1
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Isıklar A, Yilmaz E, Basaran G. The Relationship Between Body Composition and Pathological Response to Neoadjuvant Chemotherapy in Breast Cancer Patients. Cureus 2024; 16:e61145. [PMID: 38933645 PMCID: PMC11199927 DOI: 10.7759/cureus.61145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 06/28/2024] Open
Abstract
Background The pathological response rate in operable breast cancer (BC) patients receiving neoadjuvant chemotherapy (NAC) is postulated to be related to body composition. The success of complete pathological response (pCR) is a known prognostic factor in BC patients treated with NAC. We aimed to accurately measure body composition through BMI and skeletal muscle mass and observe their effects on pCR. Materials and methods Patients diagnosed with operable BC who had a positron emission tomography-computed tomography (PET-CT) or chest/abdominal CT taken at the time of diagnosis were retrospectively screened and enrolled in this study. Muscle mass was defined by third lumbar vertebra (L3) level transverse CT images, and data, including weight and height, were collected from the chemotherapy records. All these data were evaluated together with the postoperative pathological results. Results Sixty-nine operable BC patients with a median age of 46 (range: 29-72) years were included in the study. In all patients, regardless of sarcopenia, 23% (n = 16) achieved pCR to NAC. The pCR rate was 37.5% (n=6) in sarcopenic patients and 62.5% (n=10) in non-sarcopenic patients (p = 0.530). Overweight (n=4; 25%) and obese (n=2; 12.5%) patients also had a lower pathological response than normal-weight (n=10; 62.5%) BC patients (p=0.261). Conclusion Both sarcopenia and obesity independently and synergistically contribute to poorer pathological responses after NAC. Addressing these conditions through tailored interventions, such as nutritional support, exercise programs, and careful monitoring of body composition, could improve treatment outcomes. Further research with larger patient populations and comprehensive body measurements is essential to fully understand these relationships and develop effective strategies to mitigate their impact.
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Affiliation(s)
- Aysun Isıklar
- Internal Medicine, Acıbadem Ataşehir Hospital, Istanbul, TUR
| | - Ebru Yilmaz
- Radiology, Acıbadem Altunizade Hospital, Istanbul, TUR
| | - Gul Basaran
- Oncology, Acıbadem Altunizade Hospital, Istanbul, TUR
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2
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Hayward JH, Linden OE, Lewin AA, Weinstein SP, Bachorik AE, Balija TM, Kuzmiak CM, Paulis LV, Salkowski LR, Sanford MF, Scheel JR, Sharpe RE, Small W, Ulaner GA, Slanetz PJ. ACR Appropriateness Criteria® Monitoring Response to Neoadjuvant Systemic Therapy for Breast Cancer: 2022 Update. J Am Coll Radiol 2023; 20:S125-S145. [PMID: 37236739 DOI: 10.1016/j.jacr.2023.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Imaging plays a vital role in managing patients undergoing neoadjuvant chemotherapy, as treatment decisions rely heavily on accurate assessment of response to therapy. This document provides evidence-based guidelines for imaging breast cancer before, during, and after initiation of neoadjuvant chemotherapy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Olivia E Linden
- Research Author, University of California, San Francisco, San Francisco, California
| | - Alana A Lewin
- Panel Chair, New York University Grossman School of Medicine, New York, New York
| | - Susan P Weinstein
- Panel Vice-Chair, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Tara M Balija
- Hackensack University Medical Center, Hackensack, New Jersey; American College of Surgeons
| | - Cherie M Kuzmiak
- University of North Carolina Hospital, Chapel Hill, North Carolina
| | | | - Lonie R Salkowski
- University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin
| | | | | | | | - William Small
- Loyola University Chicago, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, Illinois
| | - Gary A Ulaner
- Hoag Family Cancer Institute, Newport Beach, California, and University of Southern California, Los Angeles, California; Commission on Nuclear Medicine and Molecular Imaging
| | - Priscilla J Slanetz
- Specialty Chair, Boston University School of Medicine, Boston, Massachusetts
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3
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Sabatino V, Pignata A, Valentini M, Fantò C, Leonardi I, Campora M. Assessment and Response to Neoadjuvant Treatments in Breast Cancer: Current Practice, Response Monitoring, Future Approaches and Perspectives. Cancer Treat Res 2023; 188:105-147. [PMID: 38175344 DOI: 10.1007/978-3-031-33602-7_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Neoadjuvant treatments (NAT) for breast cancer (BC) consist in the administration of chemotherapy-more rarely endocrine therapy-before surgery. Firstly, it was introduced 50 years ago to downsize locally advanced (inoperable) BCs. NAT are now widespread and so effective to be used also at the early stage of the disease. NAT are heterogeneous in terms of therapeutic patterns, class of used drugs, dosage, and duration. The poly-chemotherapy regimen and administration schedule are established by a multi-disciplinary team, according to the stage of disease, the tumor subtype and the age, the physical status, and the drug sensitivity of BC patients. Consequently, an accurate monitoring of treatment response can provide significant clinical advantages, such as the treatment de-escalation in case of early recognition of complete response or, on the contrary, the switch to an alternative treatment path in case of early detection of resistance to the ongoing therapy. Future is going toward increasingly personalized therapies and the prediction of individual response to treatment is the key to practice customized care pathways, preserving oncological safety and effectiveness. To gain such goal, the development of an accurate monitoring system, reproducible and reliable alone or as part of more complex diagnostic algorithms, will be promising.
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Affiliation(s)
- Vincenzo Sabatino
- Breast Imaging Department, Santa Chiara Hospital, APSS, Trento, Italy.
| | - Alma Pignata
- Breast Center, Spedali Civili Hospital, ASST, Brescia, Italy
| | - Marvi Valentini
- Breast Imaging Department, Santa Chiara Hospital, APSS, Trento, Italy
| | - Carmen Fantò
- Breast Imaging Department, Santa Chiara Hospital, APSS, Trento, Italy
| | - Irene Leonardi
- Breast Imaging Department, Santa Chiara Hospital, APSS, Trento, Italy
| | - Michela Campora
- Pathology Department, Santa Chiara Hospital, APSS, Trento, Italy
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4
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Shahbazi-Gahrouei D, Aminolroayaei F, Nematollahi H, Ghaderian M, Gahrouei SS. Advanced Magnetic Resonance Imaging Modalities for Breast Cancer Diagnosis: An Overview of Recent Findings and Perspectives. Diagnostics (Basel) 2022; 12:2741. [PMID: 36359584 PMCID: PMC9689118 DOI: 10.3390/diagnostics12112741] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/26/2022] [Accepted: 11/07/2022] [Indexed: 08/28/2023] Open
Abstract
Breast cancer is the most prevalent cancer among women and the leading cause of death. Diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) are advanced magnetic resonance imaging (MRI) procedures that are widely used in the diagnostic and treatment evaluation of breast cancer. This review article describes the characteristics of new MRI methods and reviews recent findings on breast cancer diagnosis. This review study was performed on the literature sourced from scientific citation websites such as Google Scholar, PubMed, and Web of Science until July 2021. All relevant works published on the mentioned scientific citation websites were investigated. Because of the propensity of malignancies to limit diffusion, DWI can improve MRI diagnostic specificity. Diffusion tensor imaging gives additional information about diffusion directionality and anisotropy over traditional DWI. Recent findings showed that DWI and DTI and their characteristics may facilitate earlier and more accurate diagnosis, followed by better treatment. Overall, with the development of instruments and novel MRI modalities, it may be possible to diagnose breast cancer more effectively in the early stages.
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Affiliation(s)
- Daryoush Shahbazi-Gahrouei
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Fahimeh Aminolroayaei
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Hamide Nematollahi
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Mohammad Ghaderian
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Sogand Shahbazi Gahrouei
- Department of Management, School of Humanities, Najafabad Branch, Islamic Azad University, Najafabad 8514143131, Iran
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5
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Increasing Imaging Value to Breast Cancer Care Through Prognostic Modeling of Multiparametric MRI Features in Patients Undergoing Neoadjuvant Chemotherapy. Acad Radiol 2022; 29 Suppl 1:S164-S165. [PMID: 35033453 DOI: 10.1016/j.acra.2021.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/23/2022]
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6
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Turan U, Aygun M, Duman BB, Kelle AP, Cavus Y, Tas ZA, Dirim AB, Irkorucu O. Efficacy of US, MRI, and F-18 FDG-PET/CT for Detecting Axillary Lymph Node Metastasis after Neoadjuvant Chemotherapy in Breast Cancer Patients. Diagnostics (Basel) 2021; 11:diagnostics11122361. [PMID: 34943597 PMCID: PMC8700016 DOI: 10.3390/diagnostics11122361] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The aim of this study was to investigate the efficacy of post-neoadjuvant chemotherapy (NAC) ultrasound (US), magnetic resonance imaging (MRI), and F-18fluorodeoxyglucose positron emission tomography (F-18 FDG-PET/CT) for detecting post-NAC axillary lymph node(ALN) metastasis in patients who had ALN metastasis at the time of diagnosis. Methods: This study included all breast cancer patients who received NAC for ALN metastasis; underwent axillary assessment with US, MRI, or F18FDG-PET/CT; and then were operated on in the General Surgery Clinic, Adana City Research and Training Hospital, Turkey. Patients’ data were recorded, including demographic data, clinicopathological parameters, NAC regimens, and operation types. The axillary response to chemotherapy on post-NAC US, MRI, and F-18 FDG-PET/CT was compared with the postoperative histopathological result of the ALN. Results: The study included a total of 171 female patients. The mean age of the patients was 53.28 ± 10.62 years. The post-NAC assessment revealed that the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of US for detecting ALN metastasis were 59.42%, 82.35%, 82.00%, and 60.00%, respectively, while the same measures regarding MRI for detecting ALN metastasis were 36.67%, 77.78%, 73.33%, and 42.42%, respectively. The sensitivity, specificity, PPV, and NPV of F-18FDG-PET/CT were 47.50%, 76.67%, 73.08%, and 52.27%, respectively. The evaluation of dual combinations of these three imaging techniques showed that the specificity and PPV of the combined use of US and F-18FDG-PET/CT was 100%. Conclusions: The results showed that US has the highest sensitivity and specificity for detecting ALN metastasis after NAC. Furthermore, ALND may be preferred for these patients instead of SLNB if both examinations simultaneously indicate lymph node metastasis in the post-NAC assessment with US and F-18 FDG-PET/CT. SLNB may be preferred if these two examinations simultaneously show a complete response.
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Affiliation(s)
- Umit Turan
- Adana City Research and Training Center, Department of General Surgery, Saglik Bilimleri University, Adana 01230, Turkey; (M.A.); (A.B.D.)
- Correspondence: ; Tel.: +90-505-360-4067
| | - Murat Aygun
- Adana City Research and Training Center, Department of General Surgery, Saglik Bilimleri University, Adana 01230, Turkey; (M.A.); (A.B.D.)
| | - Berna Bozkurt Duman
- Adana City Research and Training Center, Department of Medical Oncology, Saglik Bilimleri University, Adana 01230, Turkey;
| | - Aygül Polat Kelle
- Adana City Research and Training Center, Department of Nuclear Medicine and Molecular Imaging, Saglik Bilimleri University, Adana 01230, Turkey;
| | - Yeliz Cavus
- Adana City Research and Training Center, Department of Radiology, Saglik Bilimleri University, Adana 01230, Turkey;
| | - Zeynel Abidin Tas
- Adana City Research and Training Center, Department of Pathology, Saglik Bilimleri University, Adana 01230, Turkey;
| | - Ahmet Baris Dirim
- Adana City Research and Training Center, Department of General Surgery, Saglik Bilimleri University, Adana 01230, Turkey; (M.A.); (A.B.D.)
| | - Oktay Irkorucu
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates;
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7
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Wang J, Chu Y, Wang B, Jiang T. A Narrative Review of Ultrasound Technologies for the Prediction of Neoadjuvant Chemotherapy Response in Breast Cancer. Cancer Manag Res 2021; 13:7885-7895. [PMID: 34703310 PMCID: PMC8523361 DOI: 10.2147/cmar.s331665] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/29/2021] [Indexed: 12/21/2022] Open
Abstract
The incidence and mortality rate of breast cancer (BC) in women currently ranks first worldwide, and neoadjuvant chemotherapy (NAC) is widely used in patients with BC. A variety of imaging assessment methods have been used to predict and evaluate the response to NAC. Ultrasound (US) has many advantages, such as being inexpensive and offering a convenient modality for follow-up detection without radiation emission. Although conventional grayscale US is typically used to predict the response to NAC, this approach is limited in its ability to distinguish viable tumor tissue from fibrotic scar tissue. Contrast-enhanced ultrasound (CEUS) combined with a time-intensity curve (TIC) not only provides information on blood perfusion but also reveals a variety of quantitative parameters; elastography has the potential capacity to predict NAC efficiency by evaluating tissue stiffness. Both CEUS and elastography can greatly improve the accuracy of predicting NAC responses. Other US techniques, including three-dimensional (3D) techniques, quantitative ultrasound (QUS) and US-guided near-infrared (NIR) diffuse optical tomography (DOT) systems, also have advantages in assessing NAC response. This paper reviews the different US technologies used for predicting NAC response in BC patients based on the previous literature.
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Affiliation(s)
- Jing Wang
- Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Yanhua Chu
- Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Baohua Wang
- Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Tianan Jiang
- Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, People's Republic of China
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8
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Association between Skeletal Muscle Loss and the Response to Neoadjuvant Chemotherapy for Breast Cancer. Cancers (Basel) 2021; 13:cancers13081806. [PMID: 33918977 PMCID: PMC8070318 DOI: 10.3390/cancers13081806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/24/2021] [Accepted: 04/06/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary The loss of skeletal muscle mass is known to be associated with poor treatment outcome, treatment-related toxicity, and high mortality. The association between loss of skeletal muscle mass and the response to treatment is not well-defined yet. In this study, we evaluated the impact of loss of skeletal muscle mass on responsiveness to neoadjuvant chemotherapy in breast cancer. The prediction of response to neoadjuvant chemotherapy could be helpful to guide the treatment direction. Abstract There are no means to predict patient response to neoadjuvant chemotherapy (NAC); the impact of skeletal muscle loss on the response to NAC remains undefined. We investigated the association between response to chemotherapy and skeletal muscle loss in breast cancer patients. Patients diagnosed with invasive breast cancer who were treated with NAC, surgery, and radiotherapy were analyzed. We quantified skeletal muscle loss using pre-NAC and post-NAC computed tomography scans. The response to treatment was determined using the Response Evaluation Criteria in Solid Tumors. We included 246 patients in this study (median follow-up, 28.85 months). The median age was 48 years old (interquartile range 42–54) and 115 patients were less than 48 years old (46.7%). Patients showing a complete or partial response were categorized into the responder group (208 patients); the rest were categorized into the non-responder group (38 patients). The skeletal muscle mass cut-off value was determined using a receiver operating characteristic curve; it showed areas under the curve of 0.732 and 0.885 for the pre-NAC and post-NAC skeletal muscle index (p < 0.001 for both), respectively. Skeletal muscle loss and cancer stage were significantly associated with poor response to NAC in locally advanced breast cancer patients. Accurately measuring muscle loss to guide treatment and delaying muscle loss through various interventions would help enhance the response to NAC and improve clinical outcomes.
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9
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Huang Y, Le J, Miao A, Zhi W, Wang F, Chen Y, Zhou S, Chang C. Prediction of treatment responses to neoadjuvant chemotherapy in breast cancer using contrast-enhanced ultrasound. Gland Surg 2021; 10:1280-1290. [PMID: 33968680 DOI: 10.21037/gs-20-836] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Elucidation the efficacy of neoadjuvant chemotherapy (NAC) in breast cancer is important for informing therapeutic decisions. This study aimed at evaluating the potential value of contrast-enhanced ultrasound (CEUS) parameters in predicting breast cancer responses to NAC. Methods We performed CEUS examinations before and after two cycles of NAC. Quantitative CEUS parameters [maximum intensity (IMAX), rise time (RT), time to peak (TTP), and mean transit time (mTT)], tumor diameter, and their changes were measured and compared to histopathological responses, according to the Miller-Payne Grading (MPG) system (score 1, 2, or 3: minor response; score 4 or 5: good response). Prediction models for good response were developed by multiple logistic regression analysis and internally validated through bootstrap analysis. The receiver operating characteristic (ROC) curve was used to evaluate the performance of prediction models. Results A total of 143 patients were enrolled in this study among whom 98 (68.5%) achieved a good response and while 45 (31.5%) exhibited a minor response. Several imaging variables including diameter, IMAX, changes in diameter (Δdiameter), IMAX (ΔIMAX) and TTP (ΔTTP) were found to be significantly associated with good therapeutic responses (P<0.05). The areas under the curve (AUC) increased from 0.748 to 0.841 in the multivariate model that combined CEUS parameters and molecular subtypes with a sensitivity and specificity of 0.786, 0.745, respectively. Tumor molecular subtype was the primary predictor of primary endpoint. Conclusions CEUS is a potential tool for predicting responses to NAC in locally advanced breast cancer patients. Compared to the other molecular subtypes, triple negative and HER2+/ER- subtypes are more likely to exhibit a good response to NAC.
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Affiliation(s)
- Yunxia Huang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jian Le
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Aiyu Miao
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wenxiang Zhi
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fen Wang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yaling Chen
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shichong Zhou
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Cai Chang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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10
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Tang S, Xiang C, Yang Q. The diagnostic performance of CESM and CE-MRI in evaluating the pathological response to neoadjuvant therapy in breast cancer: a systematic review and meta-analysis. Br J Radiol 2020; 93:20200301. [PMID: 32574075 PMCID: PMC7446000 DOI: 10.1259/bjr.20200301] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Neoadjuvant chemotherapy (NAC) is an important method for breast cancer treatment. By monitoring its pathological response, the selection of clinical treatment strategies can be guided. In this study, the meta-analysis was used to compare the accuracy of contrast-enhanced MRI (CE-MRI) and contrast-enhanced spectral mammography (CESM) in detecting the pathological response of NAC. METHODS Literatures associated to CE-MRI and CESM in the evaluation of pathological response of NAC were searched from PubMed, Cochrane Library, web of science, and EMBASE databases. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to assess the quality of studies. Pooled sensitivity, specificity, and the area under the SROC curve were calculated to evaluate the diagnostic accuracy of CE-MRI and CESM in monitoring the pathological response of NAC. RESULTS There were 24 studies involved, 18 of which only underwent CE-MRI examination, three of which only underwent CESM examination, and three of which underwent both CE-MRI and CESM examination. The pooled sensitivity and specificity of CE-MRI were 0.77 (95%CI, 0.67-0.84) and 0.82 (95%CI, 0.73-0.89), respectively. The pooled sensitivity and specificity of CESM were 0.83 (95%CI, 0.66-0.93) and 0.82 (95%CI, 0.68-0.91), respectively. The AUCs of SROC curve for CE-MRI and CESM were 0.86 and 0.89, respectively. CONCLUSIONS Compared to CE-MRI, CESM has equal specificity, greater sensitivity and excellent performance, which may have a brighter prospect in evaluating the pathological response of breast cancer to NAC. ADVANCES IN KNOWLEDGE CESM showed equal specificity, greater sensitivity, and excellent performance than CE-MRI.
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Affiliation(s)
- Sudan Tang
- Department of Radiology, The Yongchuan Affiliated Hospital, Chongqing Medical University, Yongchuan District, Chongqing, PR China
| | - Chunhong Xiang
- Department of Radiology, The Yongchuan Affiliated Hospital, Chongqing Medical University, Yongchuan District, Chongqing, PR China
| | - Quan Yang
- Department of Radiology, The Yongchuan Affiliated Hospital, Chongqing Medical University, Yongchuan District, Chongqing, PR China
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11
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Li H, Yao L, Jin P, Hu L, Li X, Guo T, Yang K. MRI and PET/CT for evaluation of the pathological response to neoadjuvant chemotherapy in breast cancer: A systematic review and meta-analysis. Breast 2018; 40:106-115. [PMID: 29758503 DOI: 10.1016/j.breast.2018.04.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/30/2018] [Accepted: 04/22/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) has become an essential treatment for breast cancer. However, there is still no consensus on the best tool to evaluate pathological response to NAC. METHODS Two reviewers systematically searched Cochrane, PubMed, EMBASE, Web of Science, and CBM (last updated in February 2017) for eligible articles. We independently screened and selected studies that conformed to the inclusion criteria and extracted the requisite data. Pooled sensitivity, specificity, and the area under the SROC curve were calculated to estimate the diagnostic accuracy of magnetic resonance imaging (MRI) and positron emission computed tomography (PET/CT). And the relative DOR (RDOR) was used to compare accuracy for levels of the covariable. RESULTS Thirteen studies involving 575 patients who underwent MRI and 618 who underwent PET/CT were included in our analysis. The pooled sensitivity and specificity of MRI were 0.88 (95% CI: 0.78-0.94) and 0.69 (95% CI: 0.51-0.83), respectively. The corresponding values for PET/CT were 0.77 (95% CI: 0.58-0.90) and 0.78 (95% CI: 0.63-0.88), respectively. The area under the SROC curve for MRI and PET/CT were 0.88 and 0.84, respectively. And the RDOR = 1.44 (95% CI, 0.46-4.47 P = 0.83). CONCLUSION MRI had a higher sensitivity and PET/CT had a higher specificity in predicting the pathologic response after NAC in patients with breast cancer. According to the area under the SROC curve and anatomic discriminative resolution, MRI is the more suitable recommendation for predicting the pathologic response after NAC.
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Affiliation(s)
- Huimin Li
- Department of General Surgery, Gansu Province People's Hospital, Donggang West Road, Lanzhou, 730000, Gansu, China; School of Clinical Medical Sciences, Ningxia Medical University, Shengli Street, Yinchuan, 750000, China
| | - Liang Yao
- Clinical Division of Hong Kong Baptist University, Hong Kong, China
| | - Penghui Jin
- School of Clinical Medical Sciences, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, 730000, China
| | - Lidong Hu
- School of Clinical Medical Sciences, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, 730000, China
| | - Xiaofei Li
- Department of General Surgery, Gansu Province People's Hospital, Donggang West Road, Lanzhou, 730000, Gansu, China
| | - Tiankang Guo
- Department of General Surgery, Gansu Province People's Hospital, Donggang West Road, Lanzhou, 730000, Gansu, China.
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China.
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12
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Slanetz PJ, Moy L, Baron P, diFlorio RM, Green ED, Heller SL, Holbrook AI, Lee SJ, Lewin AA, Lourenco AP, Niell B, Stuckey AR, Trikha S, Vincoff NS, Weinstein SP, Yepes MM, Newell MS. ACR Appropriateness Criteria ® Monitoring Response to Neoadjuvant Systemic Therapy for Breast Cancer. J Am Coll Radiol 2018; 14:S462-S475. [PMID: 29101985 DOI: 10.1016/j.jacr.2017.08.037] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 12/28/2022]
Abstract
Patients with locally advanced invasive breast cancers are often treated with neoadjuvant chemotherapy prior to definitive surgical intervention. The primary aims of this approach are to: 1) reduce tumor burden thereby permitting breast conservation rather than mastectomy; 2) promptly treat possible metastatic disease, whether or not it is detectable on preoperative staging; and 3) potentially tailor future chemotherapeutic decisions by monitoring in-vivo tumor response. Accurate radiological assessment permits optimal management and planning in this population. However, assessment of tumor size and response to treatment can vary depending on the modality used, the measurement technique (such as single longest diameter, 3-D measurements, or calculated tumor volume), and varied response of different tumor subtypes to neoadjuvant chemotherapy (such as concentric shrinkage or tumor fragmentation). As discussed in further detail, digital mammography, digital breast tomosynthesis, US and MRI represent the key modalities with potential to help guide patient management. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Priscilla J Slanetz
- Principal Author, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Linda Moy
- Panel Vice Chair, NYU Clinical Cancer Center, New York, New York
| | - Paul Baron
- Roper St. Francis Physician Partners Breast Surgery, Charleston, South Carolina; American College of Surgeons
| | | | - Edward D Green
- The University of Mississippi Medical Center, Jackson, Mississippi
| | | | | | - Su-Ju Lee
- University of Cincinnati, Cincinnati, Ohio
| | - Alana A Lewin
- New York University School of Medicine, New York, New York
| | - Ana P Lourenco
- Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island
| | | | - Ashley R Stuckey
- Women and Infants Hospital, Providence, Rhode Island; American Congress of Obstetricians and Gynecologists
| | | | - Nina S Vincoff
- Hofstra Northwell School of Medicine, Manhasset, New York
| | - Susan P Weinstein
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Mary S Newell
- Panel Chair, Emory University Hospital, Atlanta, Georgia
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13
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Chu W, Jin W, Liu D, Wang J, Geng C, Chen L, Huang X. Diffusion-weighted imaging in identifying breast cancer pathological response to neoadjuvant chemotherapy: A meta-analysis. Oncotarget 2017; 9:7088-7100. [PMID: 29467952 PMCID: PMC5805538 DOI: 10.18632/oncotarget.23195] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/01/2017] [Indexed: 12/20/2022] Open
Abstract
Background Diffusion-weighted imaging (DWI) is increasingly used to identify pathological complete responses (pCRs) to neoadjuvant chemotherapy (NAC) in breast cancer. The aim of the present study was to assess the utility of DWI using a pooled analysis. Materials and Methods Literature databases were searched prior to July 2017. Fifteen studies with a total of 1181 patients were included. The data were extracted to perform pooled analysis, heterogeneity testing, threshold effect testing, sensitivity analysis, publication bias analysis and subgroup analyses. Result The methodological quality was moderate. Remarkable heterogeneity was detected, primarily due to a threshold effect. The pooled weighted values were a sensitivity of 0.88 (95% confidence interval (CI): 0.81, 0.92), a specificity of 0.79 (95% CI: 0.70, 0.86), a positive likelihood ratio of 4.1 (95% CI: 2.9, 5.9), a negative likelihood ratio of 0.16 (95% CI: 0.10, 0.24), and a diagnostic odds ratio of 26 (95% CI: 15, 46). The area under the receiver operator characteristic curve was 0.91 (95% CI: 0.88, 0.93). In the subgroup analysis, the pooled specificity of change in the apparent diffusion coefficient (ADC) subgroup was higher than that in the pre-treatment ADC subgroup (0.80 [95% CI: 0.71, 087] vs. 0.63 [95% CI: 0.52, 0.73], P = 0.027). Conclusions DWI may be an accurate and nonradioactive imaging technique for identifying pCRs to NAC in breast cancer. Nonetheless, there are a variety of issues when assessing DWI techniques for estimating breast cancer responses to NAC, and large scale and well-designed clinical trials are needed to assess the technique's diagnostic value.
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Affiliation(s)
- Wei Chu
- Department of Radiology, Wuxi Huishan District People's Hospital, Jiangsu Province, 214187, China
| | - Weiwei Jin
- Department of Radiology, Wuxi Second Traditional Chinese Medicine Hospital, Jiangsu Province, 214121, China
| | - Daihong Liu
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Chengjun Geng
- Department of Radiology, PLA No.101 Hospital, Wuxi, Jiangsu Province, 214044, China
| | - Lihua Chen
- Department of Radiology, PLA No.101 Hospital, Wuxi, Jiangsu Province, 214044, China
| | - Xuequan Huang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
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14
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Chen L, Yang Q, Bao J, Liu D, Huang X, Wang J. Direct comparison of PET/CT and MRI to predict the pathological response to neoadjuvant chemotherapy in breast cancer: a meta-analysis. Sci Rep 2017; 7:8479. [PMID: 28814795 PMCID: PMC5559519 DOI: 10.1038/s41598-017-08852-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/28/2017] [Indexed: 01/10/2023] Open
Abstract
Both PET/CT and breast MRI are used to assess pathological complete response to neoadjuvant chemotherapy (NAC) in patients with breast cancer. The aim is to compare the utility of PET/CT and breast MRI by using head-to-head comparative studies. Literature databases were searched prior to July 2016. Eleven studies with a total of 527 patients were included. For PET/CT, the pooled SEN was 0.87 (95% confidence interval (CI): 0.71-0.95) and SPE was 0.85 (95% CI: 0.70-0.93). For MRI, the pooled SEN was 0.79 (95% CI: 0.68-0.87) and SPE was 0.82 (95% CI: 0.72-0.89). In the conventional contrast enhanced (CE)-MRI subgroup, PET/CT outperformed conventional CE-MRI with a higher pooled sensitivity (0.88 (95% CI: 0.71, 0.95) vs. 0.74 (95% CI: 0.60, 0.85), P = 0.018). In the early evaluation subgroup, PET/CT was superior to MRI with a notable higher pooled specificity (0.94 (95% CI: 0.78, 0.98) vs. 0.83 (95% CI: 0.81, 0.87), P = 0.015). The diagnostic performance of MRI is similar to that of PET/CT for the assessment of breast cancer response to NAC. However, PET/CT is more sensitive than conventional CE-MRI and more specific if the second imaging scan is performed before 3 cycles of NAC.
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Affiliation(s)
- Lihua Chen
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
- Department of Radiology, PLA No.101 Hospital, Wuxi, Jiangsu Province, 214044, China
| | - Qifang Yang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
- Department of Radiology, PLA No.44 Hospital, Guiyang, Guizhou Province, 550009, China
| | - Jing Bao
- Molecular biology laboratory, Wuxi center for disease control and prevention, Wuxi, Jiangsu Province, 214001, China
| | - Daihong Liu
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Xuequan Huang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
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15
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The accuracy of 18F-FDG PET/CT in predicting the pathological response to neoadjuvant chemotherapy in patients with breast cancer: a meta-analysis and systematic review. Eur Radiol 2017; 27:4786-4796. [DOI: 10.1007/s00330-017-4831-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/13/2017] [Accepted: 03/21/2017] [Indexed: 12/22/2022]
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16
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Gu YL, Pan SM, Ren J, Yang ZX, Jiang GQ. Role of Magnetic Resonance Imaging in Detection of Pathologic Complete Remission in Breast Cancer Patients Treated With Neoadjuvant Chemotherapy: A Meta-analysis. Clin Breast Cancer 2017; 17:245-255. [PMID: 28209330 DOI: 10.1016/j.clbc.2016.12.010] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/26/2016] [Indexed: 02/07/2023]
Abstract
Pathologic complete remission after neoadjuvant chemotherapy has a role in guiding the management of breast cancer. The present meta-analysis examined the accuracy of contrast-enhanced magnetic resonance imaging (CE-MRI) and diffusion-weighted magnetic resonance imaging (DW-MRI) in detecting the response to neoadjuvant chemotherapy and compared CE-MRI with ultrasonography, mammography, and positron emission tomography/computed tomography (PET/CT). Medical subject heading terms and related keywords were searched to generate a compilation of eligible studies. The pooled sensitivity, specificity, diagnostic odds ratio, area under summary receiver operating characteristic curve (AUC), and Youden index (Q* index) were used to estimate the diagnostic efficacy of CE-MRI, DW-MRI, ultrasonography, mammography, and PET/CT. A total of 54 studies of CE-MRI and 8 studies of DW-MRI were included. The overall AUC and the Q* index values for CE-MRI and DW-MRI were 0.88 and 0.94 and 0.80 and 0.85, respectively. According to the summary receiver operating characteristic curves, CE-MRI resulted in a higher AUC value and Q* index compared with ultrasonography and mammography but had values similar to those of DW-MRI and PET/CT. CE-MRI accurately assessed pathologic complete remission in specificity, and PET/CT and DW-MRI accurately assessed pathologic complete remission in sensitivity. The present meta-analysis indicates that CE-MRI has high specificity and DW-MRI has high sensitivity in predicting pathologic complete remission after neoadjuvant chemotherapy. CE-MRI is more accurate than ultrasonography or mammography. Additionally, PET/CT is valuable for predicting pathologic complete remission. CE-MRI, combined with PET/CT or DW-MRI, might allow for a more precise assessment of pathologic complete remission.
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Affiliation(s)
- Yan-Lin Gu
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Si-Meng Pan
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Jie Ren
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Zhi-Xue Yang
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Guo-Qin Jiang
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.
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17
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Kim TH, Yoon JK, Kang DK, Kang SY, Jung YS, Han S, Kim JY, Yim H, An YS. Value of volume-based metabolic parameters for predicting survival in breast cancer patients treated with neoadjuvant chemotherapy. Medicine (Baltimore) 2016; 95:e4605. [PMID: 27741099 PMCID: PMC5072926 DOI: 10.1097/md.0000000000004605] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We evaluated the role of metabolic parameters in the prediction of disease recurrence in operable invasive ductal breast cancer patients treated with neoadjuvant chemotherapy (NAC).We retrospectively evaluated 139 female patients (mean age, 46.5 years; range: 27-72 years) with invasive ductal breast cancer, treated with NAC followed by surgery. All patients underwent F-fluorodeoxyglucose positron emission tomography/computed tomography and magnetic resonance imaging at baseline and after completion of NAC before surgery. The prognostic significance of clinicopathological and imaging parameters for disease-free survival (DFS) was evaluated.Recurrence of cancer was detected in 31 of 139 patients (22.3%; follow-up period: 6-82 months). Baseline maximum standardized uptake value, metabolic tumor volume (MTV), and reduction rate (RR) of MTV after NAC were significant independent prognostic factors for DFS in a multivariate analysis (all P < 0.05). The survival functions differed significantly between low and high histological grades (P < 0.001). DFS of the patients with high baseline MTV (≥5.23 cm) was significantly poorer than that of low MTV patients (P = 0.019). The survival function of the group with low RR of MTV after NAC (≤90.72%) was poorer than the higher RR of the MTV group (P = 0.008).Our findings suggest that breast cancer patients who have a high histological grade, large baseline MTV, or a small RR of MTV after NAC should receive great attention to check for possible recurrence.
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Affiliation(s)
| | - Joon-Kee Yoon
- Department of Nuclear Medicine and Molecular Imaging
| | | | | | | | | | | | - Hyunee Yim
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Young-Sil An
- Department of Nuclear Medicine and Molecular Imaging
- Correspondence: Young-Sil An, Department of Nuclear Medicine and Molecular Imaging, School of Medicine, Ajou University, Woncheon-dong, Yeongtong-gu, Gyeonggi-do, Suwon 443-749, Korea (e-mail: )
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18
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Sheikhbahaei S, Trahan TJ, Xiao J, Taghipour M, Mena E, Connolly RM, Subramaniam RM. FDG-PET/CT and MRI for Evaluation of Pathologic Response to Neoadjuvant Chemotherapy in Patients With Breast Cancer: A Meta-Analysis of Diagnostic Accuracy Studies. Oncologist 2016; 21:931-9. [PMID: 27401897 DOI: 10.1634/theoncologist.2015-0353] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 03/09/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION This study compared the diagnostic test accuracy of magnetic resonance imaging (MRI) with that of (18)F-fluoro-2-glucose-positron emission tomography/computed tomography (FDG-PET/CT) imaging in assessment of response to neoadjuvant chemotherapy (NAC) in breast cancer. METHODS A systematic search was performed in PubMed and EMBASE (last updated in June 2015). Studies investigating the performance of MRI and FDG-PET or FDG-PET/CT imaging during or after completion of NAC in patients with histologically proven breast cancer were eligible for inclusion. We considered only studies reporting a direct comparison between these imaging modalities to establish precise summary estimates in the same setting of patients. Pathologic response was considered as the reference standard. Two authors independently screened and selected studies that met the inclusion criteria and extracted the data. RESULTS A total of 10 studies were included. The pooled estimates of sensitivity and specificity across all included studies were 0.71 and 0.77 for FDG-PET/CT (n = 535) and 0.88 and 0.55 for MRI (n = 492), respectively. Studies were subgrouped according to the time of therapy assessment. In the intra-NAC setting, FDG-PET/CT imaging outperformed MRI with fairly similar pooled sensitivity (0.91 vs. 0.89) and higher specificity (0.69 vs. 0.42). However, MRI appeared to have higher diagnostic accuracy than FDG-PET/CT imaging when performed after the completion of NAC, with significantly higher sensitivity (0.88 vs. 0.57). CONCLUSION Analysis of the available studies of patients with breast cancer indicates that the timing of imaging for NAC-response assessment exerts a major influence on the estimates of diagnostic accuracy. FDG-PET/CT imaging outperformed MRI in intra-NAC assessment, whereas the overall performance of MRI was higher after completion of NAC, before surgery. IMPLICATIONS FOR PRACTICE The timing of therapy assessment imaging exerts a major influence on overall estimates of diagnostic accuracy. (18)F-fluoro-2-glucose-positron emission tomography (FDG-PET)/computed tomography (CT) imaging outperformed magnetic resonance imaging (MRI) in intra-neoadjuvant chemotherapy assessment with fairly similar pooled sensitivity and higher specificity. However, MRI appeared to be more accurate than FDG-PET/CT in predicting pathologic response when used in the post-therapy setting.
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Affiliation(s)
- Sara Sheikhbahaei
- Russell H. Morgan Department of Radiology and Radiological Sciences Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Tyler J Trahan
- Russell H. Morgan Department of Radiology and Radiological Sciences Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Xiao
- Russell H. Morgan Department of Radiology and Radiological Sciences Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Mehdi Taghipour
- Russell H. Morgan Department of Radiology and Radiological Sciences Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Esther Mena
- Russell H. Morgan Department of Radiology and Radiological Sciences Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Roisin M Connolly
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Rathan M Subramaniam
- Russell H. Morgan Department of Radiology and Radiological Sciences Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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19
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The Role of (18)F-FDG PET/CT and MRI in Assessing Pathological Complete Response to Neoadjuvant Chemotherapy in Patients with Breast Cancer: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3746232. [PMID: 26981529 PMCID: PMC4770138 DOI: 10.1155/2016/3746232] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 12/19/2015] [Accepted: 12/22/2015] [Indexed: 12/16/2022]
Abstract
Purpose. We performed this meta-analysis to determine the utilities of 18F-FDG PET/CT and MRI in assessing the pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) in the same cohort of patients with breast cancer. Methods. Two reviewers systematically searched on PubMed, Scopus, and Springer (from the beginning of 1992 to Aug. 1, 2015) for the eligible articles. Heterogeneity, pooled sensitivity and specificity, positive likelihood ratio, negative likelihood ratio, and the summary receiver operating characteristic (SROC) curve were calculated to estimate the diagnostic efficacy of 18F-FDG PET/CT and MRI. Results. A total of 6 studies including 382 pathologically confirmed patients were eligible. The pooled sensitivity and specificity of 18F-FDG PET/CT were 0.86 (95% CI: 0.76–0.93) and 0.72 (95% CI: 0.49–0.87), respectively. Pooled sensitivity and specificity of MRI were 0.65 (95% CI: 0.45–0.80) and 0.88 (95% CI: 0.75–0.95), respectively. The area under the SROC curve of 18F-FDG PET/CT and MRI was 0.88 and 0.84, respectively. Conclusion. Study indicated that 18F-FDG PET/CT had a higher sensitivity and MRI had a higher specificity in assessing pCR in breast cancer patients. Therefore, the combined use of these two imaging modalities may have great potential to improve the diagnostic performance in assessing pCR after NAC.
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20
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Luo J, Zhou Z, Yang Z, Chen X, Cheng J, Shao Z, Guo X, Tuan J, Fu X, Yu X. The Value of 18F-FDG PET/CT Imaging Combined With Pretherapeutic Ki67 for Early Prediction of Pathologic Response After Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer. Medicine (Baltimore) 2016; 95:e2914. [PMID: 26937935 PMCID: PMC4779032 DOI: 10.1097/md.0000000000002914] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
To evaluate the value of F-fluorodeoxyglucose-positron emission tomography/computed tomography (F-FDG PET/CT) and pretherapeutic Ki67 in predicting pathologic response in locally advanced breast cancer (LABC) after neoadjuvant chemotherapy (NAC).As a training set, total 301 LABC patients treated with NAC were retrospectively analyzed to evaluate the potential predictive value of pretherapeutic Ki67 for pathologic complete response (pCR) after NAC. Another 60 LABC patients were prospectively included as a validation set to evaluate the value of Ki67 combined PET/CT as pCR predictors. Ki67 was assessed in pretherapy core needle biopsy specimens and PET/CT scans were performed at baseline (before initiating NAC), after the 2nd, and 4th cycle of NAC. Maximum standardized uptake value (SUVmax) and its changes relative to baseline (ΔSUVmax%) were used as parameters of PEC/CT.In the training set, Ki67 was a predictor of pCR to NAC, with area under the curve (AUC) of 0.624 (P = 0.003) in receiver-operating characteristic (ROC) analysis. In the validation set, Ki67 alone did not show significant value in predicting pCR in the validation set. ΔSUVmax% after then 2nd or 4th course are predictors of pCR to NAC with the AUC of 0.774 (P = 0.002) and 0.791 (P = 0.002), respectively. When combined with ΔSUVmax% after the 2nd and 4th course NAC, Ki67 increased the value of ΔSUVmax% in predicting pCR with the AUC of 0.824 (P = 0.001). Baseline SUVmax and after 2nd, 4th course NAC had no predictive value for pCR, but SUVmax after the 2nd and 4th course showed remarkable predictive value for nonpathologic response (Grade 1 in Miller-Payne Grading System) with the AUC of 0.898 (P = 0.0001) and 0.801 (P = 0.003).Both PET/CT and Ki67 can predict pCR to NAC in LABC patients in the early phases of treatment. PET/CT combined Ki67 is a better pCR predictor for response to NAC. This helps the physician to predict the probability of pCR, and facilitates the optimization of individual treatment plan in case of ineffective and/or excessive chemotherapy.
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Affiliation(s)
- Jurui Luo
- From the Departments of Radiation Oncology (JL, ZZ, ZY, XC, XG, XF, XY), Nuclear Medicine (JC), and Breast Surgery (ZS), Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University (JL, ZZ, ZY, XC, XG, XF, XY, JC, ZS), Shanghai, China; and National Cancer Centre Singapore (JT), Singapore, Singapore
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21
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Ishiba T, Nakagawa T, Sato T, Nagahara M, Oda G, Sugimoto H, Kasahara M, Hosoya T, Kubota K, Fujioka T, Danenberg P, Danenberg K, Uetake H. Efficiency of fluorodeoxyglucose positron emission tomography/computed tomography to predict prognosis in breast cancer patients received neoadjuvant chemotherapy. SPRINGERPLUS 2015; 4:817. [PMID: 26722637 PMCID: PMC4690821 DOI: 10.1186/s40064-015-1634-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 12/17/2015] [Indexed: 11/25/2022]
Abstract
Neoadjuvant chemotherapy (NAC) has become a standard therapy for patients with advanced breast cancer. Pathological complete response (pCR) after NAC is an important prognostic indicator, but some patients with pCR continue to experience recurrence. So new predictive and prognostic markers in addition to pCR are needed following NAC for breast cancer. Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) can evaluate metastases in the entire body simultaneously, and has several potential advantages over conventional imaging modalities. The purpose of this study was to evaluate whether FDG-PET/CT can determine NAC response and whether FDG-PET/CT can be a new prognostic marker. We imaged 83 breast cancer tumors with FDG-PET/CT, ultrasound (US), and magnetic resonance imaging (MRI) to evaluate NAC efficacy. As we previously analyzed 110 breast cancers with FDG PET/CT, we defined a threshold of >1.7 maximum standardized uptake value (SUVmax) as abnormal fluorodeoxyglucose (FDG) uptake. After NAC, 16 (19.3 %) tumors had a complete response, 54 (65.1 %) had a partial response, 11 (13.3 %) showed stable disease, and 2 (2.4 %) showed progressive disease. One of the two patients with progressive disease had bone metastasis detected by FDG-PET/CT and was not operated on. Remote metastases were evident in 2.4 % of patients after NAC as determined by FDG-PET/CT. Overall, 17 patients had pathological complete response (pCR). The sensitivity of abnormal FDG uptake after NAC for non-pCR was 20.3 % and the specificity was 94.7 %. Patients with abnormal FDG uptake after NAC experienced significantly more recurrences (P = 0.004) and more of them died (P = 0.010). Moreover, the difference in disease-free survival was more significant in the estrogen receptor (ER)-negative group. FDG-PET after NAC may be more effective for predicting prognosis than for evaluating treatment response. This tendency was particularly remarkable in ER-negative breast cancer tumors. FDG-PET/CT is useful for reevaluating surgical applicability after NAC.
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Affiliation(s)
- Toshiyuki Ishiba
- Department of Breast Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan ; Liquid Genomics, Inc., 1725 Del Amo Blvd. Torrance, Torrance, 90501 CA USA ; Department of Biochemistry and Molecular Biology, University of Southern California/Norris Comprehensive Cancer Center, 1975 Zonal Ave, Los Angeles, 90089-9151 CA USA
| | - Tsuyoshi Nakagawa
- Department of Breast Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
| | - Takanobu Sato
- Department of Breast Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
| | - Makoto Nagahara
- Department of Breast Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
| | - Goshi Oda
- Department of Breast Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
| | - Hitoshi Sugimoto
- Department of Breast Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
| | - Mai Kasahara
- Department of Breast Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
| | - Tokuko Hosoya
- Department of Breast Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
| | - Kazunori Kubota
- Department of Radiology, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
| | - Tomoyuki Fujioka
- Department of Radiology, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
| | - Peter Danenberg
- Department of Biochemistry and Molecular Biology, University of Southern California/Norris Comprehensive Cancer Center, 1975 Zonal Ave, Los Angeles, 90089-9151 CA USA
| | - Kathleen Danenberg
- Liquid Genomics, Inc., 1725 Del Amo Blvd. Torrance, Torrance, 90501 CA USA
| | - Hiroyuki Uetake
- Department of Surgical Specialities, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
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22
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Marinovich ML, Macaskill P, Irwig L, Sardanelli F, Mamounas E, von Minckwitz G, Guarneri V, Partridge SC, Wright FC, Choi JH, Bhattacharyya M, Martincich L, Yeh E, Londero V, Houssami N. Agreement between MRI and pathologic breast tumor size after neoadjuvant chemotherapy, and comparison with alternative tests: individual patient data meta-analysis. BMC Cancer 2015; 15:662. [PMID: 26449630 PMCID: PMC4599727 DOI: 10.1186/s12885-015-1664-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 09/29/2015] [Indexed: 11/25/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) may guide breast cancer surgery by measuring residual tumor size post-neoadjuvant chemotherapy (NAC). Accurate measurement may avoid overly radical surgery or reduce the need for repeat surgery. This individual patient data (IPD) meta-analysis examines MRI’s agreement with pathology in measuring the longest tumor diameter and compares MRI with alternative tests. Methods A systematic review of MEDLINE, EMBASE, PREMEDLINE, Database of Abstracts of Reviews of Effects, Heath Technology Assessment, and Cochrane databases identified eligible studies. Primary study authors supplied IPD in a template format constructed a priori. Mean differences (MDs) between tests and pathology (i.e. systematic bias) were calculated and pooled by the inverse variance method; limits of agreement (LOA) were estimated. Test measurements of 0.0 cm in the presence of pathologic residual tumor, and measurements >0.0 cm despite pathologic complete response (pCR) were described for MRI and alternative tests. Results Eight studies contributed IPD (N = 300). The pooled MD for MRI was 0.0 cm (LOA: +/−3.8 cm). Ultrasound underestimated pathologic size (MD: −0.3 cm) relative to MRI (MD: 0.1 cm), with comparable LOA. MDs were similar for MRI (0.1 cm) and mammography (0.0 cm), with wider LOA for mammography. Clinical examination underestimated size (MD: −0.8 cm) relative to MRI (MD: 0.0 cm), with wider LOA. Tumors “missed” by MRI typically measured 2.0 cm or less at pathology; tumors >2.0 cm were more commonly “missed” by clinical examination (9.3 %). MRI measurements >5.0 cm occurred in 5.3 % of patients with pCR, but were more frequent for mammography (46.2 %). Conclusions There was no systematic bias in MRI tumor measurement, but LOA are large enough to be clinically important. MRI’s performance was generally superior to ultrasound, mammography, and clinical examination, and it may be considered the most appropriate test in this setting. Test combinations should be explored in future studies. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1664-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael L Marinovich
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, A27, Edward Ford Building, Sydney, NSW, 2006, Australia.
| | - Petra Macaskill
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, A27, Edward Ford Building, Sydney, NSW, 2006, Australia.
| | - Les Irwig
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, A27, Edward Ford Building, Sydney, NSW, 2006, Australia.
| | - Francesco Sardanelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Unità di Radiologia, IRCCS Policlinico San Donato, Piazza E. Malan 2, San Donato Milanese, Milano, Italy.
| | - Eleftherios Mamounas
- MD Anderson Cancer Center Orlando, 1400 South Orange Avenue, MP 700, Orlando, FL, 32806, USA.
| | - Gunter von Minckwitz
- German Breast Group & Universitäts-Frauenklinik Frankfurt, Martin-Behaim-Str. 12, 63263, Neu-Isenburg, Germany.
| | - Valentina Guarneri
- University of Padova, Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy.
| | - Savannah C Partridge
- Department of Radiology, University of Washington, 825 Eastlake Ave E, G3-200, Seattle, WA, 98109-1023, USA.
| | - Frances C Wright
- Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4C 5T2, Canada.
| | - Jae Hyuck Choi
- School of Medicine, Jeju National University Hospital, Aran 13gil 15(ara-1 dong), Jeju-si, Jeju-do, South Korea.
| | - Madhumita Bhattacharyya
- Berkshire Cancer Centre, Royal Berkshire NHS Foundation Trust, London Road, Reading, RG1 5AN, UK.
| | - Laura Martincich
- Direzione Radiodiagnostica, Fondazione del Piemonte per l'Oncologia-IRCCS, Str. Prov.142, Candiolo, Torino, Italy.
| | - Eren Yeh
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
| | - Viviana Londero
- Institute of Radiology, University of Udine, p.le S.M. della Misericordia, 15, 33100, Udine, Italy.
| | - Nehmat Houssami
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, A27, Edward Ford Building, Sydney, NSW, 2006, Australia.
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An YY, Kim SH, Kang BJ, Lee AW. Treatment Response Evaluation of Breast Cancer after Neoadjuvant Chemotherapy and Usefulness of the Imaging Parameters of MRI and PET/CT. J Korean Med Sci 2015; 30:808-15. [PMID: 26028936 PMCID: PMC4444484 DOI: 10.3346/jkms.2015.30.6.808] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 03/04/2015] [Indexed: 11/24/2022] Open
Abstract
This study was aimed to evaluate the ability of imaging parameters measured on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), diffusion-weighted MRI (DWI) and positron emission tomography/computed tomography (PET/CT) to serve as response markers in breast cancer after neoadjuvant chemotherapy (NAC). In 20 patients with breast cancer, DCE-MRI and DWI using a 3 T scanner and PET/CT were performed before and after NAC. DCE-MRI was analyzed using an automatic computer-aided detection program (MR-CAD). The response imaging parameters were compared with the pathologic response. The areas under the curve (AUCs) for DCE-MRI using MR-CAD analysis, DWI and PET/CT were 0.77, 0.59 and 0.76, respectively. The combination of all parameters measured by MR-CAD showed the highest diagnostic performance and accuracy (AUC = 0.77, accuracy = 90%). The combined use of the parameters of PET/CT with DCE-MRI or DWI showed a trend toward improved specificity and negative predictive value (100%, 100%, accuracy = 87.5%). The use of DCE-MRI using MR-CAD parameters indicated better diagnostic performance in predicting the final pathological response compared with DWI and PET/CT, although no statistically significant difference was observed. The combined use of PET/CT with DCE-MRI or DWI may improve the specificity for predicting a pathological response.
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Affiliation(s)
- Yeong Yi An
- Department of Radiology, College of Medicine, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea
| | - Sung Hun Kim
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Bong Joo Kang
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Ah Won Lee
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
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Combined use of 18F-FDG PET/CT and MRI for response monitoring of breast cancer during neoadjuvant chemotherapy. Eur J Nucl Med Mol Imaging 2014; 41:1515-24. [DOI: 10.1007/s00259-014-2770-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 03/28/2014] [Indexed: 10/25/2022]
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Predictive value of PET-CT for pathological response in stages II and III breast cancer patients following neoadjuvant chemotherapy with docetaxel. Rev Esp Med Nucl Imagen Mol 2014. [DOI: 10.1016/j.remnie.2013.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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García García-Esquinas MA, Arrazola García J, García-Sáenz JA, Furió-Bacete V, Fuentes Ferrer ME, Ortega Candil A, Cabrera Martín MN, Carreras Delgado JL. Predictive value of PET-CT for pathological response in stages II and III breast cancer patients following neoadjuvant chemotherapy with docetaxel. Rev Esp Med Nucl Imagen Mol 2013; 33:14-21. [PMID: 23809513 DOI: 10.1016/j.remn.2013.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 04/23/2013] [Accepted: 04/25/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To prospectively study the value of PET-CT with fluorine-18 fluorodeoxyglucose (FDG) to predict neoadjuvant chemotherapy (NAC) response of locoregional disease of stages II and III breast cancer patients. MATERIAL AND METHODS A written informed consent and approval were obtained from the Ethics Committee. PET-CT accuracy in the prediction of pathologic complete response (pCR) after NAC was studied in primary tumors and lymph node metastasis in 43 women (mean age: 50 years: range: 27-71 years) with histologically proven breast cancer between December 2009 and January 2011. PET-CT was performed at baseline and after NAC. SUV(max) percentage changes (ΔSUV(max)) were compared with pathology findings at surgery. Receiver-operator characteristic (ROC) analysis was used to discriminate between locoregional pCR and non-pCR. In patients not achieving pCR, it was investigated if ΔSUV(max) could accurately identify the residual cancer burden (RCB) classes: RCB-I (minimal residual disease (MRD)), RCB-II (moderate RD), and RCB-III (extensive RD). RESULTS pCR was obtained in 11 patients (25.6%). Residual disease was found in 32 patients (74.4%): 16 (37.2%) RCB-I, 15 (35.6%) RCB-II and 2 (4.7%) RCB-III. Sensitivity, specificity, and accuracy to predict pCR were 90.9%, 90.6%, and 90.7%, respectively. Specificity was 94.1% in the identification of a subset of patients who had either pCR or MRD. CONCLUSION Accuracy of ΔSUV(max) in the locoregional disease of stages II and III breast cancer patients after NAC is high for the identification of pCR cases. Its specificity is potentially sufficient to identify a subgroup of patients who could be managed with conservative surgery.
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Affiliation(s)
- Marta A García García-Esquinas
- Nuclear Medicine Department, Hospital Clínico San Carlos, Madrid, Spain; Radiology Department, Hospital Clínico San Carlos, Madrid, Spain.
| | | | | | - V Furió-Bacete
- Pathology Department, Hospital Clínico San Carlos, Madrid, Spain
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Mghanga FP, Lan X, Bakari KH, Li C, Zhang Y. Fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography in monitoring the response of breast cancer to neoadjuvant chemotherapy: a meta-analysis. Clin Breast Cancer 2013; 13:271-9. [PMID: 23714689 DOI: 10.1016/j.clbc.2013.02.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 01/06/2013] [Accepted: 02/04/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION To evaluate the diagnostic performance of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) in monitoring the response of breast cancers to neoadjuvant chemotherapy. METHODS Articles published in medical and oncologic journals between January 2000 and June 2012 were identified by systematic MEDLINE, Cochrane Database for Systematic Reviews, and EMBASE, and by manual searches of the references listed in original and review articles. Quality of the included studies was assessed by using the quality assessment of diagnosis accuracy studies score tool. Meta-DiSc statistical software was used to calculate the summary sensitivity and specificity, positive predictive and negative predictive values, and the summary receiver operating characteristics curve (SROC). RESULTS Fifteen studies with 745 patients were included in the study after meeting the inclusion criteria. The pooled sensitivity and specificity of FDG-PET or PET/CT were 80.5% (95% CI, 75.9%-84.5%) and 78.8% (95% CI, 74.1%-83.0%), respectively, and the positive predictive and negative predictive values were 79.8% and 79.5%, respectively. After 1 and 2 courses of chemotherapy, the pooled sensitivity and false-positive rate were 78.2% (95% CI, 73.8%-82.5%) and 11.2%, respectively; and 82.4% (95% CI, 77.4%-86.1%) and 19.3%, respectively. CONCLUSIONS Analysis of the findings suggests that FDG-PET has moderately high sensitivity and specificity in early detection of responders from nonresponders, and can be applied in the evaluation of breast cancer response to neoadjuvant chemotherapy in patients with breast cancer.
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Affiliation(s)
- Fabian Pius Mghanga
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
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Marinovich ML, Houssami N, Macaskill P, Sardanelli F, Irwig L, Mamounas EP, von Minckwitz G, Brennan ME, Ciatto S. Meta-analysis of magnetic resonance imaging in detecting residual breast cancer after neoadjuvant therapy. J Natl Cancer Inst 2013; 105:321-33. [PMID: 23297042 DOI: 10.1093/jnci/djs528] [Citation(s) in RCA: 256] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND It has been proposed that magnetic resonance imaging (MRI) be used to guide breast cancer surgery by differentiating residual tumor from pathologic complete response (pCR) after neoadjuvant chemotherapy. This meta-analysis examines MRI accuracy in detecting residual tumor, investigates variables potentially affecting MRI performance, and compares MRI with other tests. METHODS A systematic literature search was undertaken. Hierarchical summary receiver operating characteristic (HSROC) models were used to estimate (relative) diagnostic odds ratios ([R]DORs). Summary sensitivity (correct identification of residual tumor), specificity (correct identification of pCR), and areas under the SROC curves (AUCs) were derived. All statistical tests were two-sided. RESULTS Forty-four studies (2050 patients) were included. The overall AUC of MRI was 0.88. Accuracy was lower for "standard" pCR definitions (referent category) than "less clearly described" (RDOR = 2.41, 95% confidence interval [CI] = 1.11 to 5.23) or "near-pCR" definitions (RDOR = 2.60, 95% CI = 0.73 to 9.24; P = .03.) Corresponding AUCs were 0.83, 0.90, and 0.91. Specificity was higher when negative MRI was defined as contrast enhancement less than or equal to normal tissue (0.83, 95% CI = 0.64 to 0.93) vs no enhancement (0.54, 95% CI = 0.39 to 0.69; P = .02), with comparable sensitivity (0.83, 95% CI = 0.69 to 0.91; vs 0.87, 95% CI = 0.80 to 0.92; P = .45). MRI had higher accuracy than mammography (P = .02); there was only weak evidence that MRI had higher accuracy than clinical examination (P = .10). No difference in MRI and ultrasound accuracy was found (P = .15). CONCLUSIONS MRI accurately detects residual tumor after neoadjuvant chemotherapy. Accuracy was lower when pCR was more rigorously defined, and specificity was lower when test negativity thresholds were more stringent; these definitions require standardization. MRI is more accurate than mammography; however, studies comparing MRI and ultrasound are required.
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Affiliation(s)
- Michael L Marinovich
- Screening and Test Evaluation Program, Sydney School of Public Health, A27, Edward Ford Building, University of Sydney, NSW 2006, Australia.
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Jeh SK, Kim SH, Kang BJ. Comparison of the diagnostic performance of response evaluation criteria in solid tumor 1.0 with response evaluation criteria in solid tumor 1.1 on MRI in advanced breast cancer response evaluation to neoadjuvant chemotherapy. Korean J Radiol 2012; 14:13-20. [PMID: 23323026 PMCID: PMC3542297 DOI: 10.3348/kjr.2013.14.1.13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 08/21/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the diagnostic performance in evaluating the response of neoadjuvant chemotherapy (NAC), between the response evaluation criteria in solid tumor (RECIST) 1.0 and RECIST 1.1, on magnetic resonance imaging (MRI) for advance breast cancer patients. MATERIALS AND METHODS Breast cancer patients, who underwent NAC between 2005 and 2010, were included. Both prechemotherapy and post-chemotherapy MRIs were performed within 1-4 weeks before and after NAC. Only the patients with subsequent surgery were included. The response to NAC was assessed by using RECIST 1.0 and RECIST 1.1. Patients with a complete or partial response on MRI were considered as responders, and those with stable or progressive disease were considered as non-responders. Tumor necrosis > 50% on pathology was defined as responders and necrosis < 50% was defined as non-responders. The diagnostic accuracy of both RECIST 1.0 and RECIST 1.1 was analyzed and compared by receiver operating characteristic curve analysis. RESULTS Seventy-nine females (mean age 51.0 ± 9.3 years) were included. Pathology showed 45 responders and 34 non-responders. There were 49 responders and 30 non-responders on RECIST 1.0, and in 55 patients, RECIST 1.0 results agreed with pathologic results (69.6%). RECIST 1.1 showed 52 responders and 27 non-responders. In 60 patients, RECIST 1.1 results were in accordance with pathology results (75.9%). The area under the ROC curve was 0.809 for RECIST 1.0 and 0.853 for RECIST 1.1. CONCLUSION RECIST 1.1 showed better diagnostic performance than RECIST 1.0, although there was no statistically significant difference between the two.
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Affiliation(s)
- Su Kyung Jeh
- Department of Radiology, Hallym University College of Medicine, Seoul 150-950, Korea
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Li X, Abramson RG, Arlinghaus LR, Chakravarthy AB, Abramson V, Mayer I, Farley J, Delbeke D, Yankeelov TE. An algorithm for longitudinal registration of PET/CT images acquired during neoadjuvant chemotherapy in breast cancer: preliminary results. EJNMMI Res 2012; 2:62. [PMID: 23157877 PMCID: PMC3520720 DOI: 10.1186/2191-219x-2-62] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 11/07/2012] [Indexed: 11/24/2022] Open
Abstract
Background By providing estimates of tumor glucose metabolism, 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) can potentially characterize the response of breast tumors to treatment. To assess therapy response, serial measurements of FDG-PET parameters (derived from static and/or dynamic images) can be obtained at different time points during the course of treatment. However, most studies track the changes in average parameter values obtained from the whole tumor, thereby discarding all spatial information manifested in tumor heterogeneity. Here, we propose a method whereby serially acquired FDG-PET breast data sets can be spatially co-registered to enable the spatial comparison of parameter maps at the voxel level. Methods The goal is to optimally register normal tissues while simultaneously preventing tumor distortion. In order to accomplish this, we constructed a PET support device to enable PET/CT imaging of the breasts of ten patients in the prone position and applied a mutual information-based rigid body registration followed by a non-rigid registration. The non-rigid registration algorithm extended the adaptive bases algorithm (ABA) by incorporating a tumor volume-preserving constraint, which computed the Jacobian determinant over the tumor regions as outlined on the PET/CT images, into the cost function. We tested this approach on ten breast cancer patients undergoing neoadjuvant chemotherapy. Results By both qualitative and quantitative evaluation, our constrained algorithm yielded significantly less tumor distortion than the unconstrained algorithm: considering the tumor volume determined from standard uptake value maps, the post-registration median tumor volume changes, and the 25th and 75th quantiles were 3.42% (0%, 13.39%) and 16.93% (9.21%, 49.93%) for the constrained and unconstrained algorithms, respectively (p = 0.002), while the bending energy (a measure of the smoothness of the deformation) was 0.0015 (0.0005, 0.012) and 0.017 (0.005, 0.044), respectively (p = 0.005). Conclusion The results indicate that the constrained ABA algorithm can accurately align prone breast FDG-PET images acquired at different time points while keeping the tumor from being substantially compressed or distorted. Trial registration NCT00474604
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Affiliation(s)
- Xia Li
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, 1161 21st Avenue South, AA-1105 Medical Center North, Nashville, TN 37232-2310, USA.
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Cheng X, Li Y, Liu B, Xu Z, Bao L, Wang J. 18F-FDG PET/CT and PET for evaluation of pathological response to neoadjuvant chemotherapy in breast cancer: a meta-analysis. Acta Radiol 2012; 53:615-27. [PMID: 22734080 DOI: 10.1258/ar.2012.110603] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Neoadjuvant chemotherapy is increasingly the treatment for patients with inoperable breast cancer. Considering the side-effects of chemotherapy, there is a need for early evaluating response to neoadjuvant chemotherapy. PURPOSE To determinate the diagnostic performance of 18F-fluorodeoxyglucose position emission tomography/computed tomography (FDG PET/CT) and FDG PET for evaluating response to neoadjuvant chemotherapy in patients with breast cancer. MATERIAL AND METHODS "PubMed" (MEDLINE included) database, EMBASE, and Cochrane Database of Systematic Reviews were searched for relevant articles. We assessed the methodological quality of included study with Quality Assessment of Diagnosis Accuracy Studies (QUADAS) score tool, and used "Meta-DiSc" statistic software to obtain pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver-operating characteristic (SROC) curve. RESULTS Seventeen studies (a total of 781 subjects) met the inclusion criteria. The pooled sensitivity was 0.840 (95% confidence interval [CI] 0.796-0.878). The pooled specificity was 0.713 (95% CI 0.667-0.756). For FDG PET/CT (10 studies included), the pooled sensitivity was 0.847 (95% CI 0.793-0.892), the pooled specificity was 0.661 (95% CI 0.598-0.720). The pooled likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR) were 2.835 (95% CI 1.640-4.900), 0.221 (95% CI 0.160-0.305), and 17.628 (95% CI 7.431-41.818). The area under the SROC curve (AUC) was 0.8934. For FDG PET (7 studies included), the pooled sensitivity and specificity were 0.826 (95% CI 0.741-0.892) and 0.789 (95% CI 0.719-0.849). The pooled LR + , LR-, and DOR were 3.601 (95% CI 2.601-4.986), 0.242 (95% CI 0.157-0.374), and 13.641 (95% CI 7.433-25.030). The AUC was 0.8764. CONCLUSION Our results indicate that FDG PET/CT and PET have reasonable sensitivity in evaluating response to neoadjuvant chemotherapy in breast cancer; however, the specificity is relative low. The combination of other imaging methods with FDG PET/CT or PET is recommended.
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Affiliation(s)
| | - Yongjun Li
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | | | | | | | - Jie Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
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Fumagalli D, Bedard PL, Nahleh Z, Michiels S, Sotiriou C, Loi S, Sparano JA, Ellis M, Hylton N, Zujewski JA, Hudis C, Esserman L, Piccart M. A common language in neoadjuvant breast cancer clinical trials: proposals for standard definitions and endpoints. Lancet Oncol 2012; 13:e240-8. [PMID: 22652232 DOI: 10.1016/s1470-2045(11)70378-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Tateishi U, Miyake M, Nagaoka T, Terauchi T, Kubota K, Kinoshita T, Daisaki H, Macapinlac HA. Neoadjuvant chemotherapy in breast cancer: prediction of pathologic response with PET/CT and dynamic contrast-enhanced MR imaging--prospective assessment. Radiology 2012; 263:53-63. [PMID: 22438441 DOI: 10.1148/radiol.12111177] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To clarify whether fluorine 18 ((18)F) fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) and dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging performed after two cycles of neoadjuvant chemotherapy (NAC) can be used to predict pathologic response in breast cancer. MATERIALS AND METHODS Institutional human research committee approval and written informed consent were obtained. Accuracy after two cycles of NAC for predicting pathologic complete response (pCR) was examined in 142 women (mean age, 57 years: range, 43-72 years) with histologically proved breast cancer between December 2005 and February 2009. Quantitative PET/CT and DCE MR imaging were performed at baseline and after two cycles of NAC. Parameters of PET/CT and of blood flow and microvascular permeability at DCE MR were compared with pathologic response. Patients were also evaluated after NAC by using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 based on DCE MR measurements and European Organization for Research and Treatment of Cancer (EORTC) criteria and PET Response Criteria in Solid Tumors (PERCIST) 1.0 based on PET/CT measurements. Multiple logistic regression analyses were performed to examine continuous variables at PET/CT and DCE MR to predict pCR, and diagnostic accuracies were compared with the McNemar test. RESULTS Significant decrease from baseline of all parameters at PET/CT and DCE MR was observed after NAC. Therapeutic response was obtained in 24 patients (17%) with pCR and 118 (83%) without pCR. Sensitivity, specificity, and accuracy to predict pCR were 45.5%, 85.5%, and 82.4%, respectively, with RECIST and 70.4%, 95.7%, and 90.8%, respectively, with EORTC and PERCIST. Multiple logistic regression revealed three significant independent predictors of pCR: percentage maximum standardized uptake value (%SUV(max)) (odds ratio [OR], 1.22; 95% confidence interval [CI]: 1.11, 1.34; P < .0001), percentage rate constant (%k(ep)) (OR, 1.07; CI: 1.03, 1.12; P = .002), and percentage area under the time-intensity curve over 90 seconds (%AUC(90)) (OR, 1.04; CI: 1.01, 1.07; P = .048). When diagnostic accuracies are compared, PET/CT is superior to DCE MR for the prediction of pCR (%SUV(max) [90.1%] vs %κ(ep) [83.8%] or %AUC(90) [76.8%]; P < .05). CONCLUSION The sensitivities of %SUV(max) (66.7%), %k(ep) (51.7%), and %AUC(90) (50.0%) at (18)F-FDG PET/CT and DCE MR after two cycles of NAC are not acceptable, but the specificities (96.4%, 92.0%, and 95.2%, respectively) are high for stratification of pCR cases in breast cancer.
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Affiliation(s)
- Ukihide Tateishi
- Department of Radiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
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Identification of Potential Markers Related to Neoadjuvant Chemotherapy Sensitivity of Breast Cancer by SELDI-TOF MS. Appl Biochem Biotechnol 2011; 166:753-63. [DOI: 10.1007/s12010-011-9464-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 11/15/2011] [Indexed: 11/27/2022]
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Is 18F-FDG PET accurate to predict neoadjuvant therapy response in breast cancer? A meta-analysis. Breast Cancer Res Treat 2011; 131:357-69. [PMID: 21960111 DOI: 10.1007/s10549-011-1780-z] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 09/13/2011] [Indexed: 12/19/2022]
Abstract
Clinical evidence regarding the value of (18)F-FDG PET for therapy responses assessment in breast cancer is increasing. The objective of this study is to evaluate the accuracy of (18)F-FDG PET in predicting responses to neoadjuvant therapies with meta-analysis and explore its optimal regimen for clinical use. Articles in English language relating to the accuracy of (18)F-FDG PET for this utility were retrieved. Methodological quality was assessed by QUADAS tool. Pooled estimation and subgroup analysis data were obtained by statistical analysis. Nineteen studies met the inclusion criteria and involved 920 pathologically confirmed patients in total (mean age 49.8 years, all female). Methodological quality was relatively high. To predict histopathological response in primary breast lesions by PET, the pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic odds ratio were 84% (95% CI, 78-88%), 66% (95% CI, 62-70%), 50% (95% CI, 44-55%), 91% (95% CI, 87-94%), and 11.90 (95% CI, 6.33-22.36), respectively. In regional lymph nodes, sensitivity and NPV of PET were 92% (95% CI, 83-97%) and 88% (95% CI, 76-95%), respectively. Subgroup analysis showed that performing a post-therapy (18)F-FDG PET early (after the 1st or 2nd cycle of chemotherapy) was significantly better than later (accuracy 76% vs. 65%, P = 0.001). Furthermore, the best correlation with pathology was yielded by employing a reduction rate (RR) cutoff value of standardized uptake value between 55 and 65%. (18)F-FDG PET is useful to predict neoadjuvant therapy response in breast cancer. However, the relatively low specificity and PPV still call for caution. It is suggested to perform PET in an earlier course of therapy and use RR cutoff value between 55 and 65%, which might potentially identify non-responders early. However, further prospective studies are warranted to assess this regimen and adequately position PET in treatment management.
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Kim YH, Choi YY. Monitoring response to neo-adjuvant chemotherapy with F-18 FDG PET/CT. J Surg Oncol 2011; 103:741. [PMID: 21240987 DOI: 10.1002/jso.21834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 11/10/2010] [Indexed: 11/10/2022]
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Accuracy of unidimensional and volumetric ultrasound measurements in predicting good pathological response to neoadjuvant chemotherapy in breast cancer patients. Breast Cancer Res Treat 2011; 127:459-69. [DOI: 10.1007/s10549-011-1454-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 03/11/2011] [Indexed: 12/19/2022]
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Abstract
This paper summarises the current status of PET/CT in relation to breast cancer.
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Affiliation(s)
- C Hegarty
- St. Vincent's University Hospital, Dublin 4, Ireland
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Le-Petross HC, Hylton N. Role of breast MR imaging in neoadjuvant chemotherapy. Magn Reson Imaging Clin N Am 2010; 18:249-58, viii-ix. [PMID: 20494310 DOI: 10.1016/j.mric.2010.02.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neoadjuvant chemotherapy is now widely used in the management of locally advanced breast cancer (LABC). Early initiation of systemic therapy can improve overall and disease-free survival for patients with LABC or inflammatory cancer. MR imaging with intravenous contrast and advanced MR imaging techniques provide new opportunities for assessing tumor morphologic changes, tumor vascularity, tumor cellularity, and tumor metabolic features. MR imaging is more reliable than the conventional methods in the assessment of tumor size and vascularity changes during and after chemotherapy. The addition of advanced imaging techniques to further characterize tumor cellularity and metabolic features appears promising. However, there is still no consensus on the role of MR imaging for assessing response to neoadjuvant chemotherapy or on a standardized MR imaging examination in patients receiving neoadjuvant chemotherapy.
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Affiliation(s)
- H Carisa Le-Petross
- Department of Radiology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1350, Houston, TX 77030, USA
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