The Rush to Evaluate Response at the End of Treatment in Breast Cancer Patients Who Received Neoadjuvant Treatment: Which Tests are Effective in The Selection of Surgical Technique?

Introduction: Evaluating the treatment response after neoadjuvant therapy (NAT) is essential for determining the surgical approach and planning adjuvant therapy. A variety of imaging methods are available to monitor tumor response. Mammography (MG) and breast ultrasonography (US) combined with physical examination are the most commonly used assessment methods. Our study investigates the impact of imaging techniques used during the NAT process on selecting surgical techniques after NAT.

Materials And Methods: Patients who underwent surgery after NAT for breast cancer at the Etlik City Hospital Surgical Oncology clinic were retrospectively reviewed. These patients had local and systemic imaging performed using similar methods during before and after NAT. Radiological assessment was performed by examining changes in mammography, breast US, breast MRI, and PET findings before and after NAT. The study examined changes in planned surgical techniques before NAT and the influence of different imaging modalities on these decisions after NAT.

Results: In patients who were converted back to mastectomy, MRI was found to be the most effective imaging method. In patients converted to lumpectomy, MG and USG were most effective The axillary US stood out as the most effective examination modality for the decision to perform an axillary intervention. PET had no impact on the choice of surgical technique for the breast. Among the 4 patients who were decided to undergo axillary dissection based on PET, none showed lymph node metastasis.

Conclusion: In patients who have undergone NAT and are making decisions regarding surgery, PET imaging cannot be used to guide the surgical decision or approach for the primary tumour and axilla. In addition, PET is unsuitable for axillary staging.