas, MD Anderson Canc Ctr, Dept Pathol, Houston, TX 77030 USA
[3] Univ Texas, MD Anderson Canc Ctr, Dept Med Oncol, Houston, TX 77030 USA
[4] Univ Texas, MD Anderson Canc Ctr, Dept Radiol, Houston, TX 77030 USA
[5] Univ Louisville, Div Surg Oncol, Louisville, KY 40292 USA
关键词
D O I
10.1097/01.sla.0000197714.14318.6f
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: To assess the accuracy of physical examination, ultrasonography, and mammography in predicting residual size of breast tumors following neoadjuvant chemotherapy. Background: Neoadjuvant chemotherapy is an accepted part of the management of stage II and III breast cancer. Accurate prediction of residual pathologic tumor size after neoadjuvant chemotherapy is critical in guiding surgical therapy. Although physical examination, ultrasonography, and mammography have all been used to predict residual tumor size, there have been conflicting reports about the accuracy of these methods in the neoadjuvant setting. Methods: We reviewed the records of 189 patients who participated in 1 of 2 protocols using doxorubicin-containing neoadjuvant chemotherapy, and who had assessment by physical examination, ultrasonography, and/or mammography no more than 60 days before their surgical resection. Size correlations were performed using Spearman rho analysis. Clinical and pathologic measurements were also compared categorically using the weighted kappa statistic. Results: Size estimates by physical examination, ultrasonography, and mammography were only moderately correlated with residual pathologic tumor size after neoadjuvant chemotherapy (correlation coefficients: 0.42, 0.42, and 0.41, respectively), with an accuracy of +/- 1 cm in 66% of patients by physical examination, 75% by ultrasonography, and 70% by mammography. Kappa values (0.24-0.35) indicated poor agreement between clinical and pathologic measurements. Conclusion: Physical examination, ultrasonography, and mammography were only moderately useful for predicting residual pathologic tumor size after neoadjuvant chemotherapy.
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页码:257 / 264
页数:8
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