Can residual disease be diagnosed with image-guided vacuum-assisted breast biopsy?


The pathologic evaluation of surgical specimens is the gold standard for diagnosing residual disease and pathologic complete response following neoadjuvant chemotherapy for breast cancer, but this approach can lead to over-treatment, according to Joerg Heil, MD.

To assess the potential for image-guided vacuum-assisted biopsy (VAB) alone, as opposed to breast-conserving or ablative breast surgery, for diagnosing and ruling out residual disease, and potentially preventing unnecessary surgery, he and his colleagues performed a prospective diagnostic trial at 21 sites in Germany.

In this interview, Dr. Heil explains the study design and outcomes as presented at the San Antonio Breast Cancer Symposium and puts the negative findings of the trial, which was stopped for futility at an interim analysis, into context based on findings of earlier pilot studies and other data presented at the symposium.

“Probably, imaging is not at the end of its possibilities,” he said, explaining that the findings will guide future study and that he is confident that “with some refinements in procedures and perhaps patient selection” this approach will have benefit for preventing unnecessary surgery in the future.

“Let’s hold on and move forward,” he said.