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Neoadjuvant Response Assessment — SCE Medical Oncology MCQ

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ModerateBreast CancerNeoadjuvant Response AssessmentSCE Medical Oncology

A 48-year-old woman undergoes breast MRI during neoadjuvant chemotherapy for TNBC. MRI shows complete imaging response. Should the original tumour bed still be excised surgically?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Yes — imaging response does not reliably predict pathological complete response

Even with complete imaging response on MRI after neoadjuvant chemotherapy, residual microscopic disease may be present. MRI has a false-negative rate of approximately 20-30% for predicting pCR. Surgical excision of the original tumour bed (with clip marker placed at diagnosis) remains mandatory. Omission of surgery after neoadjuvant therapy for breast cancer is being investigated in clinical trials (e.g. NOSTRA) but is not yet standard of care.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer