THE DIAGNOSTIC ACCURACY OF TUMOR BED BIOPSY IN PREDICTING PATHOLOGICAL COMPLETE RESPONSE IN BREAST CANCER AFTER NEO ADJUVANT CHEMOTHERAPY: A META-ANALYSIS RUNNING TITLE: TUMOR BED BIOPSY FOR PCR ASSESSMENT garvitgarg365@gmail.com

3103-06

THE DIAGNOSTIC ACCURACY OF TUMOR BED BIOPSY IN PREDICTING PATHOLOGICAL COMPLETE RESPONSE IN BREAST CANCER AFTER NEO ADJUVANT CHEMOTHERAPY: A META-ANALYSIS RUNNING TITLE: TUMOR BED BIOPSY FOR PCR ASSESSMENT

2

India

Oral or Poster

Neoadjuvant chemotherapy (NACT) often achieves complete clinical response (cCR) in breast cancer, prompting interest in surgical de-escalation. Pathological complete response (pCR) is the gold standard for prognosis, but currently requires surgery. Tumor bed biopsy (TBB) has been proposed as a minimally invasive alternative. This meta-analysis evaluated the diagnostic accuracy of TBB in predicting pCR among cCR patients post-NACT.

Twelve studies met inclusion criteria; six were included in quantitative synthesis. Pooled sensitivity was 0.58 (95% CI: 0.51–0.65) and specificity was 1.00 (95% CI: 0.99–1.00). The DOR was 141.65 (95% CI: 41.97–478.01), and SROC analysis demonstrated excellent accuracy (AUC = 0.9792). However, the FNR was 41.97%, indicating that TBB missed residual disease in more than four out of ten patients. Heterogeneity stemmed primarily from biopsy technique, imaging guidance, and clip retrieval protocols.

Twelve studies met inclusion criteria; six were included in quantitative synthesis. Pooled sensitivity was 0.58 (95% CI: 0.51–0.65) and specificity was 1.00 (95% CI: 0.99–1.00). The DOR was 141.65 (95% CI: 41.97–478.01), and SROC analysis demonstrated excellent accuracy (AUC = 0.9792). However, the FNR was 41.97%, indicating that TBB missed residual disease in more than four out of ten patients. Heterogeneity stemmed primarily from biopsy technique, imaging guidance, and clip retrieval protocols.

TBB offers perfect specificity but only moderate sensitivity in predicting pCR after NACT. Its high false-negative rate precludes its use as a standalone tool for surgical omission. TBB should currently be considered an adjunct within a multimodal assessment strategy rather than a substitute for surgery.