uzspbgmuУчёные записки Первого Санкт-Петербургского государственного медицинского университета имени академика И. П. ПавловаThe Scientific Notes of the Pavlov University1607-41812541-8807Academician I.P. Pavlov First St. Petersburg State Medical University10.24884/1607-4181-2024-31-2-28-43uzspbgmu-1031Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL PAPERSПатоморфологическое исследование материала, полученного при использовании вакуум-ассистированной биопсии у пациентов с диагнозом рак молочной железы после неоадъювантной системной терапииPathomorphological examination of specimen after vacuum-assisted biopsy in patients with breast cancer after neoadjuvant systemic therapyhttps://orcid.org/0000-0002-2421-3284АмировН. С.AmirovN. S.

Амиров Николай Сергеевич - аспирант научного отделения опухолей молочной железы, врач-онколог.

197758, Санкт-Петербург, пос. Песочный, ул. Ленинградская, д. 68

Amirov Nikolay S. - Postgraduate Student of the Scientific Department of Breast Tumors, Oncologist.

68, Leningradskaya str., Saint Petersburg, village Pesochny, 197758

amirovn17@gmail.comhttps://orcid.org/0000-0002-2948-397XАртемьеваА. С.ArtemyevaA. S.

Артемьева Анна Сергеевна - кандидат медицинских наук, доцент, заведующий патологоанатомическим отделением, зав. научной лабораторией морфологии опухолей, врач-патологоанатом.

Санкт-Петербург

Artemyeva Anna S. - Cand. of Sci. (Med.), Associate Professor, Head of the Pathology Department, Head of the Scientific Laboratory of Tumor Morphology, Pathologist.

Saint Petersburg

oinochoya@gmail.comhttps://orcid.org/0000-0002-4898-9159КриворотькоП. В.KrivorotkoP. V.

Криворотько Петр Владимирович - доктор медицинских наук, профессор, ведущий научный сотрудник, заведующий отделением опухолей молочной железы, врач-онколог, врач-пластический хирург.

Санкт-Петербург

Krivorotko Petr V. - Dr. of Sci. (Med.), Professor, Leading Research Fellow, Head of the Department of Breast Tumors, Oncologist, Plastic Surgeon.

Saint Petersburg

dr.krivorotko@mail.ruhttps://orcid.org/0000-0002-1982-5710МортадаВ. В.MortadaV. V.

Мортада Виктория Владимировна - кандидат медицинских наук, врач-онколог, врач-пластический хирург.

Санкт-Петербург

Mortada Viktoriia V. - Cand. of Sci. (Med.), Oncologist, Plastic Surgeon.

Saint Petersburg

vika-gukova@mail.ruСмирноваВ. О.SmirnovaV. O.

Смирнова Виктория Олеговна - кандидат медицинских наук, врач-патологоанатом.

Санкт-Петербург

Smirnova Viktoria O. - Cand. of Sci. (Med.), Pathologist.

Saint Petersburg

Bashlyk_viktoriya@mail.ruhttps://orcid.org/0000-0002-0528-9937ЕмельяновА. С.EmelyanovA. S.

Емельянов Александр Сергеевич - кандидат медицинских наук, врач-онколог, врач-пластический хирург.

Санкт-Петербург

Emelyanov Alexander S. - Cand. of Sci. (Med.), Oncologist, Plastic Surgeon.

Saint Petersburg

ae28111992@yandex.ruhttps://orcid.org/0000-0002-2573-2211ПесоцкийР. С.PesotskiyR. S.

Песоцкий Роман Сергеевич - врач-онколог.

Санкт-Петербург

Pesotskiy Roman S. – Oncologist.

Saint Petersburg

shipmeback@gmail.comhttps://orcid.org/0000-0002-5090-7001ЕрещенкоС. С.YerechshenkoS. S.

Ерещенко Сергей Сергеевич - кандидат медицинских наук, врач-онколог.

Санкт-Петербург

Yerechshenko Sergey S. - Cand. of Sci. (Med.), Oncologist.

Saint Petersburg

dr.ereschenko@gmail.comhttps://orcid.org/0000-0002-2029-4582ЖильцоваЕ. К.ZhiltsovaE. K.

Жильцова Елена Константиновна - кандидат медицинских наук, научный сотрудник, врач-онколог, врач-пластический хирург.

Санкт-Петербург

Zhiltsova Elena K. - Cand. of Sci. (Med.), Research Fellow, Oncologist, Plastic Surgeon.

Saint Petersburg

ziltsova@yandex.ruhttps://orcid.org/0000-0003-1471-9473ТабагуаТ. Т.TabaguaT. T.

Табагуа Тенгиз Тенгизович - кандидат медицинских наук, научный сотрудник, врач-онколог, врач-пластический хирург.

Санкт-Петербург

Tabagua Tengiz T. - Cand. of Sci. (Med.), Research Fellow, Oncologist, Plastic Surgeon.

Saint Petersburg

tedo8308@mail.ruhttps://orcid.org/0000-0002-6442-0106БондарчукЯ. И.BondarchukYa. I.

Бондарчук Яна Игоревна - аспирант научного отделения опухолей молочной железы, врач-онколог.

Санкт-Петербург

Bondarchuk Yana I. - Postgraduate Student of the Scientific Department of Breast Tumors, Oncologist.

Saint Petersburg

yana_bondarchuk_2015@mail.ruhttps://orcid.org/0000-0002-2773-3111ЕналдиеваД. А.EnaldievaD. A.

Еналдиева Диана Артуровна - аспирант научного отделения опухолей молочной железы, врач-онколог.

Санкт-Петербург

Enaldieva Diana A. - Postgraduate Student of the Scientific Department of Breast Tumors, Oncologist.

Saint Petersburg

DIANAENALDIEVA932@gmail.comУльрихД. Г.UlrikhD. G.

Ульрих Дарья Глебовна - аспирант научного отделения опухолей молочной железы, врач-онколог.

Санкт-Петербург

Ulrikh Daria G. - Postgraduate Student of the Scientific Department of Breast Tumors, Oncologist.

Saint Petersburg

dashaulrikh@mail.ruhttps://orcid.org/0000-0003-0077-9619СемиглазовВ. Ф.SemiglazovV. F.

Семиглазов Владимир Федорович - членкорреспондент РАН, доктор медицинских наук, профессор, заведующий научным отделением, главный научный сотрудник научного отделения опухолей молочной железы.

Санкт-Петербург

Semiglazov Vladimir F. - Corresponding Member of the Russian Academy of Sciences, Dr. of Sci. (Med.), Professor, Head of the Scientific Department, Chief Research Fellow of the Scientific Department of Breast Tumors.

Saint Petersburg

ssemiglazov@mail.ruФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр онкологии имени Н.Н. Петрова» Министерства Здравоохранения Российской ФедерацииРоссияN.N. Petrov National Medical Research Center of OncologyRussian Federation2024031120243122843Copyright © Амиров Н.С., Артемьева А.С., Криворотько П.В., Мортада В.В., Смирнова В.О., Емельянов А.С., Песоцкий Р.С., Ерещенко С.С., Жильцова Е.К., Табагуа Т.Т., Бондарчук Я.И., Еналдиева Д.А., Ульрих Д.Г., Семиглазов В.Ф., 20242024Амиров Н.С., Артемьева А.С., Криворотько П.В., Мортада В.В., Смирнова В.О., Емельянов А.С., Песоцкий Р.С., Ерещенко С.С., Жильцова Е.К., Табагуа Т.Т., Бондарчук Я.И., Еналдиева Д.А., Ульрих Д.Г., Семиглазов В.Ф.Amirov N.S., Artemyeva A.S., Krivorotko P.V., Mortada V.V., Smirnova V.O., Emelyanov A.S., Pesotskiy R.S., Yerechshenko S.S., Zhiltsova E.K., Tabagua T.T., Bondarchuk Y.I., Enaldieva D.A., Ulrikh D.G., Semiglazov V.F.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sci-notes.ru/jour/article/view/1031Введение

Введение. Вакуум-ассистированная биопсия (ВАБ) ложа опухоли в молочной железе показала многообещающие результаты в качестве малоинвазивного метода определения pCR. Существенным недостатком ВАБ является фрагментирование полученного материала и отсутствие методики определения общепризнанных предиктивных и прогностических показателей.

Цель – представить описание накопленного опыта гистологического исследования препаратов, полученных с помощью ВАБ, у пациентов с диагнозом рака молочной железы после неоадъювантной системной терапии.

Методы и материалы

Методы и материалы. В одноцентровое проспективное нерандомизированное исследование включались пациенты с унифокальным РМЖ (cT1–2N0–1M0). Пациентам, достигшим полного клинического ответа (cCR), выполнялась ВАБ. По результатам гистологического исследования пациентам без признаков резидуальной опухоли (pCR, ypT0N0) дальнейшее оперативное вмешательство не проводилось. При выявлении резидуальных опухолевых клеток (ypTisN0-1, ypT1-2N0-1) выполнялось стандартное оперативное вмешательство на молочной железе.

Результаты

Результаты. В анализ включены 35 пациентов со средним возрастом 48,3 (31–67) года. Исследование образцов ВАБ показало, что у 11 (31,4 %) пациенток была резидуальная опухоль, а у 24 (68,6 %) пациенток опухолевые клетки не были обнаружены (ypT0N0). По системе Miller–Payne у 28 пациентов отмечался полный патоморфологический ответ, который соответствует Miller–Payne=5 и патологической стадии ypT0/ypTis (24 пациентки ypT0N0, 3 пациентки ypTisN0 и 1 пациентка ypT0N1). У 3 пациентов с резидуальной инвазивной опухолью опухолевый ответ по шкале Miller–Payne соответствовал 3 степени. Наблюдалась статистически значимая корреляция между наличием опухолевых клеток во внешнем контуре после ВАБ и наличием опухолевых клеток в материале после стандартного хирургического вмешательства (Х2 p=0,01, точный критерий Фишера p=0,048). Между статусом гормональных рецепторов и степенью опухолевого ответа наблюдалась статистически значимая корреляция при оценке с использованием критерия Пирсона (p=0,046). Наименьшая дискордантность между данными контрольного обследования и данными гистологического заключения наблюдалась при интерпретации результатов маммолимфосцинтиграфии (25 %) и в случае, если в 3 из 3 исследований описывался полный клинический регресс (16,7 %).

Выводы

Выводы. Используемый в исследовании метод оценки гистологического материала позволяет получить предиктивную и прогностическую информацию, необходимую для определения дальнейшей тактики лечения пациентов в соответствии с современными стандартами. Необходимо проведение более крупных исследований в этой сфере для ответа на вопрос о возможности внедрения данного метода в рутинную клиническую практику.

Introduction

Introduction. Vacuum-assisted biopsy (VAB) of the tumor bed in the breast has shown promising results as a minimally invasive method for determining pCR. A significant disadvantage of VAB is the fragmentation of the obtained material and the lack of methods for determining generally accepted predictive and prognostic factors.

The objective was to provide a description of the accumulated experience of histological examination of specimens obtained using VAB in patients with breast cancer after neoadjuvant systemic therapy.

Methods and materials

Methods and materials. A single-center, prospective, non-randomized study included patients with unifocal breast cancer (cT1–2N0–1M0). Patients who achieved a complete clinical response (cCR) underwent VAB. Based on the results of histological examination, patients without signs of residual tumor (pCR, ypT0N0) did not undergo further surgical intervention. When residual tumor cells (ypTisN0-1, ypT1-2N0-1) were detected, standard breast surgery was performed.

Results

Results. 35 patients with a mean age of 48.3 (31–67) years were included in the analysis. The examination of VAB samples showed that 11 (31.4 %) patients had a residual tumor, and in 24 (68.6 %) patients, no tumor cells were detected (ypT0N0). According to the Miller-Payne system, 28 patients had a complete pathological response, which corresponds to Miller-Payne=5 and pathological stage ypT0/ypTis (24 patients ypT0N0, 3 patients ypTisN0 and 1 patient ypT0N1). In 3 patients with residual invasive tumor, the tumor response according to the Miller-Payne scale corresponded to grade 3. There was a statistically significant correlation between presence of residual tumor cells in the outer counter after VAB and presence of residual tumor cells in the postoperative histology after standard surgery (Х2 p=0.01, Fisher exact test p=0.048). In addition, there was a statistically significant correlation between hormone receptor status and the degree of tumor response when evaluated using the Pearson criterion (p=0.046). We observed the smallest discordance between the data of the control examination and the data of the histological conclusion when interpreting the results of mammolymphoscintigraphy (25 %) and if 3 out of 3 studies described a complete clinical regression (16.7%).

Conclusions

Conclusions. The method used to evaluate histological material allows to obtain predictive and prognostic information necessary to clarify further treatment tactics in accordance with modern standards. It is necessary to conduct more largescale studies in this area to answer the question if this method can be used in routine clinical practice.

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The authors declare that there are no conflicts of interest present.