乳腺癌新辅助化疗后选择性避免乳房手术的研究进展

新辅助化疗（neoadjuvant chemotherapy，NAC）已广泛应用于乳腺癌的治疗，理想情况下可以实现病理完全缓解（pathological complete remission，pCR）。随着分子分型指导的NAC和靶向治疗疗效的不断改善，pCR率显著提高，尤以三阴性乳腺癌和人表皮生长因子受体2（human epidermal growth factor receptor 2，HER-2）阳性型乳腺癌为著，其pCR率可达60%。NAC显著促进了乳腺癌局部区域的降阶梯治疗，但NAC获得pCR患者均行乳房手术的必要性受到了质疑，尤其是在保乳手术患者接受辅助全乳放疗时。潜在避免乳房手术的主要障碍是常规及功能性的乳房成像技术不能准确预测残留病变，影像学方法引导的微创活检技术有望克服这一障碍。本文将就乳腺癌NAC后选择性避免乳房手术的研究进展进行综述。

Progress in selective elimination of breast surgery after neoadjuvant chemotherapy for breast cancer

Neoadjuvant chemotherapy (NAC) is widely used as an efficient breast cancer treatment. Ideally, a pathological complete remission (pCR) can be achieved. With improvements in molecular typing guided NAC and targeted therapies, there has been dramatic improvement in pCR rates, especially among triple-negative and human epidermal growth factor receptor 2-positive breast cancers. Rates of pCR in these groups of patients can reach 60% or higher. NAC has significantly promoted the loco-regional de-escalating treatment of breast cancer. However, the need for breast surgery in NAC cases with pCR has been questioned, especially in the patients undergoing breastconserving surgery with whole breast radiotherapy. The main impediment to potential elimination of breast surgery is that conventional and functional breast imaging techniques are incapable of accurate prediction of residual disease. However, imaging-guided minimally invasive biopsy techniques might have the potential to overcome this impediment. This review summarizes the progress in selective elimination of breast surgery after NAC for breast cancer.