Central pathology review with two-stage quality assurance for pathological response after neoadjuvant chemotherapy in the ARTemis Trial.

Autor: Thomas JSJ; Department of Pathology, Western General Hospital, Edinburgh, UK., Provenzano E; NIHR Cambridge Biomedical Research Centre, Addenbrookes Hospital, Cambridge, UK.; Cambridge Breast Cancer Research Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.; Department of Histopathology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK., Hiller L; Warwick Clinical Trials Unit, University of Warwick, Coventry, UK., Dunn J; Warwick Clinical Trials Unit, University of Warwick, Coventry, UK., Blenkinsop C; Warwick Clinical Trials Unit, University of Warwick, Coventry, UK., Grybowicz L; Cambridge Clinical Trials Unit-Cancer Theme, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK., Vallier AL; Cambridge Clinical Trials Unit-Cancer Theme, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK., Gounaris I; The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK., Abraham J; NIHR Cambridge Biomedical Research Centre, Addenbrookes Hospital, Cambridge, UK.; Cambridge Breast Cancer Research Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.; University of Cambridge, Department of Oncology, Addenbrooke's Hospital, Cambridge, UK., Hughes-Davies L; University of Cambridge, Department of Oncology, Addenbrooke's Hospital, Cambridge, UK.; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK., McAdam K; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.; Peterborough City Hospital, Edith Cavell Campus, Peterborough, UK., Chan S; Nottingham University Hospital (City Campus), Nottingham, UK., Ahmad R; West Middlesex University Hospital, Isleworth, UK., Hickish T; Poole Hospital NHS Foundation Trust, Poole, UK.; Bournemouth University, Poole, UK., Houston S; The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK., Rea D; Institute for Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK., Caldas C; NIHR Cambridge Biomedical Research Centre, Addenbrookes Hospital, Cambridge, UK.; Cambridge Breast Cancer Research Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.; University of Cambridge, Department of Oncology, Addenbrooke's Hospital, Cambridge, UK.; Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, UK., Bartlett JM; Ontario Institute for Cancer Research, MaRS Centre, Toronto, ON, Canada., Cameron DA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK., Hayward RL; Department of Medical Oncology, NHS Lothian, Western General Hospital, Edinburgh, UK., Earl HM; NIHR Cambridge Biomedical Research Centre, Addenbrookes Hospital, Cambridge, UK.; Cambridge Breast Cancer Research Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.; University of Cambridge, Department of Oncology, Addenbrooke's Hospital, Cambridge, UK.
Jazyk: angličtina
Zdroj: Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc [Mod Pathol] 2017 Aug; Vol. 30 (8), pp. 1069-1077. Date of Electronic Publication: 2017 May 26.
DOI: 10.1038/modpathol.2017.30
Abstrakt: The ARTemis Trial tested standard neoadjuvant chemotherapy±bevacizumab in the treatment of HER2-negative early breast cancer. We compare data from central pathology review with report review and also the reporting behavior of the two central pathologists. Eight hundred women with HER2-negative early invasive breast cancer were recruited. Response to chemotherapy was assessed from local pathology reports for pathological complete response in breast and axillary lymph nodes. Sections from the original core biopsy and surgical excision were centrally reviewed by one of two trial pathologists blinded to the local pathology reports. Pathologists recorded response to chemotherapy descriptively and also calculated residual cancer burden. 10% of cases were double-reported to compare the central pathologists' reporting behavior. Full sample retrieval was obtained for 681 of the 781 patients (87%) who underwent surgery within the trial and were evaluable for pathological complete response. Four hundred and eighty-three (71%) were assessed by JSJT, and 198 (29%) were assessed by EP. Residual cancer burden calculations were possible in 587/681 (86%) of the centrally reviewed patients, as 94/681 (14%) had positive sentinel nodes removed before neoadjuvant chemotherapy invalidating residual cancer burden scoring. Good concordance was found between the two pathologists for residual cancer burden classes within the 65-patient quality assurance exercise (kappa 0.63 (95% CI: 0.57-0.69)). Similar results were obtained for the between-treatment arm comparison both from the report review and the central pathology review. For pathological complete response, report review was as good as central pathology review but for minimal residual disease, report review overestimated the extent of residual disease. In the ARTemis Trial central pathology review added little in the determination of pathological complete response but had a role in evaluating low levels of residual disease. Calculation of residual cancer burden was a simple and reproducible method of quantifying response to neoadjuvant chemotherapy as demonstrated by performance comparison of the two pathologists.
Databáze: MEDLINE
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