Most practices define response per Response Evaluation Criteria in Solid Tumors (RECIST) or RECIST 1, which defines complete response (CR) as disappearance of the tumor in its entirety, partial response (PR) as at least 30% decrease in the longest diameter of the tumor compared with pretreatment baseline, progression of disease as at least 20% increase in longest diameter, and stable disease as no change in the tumor size that would qualify as PR or progression of disease on the basis of longest diameter [5]. Pathologic complete response (pCR) is defined as a surgical specimen free of carcinoma following therapy and represents a surrogate endpoint for treatment with pCR predicting improved disease-free survival [1,6]. Although there is a paucity of published data in men and transgender patients diagnosed with breast cancer, in practice, these patients are managed similarly to women. Special Imaging Considerations There are several single-institution studies that demonstrate contrast-enhanced mammography has comparable sensitivity and specificity to contrast-enhanced MRI in evaluating for residual disease after NAC [7-10]. Therefore, although not widely used in clinical practice, this may be an option for patients who are unable to undergo MRI [7- 10]. aUniversity of California San Francisco, San Francisco, California. bResearch Author, University of California San Francisco, San Francisco, California. cPanel Chair, New York University Grossman School of Medicine, New York, New York. dPanel Vice-Chair, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania. eBoston Medical Center, Boston, Massachusetts, Primary care physician. fHackensack University Medical Center, Hackensack, New Jersey; American College of Surgeons. gUniversity of North Carolina Hospital, Chapel Hill, North Carolina. hElizabeth Wende Breast Care, Rochester, New York.
Monitoring Response to Neoadjuvant Systemic Therapy for Breast Cancer. Most practices define response per Response Evaluation Criteria in Solid Tumors (RECIST) or RECIST 1, which defines complete response (CR) as disappearance of the tumor in its entirety, partial response (PR) as at least 30% decrease in the longest diameter of the tumor compared with pretreatment baseline, progression of disease as at least 20% increase in longest diameter, and stable disease as no change in the tumor size that would qualify as PR or progression of disease on the basis of longest diameter [5]. Pathologic complete response (pCR) is defined as a surgical specimen free of carcinoma following therapy and represents a surrogate endpoint for treatment with pCR predicting improved disease-free survival [1,6]. Although there is a paucity of published data in men and transgender patients diagnosed with breast cancer, in practice, these patients are managed similarly to women. Special Imaging Considerations There are several single-institution studies that demonstrate contrast-enhanced mammography has comparable sensitivity and specificity to contrast-enhanced MRI in evaluating for residual disease after NAC [7-10]. Therefore, although not widely used in clinical practice, this may be an option for patients who are unable to undergo MRI [7- 10]. aUniversity of California San Francisco, San Francisco, California. bResearch Author, University of California San Francisco, San Francisco, California. cPanel Chair, New York University Grossman School of Medicine, New York, New York. dPanel Vice-Chair, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania. eBoston Medical Center, Boston, Massachusetts, Primary care physician. fHackensack University Medical Center, Hackensack, New Jersey; American College of Surgeons. gUniversity of North Carolina Hospital, Chapel Hill, North Carolina. hElizabeth Wende Breast Care, Rochester, New York.