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Yaghoobpoor S, Fathi M, Ghorani H, Valizadeh P, Jannatdoust P, Tavasol A, Zarei M, Arian A. Machine learning approaches in the prediction of positive axillary lymph nodes post neoadjuvant chemotherapy using MRI, CT, or ultrasound: A systematic review. Eur J Radiol Open 2024; 12:100561. [PMID: 38699592 PMCID: PMC11063585 DOI: 10.1016/j.ejro.2024.100561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/29/2024] [Accepted: 04/09/2024] [Indexed: 05/05/2024] Open
Abstract
Background and objective Neoadjuvant chemotherapy is a standard treatment approach for locally advanced breast cancer. Conventional imaging modalities, such as magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound, have been used for axillary lymph node evaluation which is crucial for treatment planning and prognostication. This systematic review aims to comprehensively examine the current research on applying machine learning algorithms for predicting positive axillary lymph nodes following neoadjuvant chemotherapy utilizing imaging modalities, including MRI, CT, and ultrasound. Methods A systematic search was conducted across databases, including PubMed, Scopus, and Web of Science, to identify relevant studies published up to December 2023. Articles employing machine learning algorithms to predict positive axillary lymph nodes using MRI, CT, or ultrasound data after neoadjuvant chemotherapy were included. The review follows the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, encompassing data extraction and quality assessment. Results Seven studies were included, comprising 1502 patients. Four studies used MRI, two used CT, and one applied ultrasound. Two studies developed deep-learning models, while five used classic machine-learning models mainly based on multiple regression. Across the studies, the models showed high predictive accuracy, with the best-performing models combining radiomics and clinical data. Conclusion This systematic review demonstrated the potential of utilizing advanced data analysis techniques, such as deep learning radiomics, in improving the prediction of positive axillary lymph nodes in breast cancer patients following neoadjuvant chemotherapy.
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Affiliation(s)
- Shirin Yaghoobpoor
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
- Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mobina Fathi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
- Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Hamed Ghorani
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Parya Valizadeh
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Payam Jannatdoust
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Arian Tavasol
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
- Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Melika Zarei
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
- Department of Radiology and Nuclear Medicine, Paramedical School, Kermanshah University of Medical Sciences, Kermanshah, Islamic Republic of Iran
| | - Arvin Arian
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
- Cancer Research Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
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van de Loo ME, Andour L, van Heesewijk AE, Oosterkamp HM, Liefers GJ, Straver ME. Neoadjuvant endocrine treatment in hormone receptor-positive breast cancer: Does it result in more breast-conserving surgery? Breast Cancer Res Treat 2024; 205:5-16. [PMID: 38265568 DOI: 10.1007/s10549-023-07222-5] [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] [Received: 06/30/2023] [Accepted: 12/10/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Patients with locally advanced endocrine positive tumors who will not benefit from chemotherapy can be treated by either primary surgery or neoadjuvant endocrine therapy (NET). How often does NET result in breast-conserving surgery (BCS)? METHODS We conducted a literature search in PubMed and Embase, to identify articles on surgical treatment after NET. RESULTS In 19 studies the pathological complete response (pCR) rate was reported after NET; an overall pCR rate of 1% was found. Compared with neoadjuvant chemotherapy (NCT), the BCS rate was significantly higher after NET (OR 0.60; 95% CI, 0.51-0.69; P < 0.00001). The surgical conversion rate was reported in eight studies [4-75.9%], with a mean of 30.2%. CONCLUSION This review found that one out of three patients becomes eligible for BCS after treatment with NET.
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Affiliation(s)
- Merel E van de Loo
- Department of Surgery, Medical Center Haaglanden, The Hague, The Netherlands
| | - Layla Andour
- Department of Surgery, Medical Center Haaglanden, The Hague, The Netherlands
| | | | | | - Gerrit-Jan Liefers
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke E Straver
- Department of Surgery, Medical Center Haaglanden, The Hague, The Netherlands.
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López-Velazco JI, Manzano S, Otaño M, Elorriaga K, Bultó N, Herrero J, Lahuerta A, Segur V, Álvarez-López I, Caffarel MM, Urruticoechea A. A prospective study on tumour response assessment methods after neoadjuvant endocrine therapy in early oestrogen receptor-positive breast cancer. Breast Cancer Res 2024; 26:3. [PMID: 38173005 PMCID: PMC10765775 DOI: 10.1186/s13058-023-01756-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Neoadjuvant endocrine therapy (NET) in oestrogen receptor-positive (ER+) /HER2-negative (HER2-) breast cancer allows real-time evaluation of drug efficacy as well as investigation of the biological and molecular changes that occur after estrogenic deprivation. Clinical and pathological evaluation after NET may be used to obtain prognostic and predictive information of tumour response to decide adjuvant treatment. In this setting, clinical scales developed to evaluate response after neoadjuvant chemotherapy are not useful and there are not validated biomarkers to assess response to NET beyond Ki67 levels and preoperative endocrine prognostic index score (mPEPI). METHODS In this prospective study, we extensively analysed radiological (by ultrasound scan (USS) and magnetic resonance imaging (MRI)) and pathological tumour response of 104 postmenopausal patients with ER+ /HER2- resectable breast cancer, treated with NET for a mean of 7 months prior to surgery. We defined a new score, tumour cellularity size (TCS), calculated as the product of the residual tumour cellularity in the surgical specimen and the tumour pathological size. RESULTS Our results show that radiological evaluation of response to NET by both USS and MRI underestimates pathological tumour size (path-TS). Tumour size [mean (range); mm] was: path-TS 20 (0-80); radiological-TS by USS 9 (0-31); by MRI: 12 (0-60). Nevertheless, they support the use of MRI over USS to clinically assess radiological tumour response (rad-TR) due to the statistically significant association of rad-TR by MRI, but not USS, with Ki67 decrease (p = 0.002 and p = 0.3, respectively) and mPEPI score (p = 0.002 and p = 0.6, respectively). In addition, we propose that TCS could become a new tool to standardize response assessment to NET given its simplicity, reproducibility and its good correlation with existing biomarkers (such as ΔKi67, p = 0.001) and potential added value. CONCLUSION Our findings shed light on the dynamics of tumour response to NET, challenge the paradigm of the ability of NET to decrease surgical volume and point to the utility of the TCS to quantify the scattered tumour response usually produced by endocrine therapy. In the future, these results should be validated in independent cohorts with associated survival data.
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Affiliation(s)
- Joanna I López-Velazco
- Biogipuzkoa (Previously Known As Biodonostia) Health Research Institute, Paseo Dr Begiristain S/N, 20014, San Sebastian, Spain
| | - Sara Manzano
- Biogipuzkoa (Previously Known As Biodonostia) Health Research Institute, Paseo Dr Begiristain S/N, 20014, San Sebastian, Spain
| | - María Otaño
- Gipuzkoa Cancer Unit, OSI Donostialdea - Onkologikoa Foundation, Paseo Dr Begiristain 121, 20014, San Sebastian, Spain
| | - Kepa Elorriaga
- Gipuzkoa Cancer Unit, OSI Donostialdea - Onkologikoa Foundation, Paseo Dr Begiristain 121, 20014, San Sebastian, Spain
| | - Núria Bultó
- Gipuzkoa Cancer Unit, OSI Donostialdea - Onkologikoa Foundation, Paseo Dr Begiristain 121, 20014, San Sebastian, Spain
| | - Julio Herrero
- Gipuzkoa Cancer Unit, OSI Donostialdea - Onkologikoa Foundation, Paseo Dr Begiristain 121, 20014, San Sebastian, Spain
| | - Ainhara Lahuerta
- Biogipuzkoa (Previously Known As Biodonostia) Health Research Institute, Paseo Dr Begiristain S/N, 20014, San Sebastian, Spain
- Gipuzkoa Cancer Unit, OSI Donostialdea - Onkologikoa Foundation, Paseo Dr Begiristain 121, 20014, San Sebastian, Spain
| | - Virginia Segur
- Gipuzkoa Cancer Unit, OSI Donostialdea - Onkologikoa Foundation, Paseo Dr Begiristain 121, 20014, San Sebastian, Spain
| | - Isabel Álvarez-López
- Biogipuzkoa (Previously Known As Biodonostia) Health Research Institute, Paseo Dr Begiristain S/N, 20014, San Sebastian, Spain
- Gipuzkoa Cancer Unit, OSI Donostialdea - Onkologikoa Foundation, Paseo Dr Begiristain 121, 20014, San Sebastian, Spain
| | - Maria M Caffarel
- Biogipuzkoa (Previously Known As Biodonostia) Health Research Institute, Paseo Dr Begiristain S/N, 20014, San Sebastian, Spain.
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.
| | - Ander Urruticoechea
- Biogipuzkoa (Previously Known As Biodonostia) Health Research Institute, Paseo Dr Begiristain S/N, 20014, San Sebastian, Spain.
- Gipuzkoa Cancer Unit, OSI Donostialdea - Onkologikoa Foundation, Paseo Dr Begiristain 121, 20014, San Sebastian, Spain.
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Zhang C, Kosiorek HE, Patel BK, Pockaj BA, Ahmad SB, Cronin PA. Accuracy of Posttreatment Imaging for Evaluation of Residual in Breast Disease After Neoadjuvant Endocrine Therapy. Ann Surg Oncol 2022; 29:6207-6212. [PMID: 35831526 DOI: 10.1245/s10434-022-12128-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/16/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Neoadjuvant endocrine therapy (NET) can help downstage certain breast cancers prior to surgical resection. This study measured the accuracy of conventional mammography (MMG), ultrasound (US), magnetic resonance imaging (MRI), and contrast-enhanced mammography (CEM) for assessing breast tumor size in response to NET. PATIENTS AND METHODS Patients who underwent surgery after NET from 2013 to 2021 were identified. The maximal dimension of residual tumor on imaging was compared with the maximal dimension on final pathology. Lin's concordance correlation coefficient (rc) and Spearman's rank correlation coefficient (r) were used to assess agreement. RESULTS In total, 119 patients with invasive breast cancer underwent NET, posttreatment imaging, and surgery. Tumor size reported on posttreatment CEM correlated with size on final pathology to within 1 cm in n = 42 (58%) of patients, equivalent to the accuracy of MRI (n = 35, 58%). Size was accurately predicted by US in 54% and in 48% of MMG. Posttreatment imaging tumor size was moderately correlated with final tumor size on pathology CEM (r = 0.49; rc = 0.38), MRI (r = 0.52; rc = 0.45), and US (r = 0.41; rc = 0.28). MMG was weakly correlated (r = 0.21; rc = 0.16). Similar findings were shown in subgroup analysis; in those who received all four post-NET imaging, CEM and MRI again performed comparably, with r = 0.36 and 0.41, respectively, US (r = 0.43) and MMG (r = 0.28). CONCLUSIONS Compared with mammography and US, CEM and MRI had higher accuracy in estimating final tumor size for breast cancers treated with NET. Contrast-enhanced imaging is a helpful adjunct when response to preoperative therapy will impact clinical management.
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Affiliation(s)
- Chi Zhang
- Department of General Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Heidi E Kosiorek
- Department of Research-Biostatistics, Mayo Clinic, Phoenix, AZ, USA
| | | | - Barbara A Pockaj
- Division of Surgical Oncology and Endocrine Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Sarwat B Ahmad
- Division of Surgical Oncology and Endocrine Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Patricia A Cronin
- Department of General Surgery, Mayo Clinic, Phoenix, AZ, USA. .,Division of Surgical Oncology and Endocrine Surgery, Mayo Clinic, Phoenix, AZ, USA.
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Reis J, Boavida J, Tran HT, Lyngra M, Reitsma LC, Schandiz H, Melles WA, Gjesdal KI, Geisler J, Geitung JT. Assessment of preoperative axillary nodal disease burden: breast MRI in locally advanced breast cancer before, during and after neoadjuvant endocrine therapy. BMC Cancer 2022; 22:702. [PMID: 35752785 PMCID: PMC9233812 DOI: 10.1186/s12885-022-09813-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Axillary lymph node (LN) metastasis is one of the most important predictors of recurrence and survival in breast cancer, and accurate assessment of LN involvement is crucial. Determining extent of residual disease is key for surgical planning after neoadjuvant therapy. The aim of the study was to evaluate the diagnostic reliability of MRI for nodal disease in locally advanced breast cancer patients treated with neoadjuvant endocrine therapy (NET). Methods Thirty-three clinically node-positive locally advanced breast cancer patients who underwent NET and surgery were prospectively enrolled. Two radiologists reviewed the axillary nodes at 3 separate time points MRI examinations at baseline (before the first treatment regimen), interim (following at least 2 months after the first cycle and prior to crossing-over), and preoperative (after the final administration of therapy and immediately before surgery). According to LN status after surgery, imaging features and diagnostic performance were analyzed. Results All 33 patients had a target LN reduction, the greatest treatment benefit from week 8 to week 16. There was a positive correlation between the maximal diameter of the most suspicious LN measured by MRI and pathology during and after NET, being highest at therapy completion (r = 0.6, P ≤ .001). Mean and median differences of maximal diameter of the most suspicious LN were higher with MRI than with pathology. Seven of 33 patients demonstrated normal posttreatment MRI nodal status (yrN0). Of these 7 yrN0, 3 exhibited no metastasis on final pathology (ypN0), 2 ypN1 and 2 ypN2. Reciprocally, MRI diagnosed 3 cases of ypN0 as yrN + . Diffusion -weighted imaging (DWI) was the only axillary node characteristic significant when associated with pathological node status (χ2(4) = 8.118, P = .072). Conclusion Performance characteristics of MRI were not completely sufficient to preclude surgical axillary staging. To our knowledge, this is the first study on MRI LN assessment following NET in locally advanced breast cancer, and further studies with larger sample sizes are required to consolidate the results of this preliminary study. Trial Registration Institutional Review Board approval was obtained (this current manuscript is from a prospective, open-label, randomized single-center cohort substudy of the NEOLETEXE trial). NEOLETEXE, a phase 2 clinical trial, was registered on March 23rd, 2015 in the National trial database of Norway and approved by the Regional Ethical Committee of the South-Eastern Health Region in Norway; registration number: REK-SØ-84–2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09813-9.
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Affiliation(s)
- Joana Reis
- Department of Diagnostic Imaging and Intervention, Akershus University Hospital (AHUS), Postboks 1000, 1478, Lørenskog, Norway. .,Institute of Clinical Medicine, Campus AHUS, University of Oslo, Postboks 1000, 1478, Lørenskog, Norway. .,Translational Cancer Research Group, Akershus University Hospital (AHUS), Postboks 1000, 1478, Lørenskog, Norway.
| | - Joao Boavida
- Department of Diagnostic Imaging and Intervention, Akershus University Hospital (AHUS), Postboks 1000, 1478, Lørenskog, Norway
| | - Hang T Tran
- Department of Diagnostic Imaging and Intervention, Akershus University Hospital (AHUS), Postboks 1000, 1478, Lørenskog, Norway
| | - Marianne Lyngra
- Department of Pathology, Akershus University Hospital (AHUS), Postboks 1000, 1478, Lørenskog, Norway
| | - Laurens Cornelus Reitsma
- Department of Breast and Endocrine Surgery, Akershus University Hospital (AHUS), Postboks 1000, 1478, Lørenskog, Norway
| | - Hossein Schandiz
- Department of Pathology, Akershus University Hospital (AHUS), Postboks 1000, 1478, Lørenskog, Norway
| | - Woldegabriel A Melles
- Department of Diagnostic Imaging and Intervention, Akershus University Hospital (AHUS), Postboks 1000, 1478, Lørenskog, Norway
| | - Kjell-Inge Gjesdal
- Department of Diagnostic Imaging and Intervention, Akershus University Hospital (AHUS), Postboks 1000, 1478, Lørenskog, Norway.,Sunnmøre MR-Clinic, Agrinorbygget, Langelansveg 15, 6010, Ålesund, Norway
| | - Jürgen Geisler
- Institute of Clinical Medicine, Campus AHUS, University of Oslo, Postboks 1000, 1478, Lørenskog, Norway.,Translational Cancer Research Group, Akershus University Hospital (AHUS), Postboks 1000, 1478, Lørenskog, Norway.,Department of Oncology, Akershus University Hospital (AHUS), Postboks 1000, 1478, Lørenskog, Norway
| | - Jonn Terje Geitung
- Department of Diagnostic Imaging and Intervention, Akershus University Hospital (AHUS), Postboks 1000, 1478, Lørenskog, Norway.,Institute of Clinical Medicine, Campus AHUS, University of Oslo, Postboks 1000, 1478, Lørenskog, Norway.,Translational Cancer Research Group, Akershus University Hospital (AHUS), Postboks 1000, 1478, Lørenskog, Norway
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6
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Ragusi MA, Winter-Warnars GA, Wesseling J, Linn SC, Beets-Tan RG, van der Velden BH, Elias SG, Gilhuijs KG, Loo CE. Prognostic value of breast MRI characteristics before and during neoadjuvant endocrine therapy in patients with ER+/HER2- breast cancer. Br J Radiol 2021; 94:20201125. [PMID: 34142870 PMCID: PMC8248214 DOI: 10.1259/bjr.20201125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To investigate whether BIRADS MRI characteristics before or during neoadjuvant endocrine therapy (NET) are associated with the preoperative endocrine prognostic index (PEPI) in ER+/HER2- breast cancer patients. Methods: This retrospective observational cohort study included 35 ER+/HER2- patients with 38 tumors (3 bilateral cases) treated with NET. The pre- and midtreatment (after 3 months) MRIs were evaluated by two breast radiologists for BIRADS imaging characteristics, shrinkage pattern, and radiologic response. PEPI was used as end point. PEPI is based on the post-treatment surgical specimen’s pT- and pN-stage, Ki67, and ER-status. Tumors were assigned PEPI-1 (good prognosis) or PEPI-2/3 (poor prognosis). We investigated whether pre- and midtreatment BIRADS characteristics were associated with PEPI. Results: Median patient age was 65 years (interquartile interval [IQI]: 53, 70). 17 tumors (44.7%) were associated with good prognosis (PEPI-1), and 21 tumors (55.3%) with poor prognosis (PEPI-2/3). A larger reduction in tumor size after 3 months of NET was significantly associated with PEPI; 10 mm (IQI: 5, 13.5) in PEPI-1 tumors vs 4.5 mm (IQI: 3, 7; p = .045) in PEPI-2/3 tumors. Other BIRADS characteristics, shrinkage pattern or radiologic response were not associated with PEPI. Conclusion: Only a larger reduction in tumor size on MRI after 3 months of NET was associated with PEPI-1 (good prognosis) in ER+/HER2- breast cancer patients. Advances in knowledge: MRI characteristics previously reported to be associated with prognosis during neoadjuvant chemotherapy are not necessarily associated with prognosis during NET in ER+/HER2- breast cancer patients.
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Affiliation(s)
- Max Aa Ragusi
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Department of Radiology/Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Gonneke Ao Winter-Warnars
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Jelle Wesseling
- Department of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Sabine C Linn
- Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Regina G Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Bas Hm van der Velden
- Department of Radiology/Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kenneth Ga Gilhuijs
- Department of Radiology/Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Claudette E Loo
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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The Present and Future of Neoadjuvant Endocrine Therapy for Breast Cancer Treatment. Cancers (Basel) 2021; 13:cancers13112538. [PMID: 34064183 PMCID: PMC8196711 DOI: 10.3390/cancers13112538] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary The treatment of breast cancer has evolved considerably over the last two decades, leading toward individualized disease management. Hormone-sensitive breast cancers constitute the vast majority of cases and endocrine therapy is the mainstay of their treatment. On the other hand, neoadjuvant or pre-surgical treatments provide a number of advantages for tumor management. In this review we will discuss the existing evidence on neoadjuvant endocrine therapy, as well as its possible future indications. Abstract Endocrine therapy (ET) has established itself as an efficacious treatment for estrogen receptor-positive (ER+) breast cancers, with a reduction in recurrence rates and increased survival rates. The pre-surgical approach with chemotherapy (NCT) has become a common form of management for large, locally advanced, or high-risk tumors. However, a good response to NCT is not usually expected in ER+ tumors. Good results with primary ET, mainly in elderly women, have encouraged studies in other stages of life, and nowadays neoadjuvant endocrine treatment (NET) has become a useful approach to many ER+ breast cancers. The aim of this review is to provide an update on the current state of art regarding the present and the future role of NET.
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8
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Reis J, Thomas O, Lahooti M, Lyngra M, Schandiz H, Boavida J, Gjesdal KI, Sauer T, Geisler J, Geitung JT. Correlation between MRI morphological response patterns and histopathological tumor regression after neoadjuvant endocrine therapy in locally advanced breast cancer: a randomized phase II trial. Breast Cancer Res Treat 2021; 189:711-723. [PMID: 34357493 PMCID: PMC8505284 DOI: 10.1007/s10549-021-06343-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/28/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE To correlate MRI morphological response patterns with histopathological tumor regression grading system based on tumor cellularity in locally advanced breast cancer (LABC)-treated neoadjuvant with third-generation aromatase inhibitors. METHODS Fifty postmenopausal patients with ER-positive/HER-2-negative LABC treated with neoadjuvant letrozole and exemestane given sequentially in an intra-patient cross-over regimen for at least 4 months with MRI response monitoring at baseline as well as after at least 2 and 4 months on treatment. The MRI morphological response pattern was classified into 6 categories: 0/complete imaging response; I/concentric shrinkage; II/fragmentation; III/diffuse; IV/stable; and V/progressive. Histopathological tumor regression was assessed based on the recommendations from The Royal College of Pathologists regarding tumor cellularity. RESULTS Following 2 and 4 months with therapy, the most common MRI pattern was pattern II (24/50 and 21/50, respectively). After 4 months on therapy, the most common histopathological tumor regression grade was grade 3 (21/50). After 4 months an increasing correlation is observed between MRI patterns and histopathology. The overall correlation, between the largest tumor diameter obtained from MRI and histopathology, was moderate and positive (r = 0.50, P-value = 2e-04). Among them, the correlation was highest in type IV (r = 0.53). CONCLUSION The type II MRI pattern "fragmentation" was more frequent in the histopathological responder group; and types I and IV in the non-responder group. Type II pattern showed the best endocrine responsiveness and a relatively moderate correlation between sizes obtained from MRI and histology, whereas type IV pattern indicated endocrine resistance but the strongest correlation between MRI and histology.
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Affiliation(s)
- Joana Reis
- Department of Diagnostic Imaging and Intervention, Akershus University Hospital (AHUS), Postboks 1000, 1478, Lørenskog, Norway. .,Institute of Clinical Medicine, Campus AHUS, University of Oslo, Postboks 1000, 1478, Lørenskog, Norway. .,Translational Cancer Research Group, Akershus University Hospital (AHUS), Postboks 1000, 1478, Lørenskog, Norway.
| | - Owen Thomas
- grid.411279.80000 0000 9637 455XHealth Services Research Department, Akershus University Hospital (AHUS), Postboks 1000, 1478 Lørenskog, Norway
| | - Maryam Lahooti
- grid.411279.80000 0000 9637 455XDepartment of Diagnostic Imaging and Intervention, Akershus University Hospital (AHUS), Postboks 1000, 1478 Lørenskog, Norway
| | - Marianne Lyngra
- grid.411279.80000 0000 9637 455XDepartment of Pathology, Akershus University Hospital (AHUS), Postboks 1000, 1478 Lørenskog, Norway
| | - Hossein Schandiz
- grid.411279.80000 0000 9637 455XDepartment of Pathology, Akershus University Hospital (AHUS), Postboks 1000, 1478 Lørenskog, Norway
| | - Joao Boavida
- grid.411279.80000 0000 9637 455XDepartment of Diagnostic Imaging and Intervention, Akershus University Hospital (AHUS), Postboks 1000, 1478 Lørenskog, Norway
| | - Kjell-Inge Gjesdal
- grid.411279.80000 0000 9637 455XDepartment of Diagnostic Imaging and Intervention, Akershus University Hospital (AHUS), Postboks 1000, 1478 Lørenskog, Norway ,Sunnmøre MR-Clinic, Agrinorbygget, Langelansveg 15, 6010 Ålesund, Norway
| | - Torill Sauer
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, Campus AHUS, University of Oslo, Postboks 1000, 1478 Lørenskog, Norway ,grid.411279.80000 0000 9637 455XTranslational Cancer Research Group, Akershus University Hospital (AHUS), Postboks 1000, 1478 Lørenskog, Norway ,grid.411279.80000 0000 9637 455XDepartment of Pathology, Akershus University Hospital (AHUS), Postboks 1000, 1478 Lørenskog, Norway
| | - Jürgen Geisler
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, Campus AHUS, University of Oslo, Postboks 1000, 1478 Lørenskog, Norway ,grid.411279.80000 0000 9637 455XTranslational Cancer Research Group, Akershus University Hospital (AHUS), Postboks 1000, 1478 Lørenskog, Norway ,grid.411279.80000 0000 9637 455XDepartment of Oncology, Akershus University Hospital (AHUS), Postboks 1000, 1478 Lørenskog, Norway
| | - Jonn Terje Geitung
- grid.411279.80000 0000 9637 455XDepartment of Diagnostic Imaging and Intervention, Akershus University Hospital (AHUS), Postboks 1000, 1478 Lørenskog, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, Campus AHUS, University of Oslo, Postboks 1000, 1478 Lørenskog, Norway
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