by Isabel T. Rubio, Carolina Sobrido
The Breast: Published: December 31, 2021
Abstract
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.
