Can MRI accurately identify which patients with operable breast cancer will have a pathologic complete response after neoadjuvant therapy? (original) (raw)
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MRI does not predict pathologic complete response after neoadjuvant chemotherapy for breast cancer
Journal of Surgical Oncology, 2019
Background: This study assessed whether magnetic resonance imaging (MRI) could accurately predict pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) for patients receiving standardized treatment, pre-and post-NAC MRI on the same instrumentation using a consistent imaging protocol, interpreted by a single breast fellowship-trained radiologist. Methods: A single-institution retrospective analysis was performed including clinical, radiographic, and pathologic parameters for all patients with breast cancer treated with NAC from 2015 to 2018. Radiographic complete response (rCR) was defined as absence of suspicious MRI findings in the ipsilateral breast or lymph nodes. pCR was defined as the absence of invasive cancer or ductal carcinoma in-situ in breast or lymph nodes after operation (ypT0N0M0). Results: Data for 102 consecutive patients demonstrated that 44 (43.1%) had rCR and 41 (40.1%) had pCR. pCR occurred in 12 (25.0%) of 48 estrogen receptor positive (ER+) patients, 29 (53.7%) of 54 ER− patients, and 25 (52.1%) of 48 human epidermal growth factor receptor 2 positive patients. The positive predictive value for MRI after NAC was 84.5% and the negative predictive value was 72.7%. The accuracy rate for MRI was 78.6%. Of the 44 patients with rCR, 12 (27.3%) had residual cancer on the pathologic specimen after surgical excision. Conclusion: rCR is not accurate enough to serve as a surrogate marker for pCR on MRI after NAC.
Journal of Cell Science & Therapy, 2013
Introduction: Neoadjuvant chemotherapy is the standard treatment modality in locally advanced breast cancer, and accepted as an alternate modality in operable breast cancer. Pathological Complete Response (pCR) is a surrogate for better outcome. The identification of the most sensitive clinical and radiological method to pCR will be helpful in patient's management. Patients and methods: Multicenterprospective study assessed the correlation between (pCR) and radiological Complete Response (rCR) using different radiological modalities. 125 female with primary measurable stage II or III non inflammatory breast cancer, were enrolled in the study after pathological confirmation using image guided core biopsy. Pathological assessment was done. All eligible cases received neoadjuvant chemotherapy (FEC) IV every 3 weeks for three cycles followed by Docetaxel IV every 3 weeks for three cycles. Trastuzumab was added in Her2neu positive patients concomitantly with docetaxel. Radiological evaluation was done before chemotherapy and prior to definitive surgery. pCR was defined as complete disappearance of invasive tumor cells in both breast surgical specimen and lymph nodes. Patients who achieved pCR were correlated with truly positive rCR by different modalities. The results were statistically analyzed using the Kappa method for agreement. Results: 20% of the patients achieved pCR 25/125. All these patients received 6 cycles of chemotherapy, only 4 patients received Trastuzumab. Conservative surgery was performed in 80% of cases and MRM in 5/25 of them. True radiological Complete Response (rCR) was achieved in 56% of patients by mammography, 17/25 (68%) of patients by ultrasonography who showed complete disappearance of the mass. 23/25 (92%) achieved rCR morphologically by Dynamic MR-Mammography and in 24/25 (96%) of cases using the kinetic data. MR Spectroscopy showed rCR in (92%) cases. In our study, predictions made on the basis of MRI showed a better correlation with the pathological response after neoadjuvant chemotherapy than did estimations made on the basis of mammography or sonography. The sensitivity, specificity, PPV and NPV for Dynamic MRI in predicting complete pathological response were 96%, 94%, 89% and 99% respectively. The sensitivity, specificity, PPV and NPV for MRS were 92%, 92%, 85% and 97% respectively while the sensitivity, specificity, PPV and NPV for Mammography were 44%, 87%, 61% and 87% respectively and the sensitivity, specificity, PPV and NPV for ultrasonography were 68%, 90%, 77% and 92% respectively. Conclusion: The most sensitive radiological methods correlated with pCR were dynamic MR mammography and MR Spectroscopy, further studies using new modalities and larger number of patients is required to confirm our results.
Clinical and Translational Oncology, 2012
Changes in magnetic resonance imaging (MRI) during neoadjuvant chemotherapy (NAC) have been reported as predictive of pathology outcome in triple-negative and HER2-positive breast cancer. The purpose of our study was to evaluate the relevance of breast cancer subtype for MRI response in 24 women before and during NAC in our centre. Our results show that a reduction greater than 23% is associated with a pathological complete response (pCR) in Her-2-positive and ER-negative/Her2-negative breast cancer, and suggest a trend correlation between higher ADC values and pCR in these subtypes in comparison with ER-positive/Her2-negative breast cancers. Higher proliferating tumours respond better to chemotherapy and our study suggests that changes in MRI during NAC are predictive of pCR in these breast cancer subtypes.
Iranian journal of cancer prevention, 2013
Physical Examination (PE) and breast MRI are two of the currentmethods which have usually used in diagnosis of primary breast cancer. Their accuracy in detection of: either complete response or presence of residual tumor, however, has not yet been established in patients who have been received Neoadjuvant Chemotherapy (NAC).The purpose of this study was to evaluate the diagnostic accuracy of breast MRI in assessment of residual neoplastic tissue after NAC in patients with Locally Advanced Breast Cancer (LABC). Twenty patients with LABC have undergone contrast-enhanced MRI before and after the NAC. Considering histology as the gold standard, the tumor sizes in MRI and PE have compared with the histology results. We have calculated for all below: the accuracy, sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) for each of MRI and physical examination, as well as Pearson's correlation coefficients between the results of MRI and PE, and the...
Radiology and oncology, 2016
The aim, of the study was to estimate the accuracy of magnetic resonance imaging (MRI) in assessing residual disease in breast cancer patients receiving neoadjuvant chemotherapy (NAC) and to identify the clinico-pathological factors that affect the diagnostic accuracy of breast MRI to determine residual tumour size following NAC. 91 breast cancer patients undergoing NAC (92 breast lesions) were included in the study. Breast MRI was performed at baseline and after completion of NAC. Treatment response was evaluated by MRI and histopathological examination to investigate the ability of MRI to predict tumour response. Residual tumour size was measured on post-treatment MRI and compared with pathology in 89 lesions. Clinicopathological factors were analyzed to compare MRI-pathologic size differences. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for diagnosing invasive residual disease by using MRI were 75.00%, 78.57%, 88.89%, 5...
MRI Staging After Neoadjuvant Chemotherapy for Breast Cancer: Does Tumor Biology Affect Accuracy?
Annals of Surgical Oncology, 2011
Background. A discrepancy often exists between the postneoadjuvant chemotherapy (NAC) breast tumor size on magnetic resonance imaging (MRI) and pathologic tumor size. We seek to quantify this MRI/pathology discrepancy and determine if the accuracy of MRI post NAC varies with tumor subtype. Methods. The University of Pittsburgh Medical Center (UPMC) Cancer Registry and radiology database were searched for patients with breast cancer who underwent NAC and MRI staging between 2004 and 2009. We compared radiologic to pathologic staging and stratified differences based on tumor biology using univariate, multivariate, and receiver operating characteristic (ROC) analysis. Results. Two hundred three of 592 patients undergoing surgery after NAC for breast cancer had MRI staging pre and post chemotherapy. All patients had intact tumors prior to the initiation of chemotherapy. Average tumor size by MRI was 4.0 cm pre chemotherapy and 1.2 cm post chemotherapy. The average pathologic tumor size was 1.7 cm (range 0-13 cm). The difference between MRI and pathologic tumor size was greatest in luminal (1.1 cm) and least in triple-negative (TN) and human epidermal growth factor receptor 2 (HER2)-positive tumors (\0.1 cm) (p = 0.015). MRI was a good discriminator for pathologic complete response (pCR) [area under the curve (AUC)
Abbreviated Mri Protocol to Evaluate Response to Breast Cancer Neoadjuvant Chemotherapy
Mastology
Introduction: Abbreviated MRI protocols have been proposed to reduce examination time, patient discomfort, and costs for breast cancer screening. However, an abbreviated MRI protocol for assessing neoadjuvant chemotherapy in breast cancer is yet to be explored. Objective: We sought to develop an abbreviated MRI protocol to evaluate the response to neoadjuvant chemotherapy treatment for invasive breast cancer carcinoma with diagnostic performance equivalent to that of the full protocol. Methods: This was a retrospective, single-center, cross-sectional study. This study comprised 210 women diagnosed with invasive breast carcinoma of no special type who underwent breast MRI after neoadjuvant chemotherapy between 2016 and 2020 in Curitiba, PR, Brazil. Breast MRI scans were reevaluated, first with access only to axial 3D SPAIR without contrast and first post-contrast time (two sequences); next to the second post-contrast time (three sequences); then to the third post-contrast time (four ...