Image-Guided Biopsies May Allow Breast Cancer Patients to Skip Surgery After Chemo

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Many women who have surgery for breast cancer may not need it, according to a new study led by Dr. Henry Kuerer, a professor in the Department of Breast Surgical Oncology at the University of Texas MD Anderson Cancer Center.

Currently, the only way to know if systemic therapies like chemotherapy, targeted therapy, or hormone therapy have worked is by performing a surgery to remove nearby lymph nodes and test them for disease. If the lymph nodes have any residual disease, a lumpectomy or mastectomy may be needed.

But because these systemic treatments usually shrink the size of tumors, further surgery may be redundant. "If [the cancer] is no longer there and has been killed with systemic therapy, the surgery itself may not be necessary," Dr. Kuerer said. By using image-guided biopsies, doctors may be able to confirm that breast cancer has been wiped out without needing to remove lymph nodes.

In an initial study, image-guided biopsy had an accuracy of about 98% when identifying any residual disease in people with HER2-positive, triple-negative breast cancer.

Dr. Kuerer and his colleagues reviewed the records of 527 patients. They found that out of 237 patients who had lymph node disease when they were diagnosed with breast cancer, nearly 90% had node-negative disease on final examination, suggesting they could skip surgery to remove their lymph nodes, as well as any surgery to remove breast tissue.

Now, Dr. Kuerer and his colleagues are testing image-guided biopsies in a clinical trial at MD Anderson and other centers. They are enrolling women 40 years or older who have a stage 1 or stage 2 HER2-positive or triple-negative breast tumor. "This technology is out there and if our study proves that the local recurrence without surgery in these cases is extremely low, this would drastically change the management of breast cancer," Dr. Kuerer said.

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