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. 2021 Feb 21;13(4):902. doi: 10.3390/cancers13040902

Figure 1.

Figure 1

Proposal for optimal NET management. Postmenopausal women with clinical stage II or III ER‑positive, HER2-negative breast cancer are eligible for NET. Initial evaluation should include: mammogram, breast and axillary US (+/− concomitant fine-needle aspiration for nodal status), breast MRI and staging; a core biopsy is needed for assessment of histological subtype, histological grade, hormone receptors, Ki67 and optional genomic signature. After initial tumor board, an aromatase inhibitor should be given if no clinical trial is available. Clinical evaluations at 1 month and then every 3 to 4 months should be performed. Tumor biopsy 2 to 4 weeks after NET initiation may be done for Ki67 assessment and a switch for NCT encouraged if Ki67 > 10%. After 4 to 8 months of NET, surgery -after breast imaging- should be planned if feasible. Pathological examination should collect ypTN, RCB, PEPI score and optional genomic signature. Adjuvant treatments are decided according to the local policy if no clinical trial is available. Adjuvant chemotherapy is not recommended for patients with PEPI score 0. Abbreviations: ER: estrogen receptor; PgR: progesterone receptor; MRI: magnetic resonance imaging; NCT: neoadjuvant chemotherapy; RCB: residual cancer burden; PEPI: preoperative endocrine prognostic index; GS: genomic signature.