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 University10.24884/1607-4181-2026-33-2-56-66uzspbgmu-1221Research ArticleОРИГИНАЛЬНЫЕ РАБОТЫORIGINAL PAPERSОценка компонентов и площади ложа опухоли при полном патоморфологическом ответе после неоадъювантной химиотерапии у пациенток с ранним раком молочной железы: сравнение вакуум-ассистированной биопсии и стандартного хирургического материалаEvaluation of tumor bed area and components in patients with early breast cancer achieved pathological complete response after neoadjuvant chemotherapy: comparison of vacuum-assisted biopsy and standard surgical specimenshttps://orcid.org/0009-0000-7635-2502МихаськоваН. С.MikhaskovaN. S.

Михаськова Надежда Сергеевна, врач-ординатор патологоанатомического отделения 

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

Mikhaskova Nadezhda S., Resident Pathologist, Department of Pathological Anatomy 

68, Leningradskaya str., Saint Petersburg, 197758 

iodiosono@mail.ruhttps://orcid.org/0000-0002-2421-3284АмировН. С.AmirovN. S.

Амиров Николай Сергеевич, кандидат медицинских наук, врач-онколог отделения опухолей молочной железы

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

Amirov Nikolay S., Cand. of Sci. (Med.), Oncologist, Department of Breast Tumors

68, Leningradskaya str., Saint Petersburg, 197758 

amirovn17@gmail.comhttps://orcid.org/0009-0009-1460-4108СмутинД. В.SmutinD. V.

Смутин Даниил Валерьевич, инженер института прикладных компьютерных наук

197101, Санкт-Петербург, Кронверкский проспект, д. 49, лит. А 

Smutin Daniil V., Engineer, Institute of Applied Computer Science 

49, lit. A, Kronverksky pr., Saint Petersburg, 197101 

smutin@sut.ruhttps://orcid.org/0000-0002-4898-9159КриворотькоП. В.KrivorotkoP. V.

Криворотько Петр Владимирович, доктор медицинских наук, профессор, зав. отделением – врач-онколог отделения опухолей молочной железы, зав. отделением – врач-пластический хирург отделения онкологии и реконструктивно-пластической хирургии, ведущий научный сотрудник научного отделения опухолей молочной железы

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

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

68, Leningradskaya str., Saint Petersburg, 197758 

dr.krivorotko@mail.ruhttps://orcid.org/0000-0001-7797-088XКудайбергеноваА. Г.KudaibergenovaA. G.

Кудайбергенова Асель Галимовна, кандидат медицинских наук, врач-патологоанатом патологоанатомического отделения, старший научный сотрудник научной лаборатории морфологии опухолей

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

Kudaibergenova Asel G., Cand. of Sci. (Med.), Pathologist, Department of Pathological Anatomy; Senior Research Fellow, Laboratory of Tumor Morphology

68, Leningradskaya str., Saint Petersburg, 197758 

asel1972@mail.ruНациональный медицинский исследовательский центр онкологии имени Н. Н. ПетроваРоссияN. N. Petrov National Medical Research Center of OncologyRussian FederationНациональный исследовательский университет информационных технологий, механики и оптики (Университет ИТМО)РоссияNational Research University of Information Technologies, Mechanics and Optics (ITMO University)Russian Federation2026091020263325666Copyright © Михаськова Н.С., Амиров Н.С., Смутин Д.В., Криворотько П.В., Кудайбергенова А.Г., 20262026Михаськова Н.С., Амиров Н.С., Смутин Д.В., Криворотько П.В., Кудайбергенова А.Г.Mikhaskova N.S., Amirov N.S., Smutin D.V., Krivorotko P.V., Kudaibergenova A.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sci-notes.ru/jour/article/view/1221Введение

Введение. В настоящее время наблюдается устойчивый тренд к деэскалации хирургического лечения при раке молочной железы (РМЖ), ключевую роль в которой играют возможности современной неоадъювантной химиотерапии (НАХТ), повышающей частоту клинического (cCR) и патоморфологического ответа (pCR). Нередко при выборе хирургического вмешательства при достижении полного регресса предпочтение отдается в пользу миниинвазивных методик, таких как вакуум-ассистированная биопсия (ВАБ). Патоморфологическая оценка ответа опухоли на НАХТ требует стандартизированного подхода и включает использование специальных шкал, одной из которых является расчет индекса остаточной опухолевой нагрузки (RCB). Линейные размеры ложа опухоли, которые являются одним из важных компонентов формулы, невозможно оценить на фрагментированном материале ВАБ.

Цель

Цель. Изучить возможность оценки площади ложа опухоли на материале ВАБ в сравнении со стандартным хирургическим вмешательством у пациенток с ранним РМЖ, достигших полного клинического и патоморфологического ответа после НАХТ.

Методы и материалы

Методы и материалы. В исследование включено 57 пациенток с РМЖ сT1-2N0-1M0, получавших НАХТ и достигших pCR. ВАБ была выполнена 21 пациентке, 36 получили стандартное хирургическое лечение (мастэктомия (МЭ)/ органосохранная операция (ОСО)). Гистологический материал оцифровывался с помощью сканера микропрепаратов 3D HISTECH PANORAMIC 1000, проводилась ручная разметка площади ложа опухоли различными методами.

Результаты

Результаты. Средний возраст пациенток составил 48,79 лет (27–68), в группе ВАБ – 49,19 лет (35–68), в группе стандартного вмешательства – 48,56 лет (27–68). Медиана площади ложа опухоли с терминальными протоково-дольковыми единицами (ТПДЕ) в ВАБ составила 175,24 (124,73–309,69), в группе стандартного вмешательства – 151,83 (85,66–282,67). Медиана площади ложа опухоли без ТПДЕ в ВАБ составила 170,07 (123,75–262,69), в группе стандартного вмешательства –129,86 (79,39–264,08). Различия между группами при сравнении площади ложа опухоли с ТПДЕ и без не достигли статистической значимости (критерий Манна – Уитни U=448,0, p=0,2503 и U= 450,0, p=0,2369). Медиана ТПДЕ/мм2 составила 0,274 (0,150–0,452), для группы ВAБ 0,265 (0,177–0,461), для группы стандартного вмешательства 0,278 (0,150–0,365). Статистически значимой разницы в плотности ТПДЕ/мм2 между группами не выявлено (критерий Манна – Уитни U=455,5, p=0,203). При анализе плотности ТПДЕ относительно возраста отмечается нисходящий линейный тренд. Средняя относительная доля ТПДЕ в образцах составила 6,67 % (0,00–28,40). Для группы ВАБ средняя относительная доля составила 6,34 % (0,79–19,94), для группы стандартного вмешательства 6,87 % (0,00–28,40).

Выводы

Выводы. Объем гистологического материала, получаемого при ВАБ, является сопоставимым с хирургическими образцами в контексте оценки площади ложа опухоли. Средняя доля ТПДЕ в образцах составляет около 6 %, однако в частных случаях в ложе опухоли сохраняются остаточные структуры аденоза, что может увеличивать среднюю долю ТПДЕ до 29 %.

Introduction

Introduction. Currently, there is a consistent trend toward de-escalation of surgical treatment in breast cancer (BC), largely driven by advances in modern neoadjuvant chemotherapy (NACT), which increase the rates of clinical (cCR) and pathological complete response (pCR). When complete regression is achieved, minimally invasive approaches such as vacuum-assisted biopsy (VAB) are often preferred over conventional surgery. Pathomorphological assessment of tumor response to NACT requires a standardized approach and often involves specialized grading systems, one of which is the Residual Cancer Burden (RCB) index. However, one of the key components of the RCB formula – the linear dimensions of the tumor bed – cannot be accurately determined from fragmented VAB specimens.

The objective was to evaluate the feasibility of measuring the tumor bed area in VAB specimens compared to standard surgical samples in patients with early-stage breast cancer who achieved both clinical and pathological complete responses following NACT.

Methods and materials

Methods and materials. The study included 57 patients with breast cancer cT1–2N0–1M0 who received NACT and achieved pCR. VAB was performed in 21 patients, while 36 underwent standard surgical treatment (mastectomy or breast-conserving surgery). Histological specimens were digitized using a 3D HISTECH PANORAMIC 1000 slide scanner, and manual annotation of tumor bed areas was performed using various methods.

Results

Results. The mean age of the patients was 48.79 years (range 27–68): 49.19 years (35–68) in the VAB group and 48.56 years (27–68) in the standard surgery group.The median tumor bed area with terminal ductal-lobular units (TDLU) in the VAB group was 175.24 mm2 (124.73–309.69), and 151.83 mm2 (85.66–282.67) in the standard surgery group. The median tumor bed area without TDLU was 170.07 mm2 (123.75–262.69) for VAB and 129.86 mm2 (79.39–264.08) for standard surgery. Differences between the groups were not statistically significant (Mann–Whitney U=448.0, p=0.2503, and U=450.0, p=0.2369, respectively). The median TDLU density was 0.274/mm2 (0.150–0.452): 0.265/mm2 (0.177–0.461) in the VAB group and 0.278/mm2 (0.150–0.365) in the surgery group. No statistically significant differences in TDLU density were observed (Mann–Whitney U=455.5, p=0.203). A downward linear trend in TDLU density was observed with increasing age. The mean relative proportion of TDLU in the samples was 6.67 % (0.00–28.40): 6.34 % (0.79–19.94) in the VAB group and 6.87 % (0.00–28.40) in the standard surgery group.

Conclusions

Conclusions. The volume of histological material obtained via vacuum-assisted biopsy is comparable to that from surgical specimens in the context of tumor bed area assessment. The average proportion of TDLU in samples is approximately 6 %; however, in some cases, residual adenosis structures may persist within the tumor bed, increasing the TDLU proportion to as much as 29 %.

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