Neoplasms

Skin and Connective Tissue Diseases

All Conditions

Breast Neoplasms

Breast Diseases

Skin Diseases

Antineoplastic Agents

All Drugs and Chemicals

Anti-Infective Agents

Central Nervous System Depressants

Antirheumatic Agents

Anti-Inflammatory Agents

Pharmaceutical Solutions

Paclitaxel

Docetaxel

Albumin-Bound Paclitaxel

Trastuzumab

Carboplatin

Fluorouracil

Ethanol

Cyclophosphamide

Doxorubicin

Liposomal doxorubicin

Hormones

Triamcinolone

Triamcinolone Acetonide

Triamcinolone hexacetonide

Triamcinolone diacetate

Epirubicin

Tubulin Modulators

Antimitotic Agents

Immunosuppressive Agents

Immunologic Factors

Antineoplastic Agents, Alkylating

Alkylating Agents

Anti-Bacterial Agents

Antibiotics, Antitubercular

Enzyme Inhibitors

Antimetabolites

Antineoplastic Agents, Immunological

Patients complete half of the whole cycles of neoadjuvant chemotherapy.

Patients complete whole cycles of neoadjuvant chemotherapy.

1. Evaluation of the tumor size by sonography is performed before neoadjuvant chemotherapy and prior to surgery.
2. Measurement of tumor size refers to WHO standards.

Ultrasound

Typically, the pretreatment tumor specimen will be a core needle biopsy. Because 15% to 28% of patients will have no residual tumor after NAT, it is important to have an adequate pretreatment sample in which an unequivocal diagnosis of invasive carcinoma is established and evaluation of hormone receptors and HER2/ neu status is completed before treatment.

All patients after neoadjuvant chemotherapy are performed BCS and modified radical mastectomy.

BCS, Modified Radical Mastectomy

1. Pathologic large tissue selected table has obtained Chinese patent.Its license ID is CN101261200.
2. Each piece of breast tissues by cutting with the table has 3mm thickness.

Pathologic Large Tissue Selected Table

Procedure:

1. Alcohol 70 % 1h
2. Alcohol 80 % 1h
3. Alcohol 85 % 1h
4. Alcohol 90 % 1h
5. Alcohol 95 % 1h
6. Alcohol Ⅰ 100 % 1h
7. Alcohol Ⅱ 100 % 1h
8. Xylene Ⅰ 2h
9. Xylene Ⅱ 2h
10. Xylene Ⅲ 2h
11. Paraffin 6h
12. Paraffin 6h

Leica TP1020

1. The table is made of brass .It is applying for a chinese patent.
2. The table can simultaneously embed 8 piece of breast tissues.

Pathologic Large Tissue Embedded Table

Each of paraffin section has 4 um thickness.

Leica SM2000 R

Procedure:

1. Xylene Ⅰ 60℃ 15-20 minutes
2. Xylene Ⅱ 60℃ 15-20 minutes
3. Alcohol 100% Ⅰ 3-5 minutes
4. Alcohol 100% Ⅱ 3-5 minutes
5. Alcohol 95% Ⅱ 3-5 minutes
6. Alcohol 90% Ⅱ 3-5 minutes
7. Wash in running tap water for 3 minutes
8. Hematoxylin 5-10 minutes
9. Wash in running tap water for 3 minutes
10. Differentiate in 1% acid alcohol for 30 seconds
11. Wash in running tap water for 1 minute
12. Bluing in 0.2% ammonia water for 30-60 seconds
13. Wash in running tap water for 3 minutes
14. Counterstain in eosin Y solution for 30-60 seconds
15. Wash in running tap water for 1 minute
16. Alcohol 90% Ⅱ 2-3 minutes
17. Alcohol 95% Ⅱ 2-3 minutes
18. Alcohol 100% Ⅱ 3-5 minutes
19. Alcohol 100% Ⅱ 3-5 minutes
20. Xylene Ⅲ 5-10 minutes
21. Xylene Ⅳ 5-10 minutes
22. Mounting with neutral resin

HE Stain

The residual tumor areas are microscopically outlined on each slice by pathologist.

CX22

1. Each slice that has been microscopically outlined is scanned by Epson V600.
2. Every image by scanning should be saved as JPG.

Epson V600

1. Evaluation of the tumor size by MRI was performed before neoadjuvant chemotherapy and prior to surgery.
2. Measurement of tumor size refers to WHO standards.
3. The images of patients which were scanned by MRI should be burned onto disc for 3d reconstruction.

A.Pathological images three-dimensional reconstruction:

1. Pathological images registration is based on skin and shear mark by Photoshop 13.0 software.
2. Residual tumor boundary on Pathological images after registration are outlined and taken three-dimensional reconstruction by 3D-doctor 4.0 software.
3. Observe the shrinkage modes in three-dimensional space.
4. According to WHO standard,the boundaries of all residual tumor images are displayed in one plane and the longest diameter and its longest perpendicular diameter of boundaries are measured in one-dimensional space.
5. According to RECIST standard,the longest diameter of boundaries of residual tumor images in three-dimensional space.

B.MRI images three-dimensional reconstruction:the procedure is similar to Pathological images three-dimensional reconstruction

Three-Dimensional Reconstruction

1. Evaluation of the tumor size by mammography is performed before neoadjuvant chemotherapy and prior to surgery.
2. Measurement of tumor size and calcification extent refers to WHO standards.
3. Calcification extent is not only measured in mammography image but also under microscope.

Mammography

1. TAC:Docetaxel 75 mg/㎡ iv day 1 + Doxorubicin 50 mg/㎡ in day 1 + Cyclophosphamide 500 mg/㎡ iv day 1(Cycled every 21 days for 3 cycles)
2. TC:Docetaxel 75 mg/㎡ iv day 1 + Cyclophosphamide 600 mg/㎡in day 1(Cycled every 21 days for 2 cycles)
3. TA:Docetaxel 75 mg/㎡ iv day 1 + Doxorubicin 50 mg/㎡ in day 1(Cycled every 21 days for 2 cycles)
4. CAF:Cyclophosphamide 100 mg/㎡ po days 1-14 + Doxorubicin 30 mg/㎡ iv days 1,8 +5-fluorouracil 500 mg/㎡ iv days 1,8(cycled every 28 days for 3 cycles)
5. CEF:Cyclophosphamide 75 mg/㎡ po day 1-14 + Epirubicin 60 mg/㎡ iv days 1,8 + 5-fluorouracil 500mg/㎡ iv days 1,8(cycled every 28 days for 3 cycles)

TAC,TC,TA,CAF,CEF

1. AC-P:Doxorubicin 60 mg/㎡ iv day 1 +Cyclophosphamide 600 mg/㎡ iv day 1(Cycled every 14 days for 4 cycles)→ Paclitaxel 175mg/㎡ by 3h iv infusion day 1(Cycled every 14 days for 4 cycles) or Paclitaxel 80mg/㎡ by 1h iv infusion weekly for 12 wks.
2. TEC:Docetaxel 75 mg/㎡ iv day 1 + Epirubicin 75 mg/㎡ in day 1 + Cyclophosphamide 500 mg/㎡ iv day 1(Cycled every 21 days for 6 cycles)
3. AC:Doxorubicin 60 mg/㎡ in day 1 + Cyclophosphamide 600 mg/㎡ iv day 1(Cycled every 21 days for 4 cycles)
4. TC:Docetaxel 75 mg/㎡ iv day 1 + Cyclophosphamide 600 mg/㎡in day 1(Cycled every 21 days for 4 cycles)
5. TCH:Docetaxel 75 mg/㎡ iv day 1 + Carboplatin AUC 6 iv day1(Cycled every 21 days for 6 cycles) + Trastuzumab 4 mg/kg iv wk 1 → Trastuzumab 2 mg/kg iv for 17 wks → Trastuzumab 6 mg/kg iv every 3 wks to complete 1 year.
6. CEF:Cyclophosphamide 75 mg/㎡ po day 1-14 + Epirubicin 60 mg/㎡ iv days 1,8 + 5-fluorouracil 500mg/㎡ iv days 1,8(cycled every 28 days for 6 cycles)

AC-P,TEC,AC,TC,TCH,CEF,TAC,CAF

Yong-sheng Wang, MD

Tao Yang, MD

The main clinical goal of NAC is to down-stage the primary tumor for BCS,yet BCS after NAC has been associated with significantly higher ipsilateral breast tumor recurrences.The accuracy of breast tumor excision in BCS can dramatically reduce IBTR.The main reseason of IBTR might be the uncertain shrinkage modes of the breast cancer after NAC.This clinical trial is firstly carried out to make clear the shrinkage modes of the primary tumor after 3 cycles and whole cycles of NAC,respectively,with whole-mount serial section(WMSS) and three-dimensional(3D) pathological reconstruction of the residual tumor.The second objective is to investigate the predictive value of 3D MRI reconstruction for the shrinkage modes of the primary tumor after NAC.

Study of Breast Cancer Shrinkage Modes After Neoadjuvant Chemotherapy With Whole-mount Serial Sections and Three-dimensional Pathological and MRI Reconstruction

Phase III Trail of Breast Cancer Shrinkage Modes After Neoadjuvant Chemotherapy With Whole-mount Serial Sections and Three-dimensional Pathological and MRI Reconstruction

The predictive value of 3D MRI reconstruction for the shrinkage modes of the primary tumor after whole cycles of NAC.

The tumor shrinkage modes of the primary tumor in patients with locally advanced breast cancer after 3 cycles and whole cycles of neoadjuvant chemotherapy(NAC).

The whole-mount serial section(WMSS) and three-dimensional(3D) pathological reconstruction of the residual tumors after NAC.

Spots Global Cancer Trial Database for pathologic large tissue selected table