الفهرس 
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Abstract
The breast is the most common site of cancer in women, the incidence being higher than that of all malignant neoplasm of the reproductive organs combined. In Egypt, Breast cancer ranked as number one among all malignant tumors, constituting 17% of total malignancies, and it is the most common tumor affecting the females accounting for 37.7% of their total new cases.
Despite efforts at early detection, LABC remains a clinical challenge, as the majority of patients develop distant metastasis, and most of the patients will experience disease relapse and eventual death. In the past many of these patients have been considered to be inoperable however over the last decade, the use of neoadjuvant chemotherapy has emerged as the standard of care for those patients. Major roles of neoadjuvant chemotherapy in LABC are conversion of inoperable to operable status, increasing the rate of breast conserving surgery and that response to therapy is correlated with the patient’s ultimate disease-free survival.
Induction chemotherapy also has the theoretical advantages of early initiation of systemic therapy, delivery of drugs through intact vasculature, in vivo assessment of response to therapy, the opportunity to study the biologic effects of chemotherapy, Preoperative chemotherapy reduces the size of primary tumor and the number of positive lymph nodes in more than 80% of cases and so increase the rate of breast conservation compared to total breast removal.
Tumor response can be evaluated clinically by palpation or by breast imaging, and these are useful techniques to monitor response
during therapy. However, clinical and radiologic assessments of response often underestimate or overestimate the amount of residual carcinoma present. Thus, pathologic examination of the excised tumor bed is the gold standard and is essential for identifying the group of patients with a pathologic complete response to treatment, as well as the other patients who have a partial response to treatment.
Accurate prediction of pathologic residual tumor size is essential for surgical decision making because Underestimation of residual disease could lead to positive resection margins with viable residual tumor cells, necessitating re-surgery. In addition, positive resection margins are associated with an increased long-term risk of disease recurrence in patients who have undergone breast-conserving therapy
In this study, we compared the combined accuracy of two commonly used diagnostic imaging modalities in predicting residual tumor size and pathologic complete response.
Our study included 30 female patients who had pathologically proven breast cancer and staged as locally advanced by clinical examination and/or imaging methods.
All patients had primary evaluation of their breast tumor using physical examination, sonomammography, and histo-pathological assessment before and after receiving neo-adjuvant chemotherapy
In our study 8 (26.7%) patients that show complete response to NACT, 4 of them were treated with breast conserving surgery and 4 with modified radical mastectomy then postoperative radiotherapy. Among the 16 patients in whom partial response to NACT was seen, only 1 patient had breast conserving surgery and 15 patients were considered to be
suitable candidates for modified radical mastectomy. All patients with no response to NACT were treated with modified radical mastectomy.
Clinical and radiological examination revealed a significant reduction in tumor sizes post-neoadjuvant chemotherapy. Mean ±SD tumor size before neoadjuvant chemotherapy was 5.55±2.81 and 4.93±2.41 for clinical and radiological examination respectively while after neoadjuvant chemotherapy was 3.15±2.43 and 3.08±2.21 respectively. This is also confirmed by the pathological examination of surgical specimens which revealed a significant reduction in tumor sizes post-neoadjuvant chemotherapy (Mean ±SD was 2.67± 2.24). 26.7% cases had complete response, 53.30% had partial response and 20% had no response.
Clinical examination was able to measure the residual tumor size with sensitivity 73%, specificity 40%, positive predictive value 56%, negative predictive value 60% and overall diagnostic accuracy 56% while Sonomammography was able to measure the residual tumor size with sensitivity 88%, positive predictive value 58%, negative predictive value 67% and overall diagnostic accuracy 60% and it was able to predict the complete response with (83.3%) accuracy.