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Rajan KK, Boersma C, Beek MA, Berendsen TA, van der Starre-Gaal J, Kate MV'VT, Francken AB, Noorda EM. Optimizing surgical strategy in locally advanced breast cancer: a comparative analysis between preoperative MRI and postoperative pathology after neoadjuvant chemotherapy. Breast Cancer Res Treat 2024; 203:477-486. [PMID: 37923963 DOI: 10.1007/s10549-023-07122-8] [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: 04/02/2023] [Accepted: 08/31/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE In the treatment of breast cancer, neo-adjuvant chemotherapy is often used as systemic treatment followed by tumor excision. In this context, planning the operation with regard to excision margins relies on tumor size measured by MRI. The actual tumor size can be determined through pathologic evaluation. The aim of this study is to investigate the correlation and agreement between pre-operative MRI and postoperative pathological evaluation. METHODS One hundred and ninety-three breast cancer patients that underwent neo-adjuvant chemotherapy and subsequent breast surgery were retrospectively included between January 2013 and July 2016. Preoperative tumor diameters determined with MRI were compared with postoperative tumor diameters determined by pathological analysis. Spearman correlation and Bland-Altman agreement methods were used. Results were subjected to subgroup analysis based on histological subtype (ER, HER2, ductal, lobular). RESULTS The correlation between tumor size at MRI and pathology was 0.63 for the whole group, 0.39 for subtype ER + /HER2-, 0.51 for ER + /HER2 + , 0.63 for ER-/HER2 +, and 0.85 for ER-/HER2-. The mean difference and limits of agreement (LoA) between tumor size measured MRI vs. pathological assessment was 4.6 mm (LoA -27.0-36.3 mm, n = 195). Mean differences and LoA for subtype ER + /HER2- was 7.6 mm (LoA -31.3-46.5 mm, n = 100), for ER + /HER2 + 0.9 mm (LoA -8.5-10.2 mm, n = 33), for ER-/HER2+ -1.2 mm (LoA -5.1-7.5 mm, n = 21), and for ER-/HER- -0.4 mm (LoA -8.6-7.7 mm, n = 41). CONCLUSION HER2 + and ER-/HER2- tumor subtypes showed clear correlation and agreement between preoperative MRI and postoperative pathological assessment of tumor size. This suggests that MRI evaluation could be a suitable predictor to guide the surgical approach. Conversely, correlation and agreement for ER + /HER2- and lobular tumors was poor, evidenced by a difference in tumor size of up to 5 cm. Hence, we demonstrate that histological tumor subtype should be taken into account when planning breast conserving surgery after NAC.
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Affiliation(s)
- K K Rajan
- Department of Surgical Oncology, Isala Zwolle, Dokter Van Heesweg 2, 8025 AB, Zwolle, the Netherlands.
| | - C Boersma
- Department of Surgical Oncology, Isala Zwolle, Dokter Van Heesweg 2, 8025 AB, Zwolle, the Netherlands
| | - M A Beek
- Department of Surgical Oncology, Isala Zwolle, Dokter Van Heesweg 2, 8025 AB, Zwolle, the Netherlands
| | - T A Berendsen
- Department of Surgical Oncology, Isala Zwolle, Dokter Van Heesweg 2, 8025 AB, Zwolle, the Netherlands
| | | | | | - A B Francken
- Department of Surgical Oncology, Isala Zwolle, Dokter Van Heesweg 2, 8025 AB, Zwolle, the Netherlands
| | - E M Noorda
- Department of Surgical Oncology, Isala Zwolle, Dokter Van Heesweg 2, 8025 AB, Zwolle, the Netherlands
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Peng Y, Yuan F, Xie F, Yang H, Wang S, Wang C, Yang Y, Du W, Liu M, Wang S. Comparison of automated breast volume scanning with conventional ultrasonography, mammography, and MRI to assess residual breast cancer after neoadjuvant therapy by molecular type. Clin Radiol 2023; 78:e393-e400. [PMID: 36822980 DOI: 10.1016/j.crad.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/28/2022] [Accepted: 12/04/2022] [Indexed: 01/15/2023]
Abstract
AIM To compare the accuracy of hand-held ultrasonography (US), mammography (MG), magnetic resonance imaging (MRI), and automated breast volume scanning (ABVS) in defining residual breast cancer tumour size after neoadjuvant therapy (NAT). MATERIALS AND METHODS Patients diagnosed breast cancer and who received NAT at the Breast Center, Peking University People's Hospital, were enrolled prospectively. Imaging was performed after the last cycle of NAT. The residual tumour size, intraclass correlation coefficients (ICCs), and receiver operating characteristic (ROC) to predict pathological complete response (pCR) were analysed. RESULTS A total of 156 patients with 159 tumours were analysed. ABVS had a moderate correlation with histopathology residual tumour size (ICC = 0.666), and showed high agreement among triple-positive tumours (ICC = 0.797). With 5 mm as the threshold, the coincidence rate reached 64.7% between ABVS and pathological size, which was significantly higher than that between US, MG, MRI, and pathological size (50%, 45.1%, 41.4%; p=0.009, p=0.001, p<0.001, respectively). For ROC analysis, ABVS demonstrated a higher area under the ROC curve, but with no statistical difference, except for MG (0.855, 0.816, 0.819, and 0.788, respectively; p=0.183 for US, p=0.044 for MG, and p=0.397 for MRI, with ABVS as the reference). CONCLUSIONS The longest tumour diameter on ABVS had a moderate correlation with pathological residual invasive tumour size. ABVS was shown to have good ability to predict pCR and would appear to be a potential useful tool for the assessment after NAT for breast cancer.
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Affiliation(s)
- Y Peng
- Breast Center, Peking University People's Hospital, Beijing, China
| | - F Yuan
- Department of Radiology, Breast Center, Peking University People's Hospital, Beijing, China
| | - F Xie
- Breast Center, Peking University People's Hospital, Beijing, China
| | - H Yang
- Breast Center, Peking University People's Hospital, Beijing, China
| | - S Wang
- Breast Center, Peking University People's Hospital, Beijing, China
| | - C Wang
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Y Yang
- Breast Center, Peking University People's Hospital, Beijing, China
| | - W Du
- Breast Center, Peking University People's Hospital, Beijing, China
| | - M Liu
- Breast Center, Peking University People's Hospital, Beijing, China.
| | - S Wang
- Breast Center, Peking University People's Hospital, Beijing, China.
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Graeser M, Schrading S, Gluz O, Strobel K, Herzog C, Umutlu L, Frydrychowicz A, Rjosk-Dendorfer D, Würstlein R, Culemann R, Eulenburg C, Adams J, Nitzsche H, Prange A, Kümmel S, Grischke EM, Forstbauer H, Braun M, Potenberg J, von Schumann R, Aktas B, Kolberg-Liedtke C, Harbeck N, Kuhl CK, Nitz U. Magnetic resonance imaging and ultrasound for prediction of residual tumor size in early breast cancer within the ADAPT subtrials. Breast Cancer Res 2021; 23:36. [PMID: 33736679 PMCID: PMC7977310 DOI: 10.1186/s13058-021-01413-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 02/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Prediction of histological tumor size by post-neoadjuvant therapy (NAT) ultrasound and magnetic resonance imaging (MRI) was evaluated in different breast cancer subtypes. Methods Imaging was performed after 12-week NAT in patients enrolled into three neoadjuvant WSG ADAPT subtrials. Imaging performance was analyzed for prediction of residual tumor measuring ≤10 mm and summarized using positive (PPV) and negative (NPV) predictive values. Results A total of 248 and 588 patients had MRI and ultrasound, respectively. Tumor size was over- or underestimated by < 10 mm in 4.4% and 21.8% of patients by MRI and in 10.2% and 15.8% by ultrasound. Overall, NPV (proportion of correctly predicted tumor size ≤10 mm) of MRI and ultrasound was 0.92 and 0.83; PPV (correctly predicted tumor size > 10 mm) was 0.52 and 0.61. MRI demonstrated a higher NPV and lower PPV than ultrasound in hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-positive and in HR−/HER2+ tumors. Both methods had a comparable NPV and PPV in HR−/HER2− tumors. Conclusions In HR+/HER2+ and HR−/HER2+ breast cancer, MRI is less likely than ultrasound to underestimate while ultrasound is associated with a lower risk to overestimate tumor size. These findings may help to select the most optimal imaging approach for planning surgery after NAT. Trial registration Clinicaltrials.gov, NCT01815242 (registered on March 21, 2013), NCT01817452 (registered on March 25, 2013), and NCT01779206 (registered on January 30, 2013). Supplementary Information The online version contains supplementary material available at 10.1186/s13058-021-01413-y.
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Affiliation(s)
- Monika Graeser
- West German Study Group, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany. .,Ev. Hospital Bethesda, Breast Center Niederrhein, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany. .,Department of Gynecology, University Medical Center Hamburg, Martinistrasse 52, 20251, Hamburg, Germany.
| | - Simone Schrading
- Department of Diagnostic and Interventional Radiology, Hospital of the University of Aachen, RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Oleg Gluz
- West German Study Group, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany.,University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Kevin Strobel
- Department of Diagnostic and Interventional Radiology, Hospital of the University of Aachen, RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany
| | | | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Alex Frydrychowicz
- Department of Radiology and Nuclear Medicine, Schleswig-Holstein University Hospital, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Dorothea Rjosk-Dendorfer
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse. 15, 81377, Munich, Germany
| | - Rachel Würstlein
- West German Study Group, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics, Breast Center, University of Munich (LMU) and CCCLMU, Marchioninistrasse 15, 81377, Munich, Germany
| | - Ralph Culemann
- Medizinisches Versorgungszentrum Radiologie Rhein-Sieg, GFO Kliniken Troisdorf, Hospitalstrasse 45, 53840, Troisdorf, Germany
| | - Christine Eulenburg
- West German Study Group, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany
| | - Jascha Adams
- Alcedis GmbH, Winchesterstrasse 3, 35394, Giessen, Germany
| | - Henrik Nitzsche
- Ev. Hospital Bethesda, Breast Center Niederrhein, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany
| | - Anna Prange
- Department of Radiology, Clinics Essen-Mitte, Breast Centre, Henricistrasse 92, 45136, Essen, Germany
| | - Sherko Kümmel
- West German Study Group, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany.,Clinics Essen-Mitte, Breast Centre, Henricistrasse 92, 45136, Essen, Germany.,University Hospital Charité, Women's Clinic, Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Eva-Maria Grischke
- University Clinic Tuebingen, Women's Clinic, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - Helmut Forstbauer
- Practice Network Troisdorf, Schlossstrasse 18, 53840, Troisdorf, Germany
| | - Michael Braun
- Red Cross Women's Hospital, Nymphenburger Strasse 163, 80634, Munich, Germany
| | - Jochem Potenberg
- Ev. Waldkrankenhaus Berlin, Stadtrandstrasse 555, 13589, Berlin, Germany
| | - Raquel von Schumann
- Ev. Hospital Bethesda, Breast Center Niederrhein, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany
| | - Bahriye Aktas
- Department of Gynecology and Obstetrics, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.,Department of Gynecology, University Hospital Leipzig, Liebeigstrasse 20A, 04103, Leipzig, Germany
| | - Cornelia Kolberg-Liedtke
- University Hospital Charité, Women's Clinic, Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Department of Gynecology and Obstetrics, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Nadia Harbeck
- West German Study Group, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics, Breast Center, University of Munich (LMU) and CCCLMU, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, Hospital of the University of Aachen, RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Ulrike Nitz
- West German Study Group, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany
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MRI, Clinical Examination, and Mammography for Preoperative Assessment of Residual Disease and Pathologic Complete Response After Neoadjuvant Chemotherapy for Breast Cancer: ACRIN 6657 Trial. AJR Am J Roentgenol 2018; 210:1376-1385. [PMID: 29708782 DOI: 10.2214/ajr.17.18323] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The objective of our study was to determine the accuracy of preoperative measurements for detecting pathologic complete response (CR) and assessing residual disease after neoadjuvant chemotherapy (NACT) in patients with locally advanced breast cancer. SUBJECTS AND METHODS The American College of Radiology Imaging Network 6657 Trial prospectively enrolled women with ≥ 3 cm invasive breast cancer receiving NACT. Preoperative measurements of residual disease included longest diameter by mammography, MRI, and clinical examination and functional volume on MRI. The accuracy of preoperative measurements for detecting pathologic CR and the association with final pathology size were assessed for all lesions, separately for single masses and nonmass enhancements (NMEs), multiple masses, and lesions without ductal carcinoma in situ (DCIS). RESULTS In the 138 women with all four preoperative measures, longest diameter by MRI showed the highest accuracy for detecting pathologic CR for all lesions and NME (AUC = 0.76 and 0.84, respectively). There was little difference across preoperative measurements in the accuracy of detecting pathologic CR for single masses (AUC = 0.69-0.72). Longest diameter by MRI and longest diameter by clinical examination showed moderate ability for detecting pathologic CR for multiple masses (AUC = 0.78 and 0.74), and longest diameter by MRI and longest diameter by mammography showed moderate ability for detecting pathologic CR for tumors without DCIS (AUC = 0.74 and 0.71). In subjects with residual disease, longest diameter by MRI exhibited the strongest association with pathology size for all lesions and single masses (r = 0.33 and 0.47). Associations between preoperative measures and pathology results were not significantly influenced by tumor subtype or mammographic density. CONCLUSION Our results indicate that measurement of longest diameter by MRI is more accurate than by mammography and clinical examination for preoperative assessment of tumor residua after NACT and may improve surgical planning.
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5
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Candelaria RP, Bassett RL, Symmans WF, Ramineni M, Moulder SL, Kuerer HM, Thompson AM, Yang WT. Performance of Mid-Treatment Breast Ultrasound and Axillary Ultrasound in Predicting Response to Neoadjuvant Chemotherapy by Breast Cancer Subtype. Oncologist 2017; 22:394-401. [PMID: 28314842 DOI: 10.1634/theoncologist.2016-0307] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 12/02/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The primary objective was to determine whether mid-treatment ultrasound measurements of index breast tumors and index axillary nodes of different cancer subtypes associate with residual cancer burden (RCB). METHODS Patients with invasive breast cancer who underwent neoadjuvant chemotherapy and had pre-treatment and mid-treatment breast and axillary ultrasound were included in this single-institution, retrospective cohort study. Linear regression analysis assessed associations between RCB with (a) change in index breast tumor size, (b) change in index node size, and (c) absolute number of abnormal nodes at mid-treatment. Multivariate linear regression was used to calculate best-fit models for RCB. RESULTS One hundred fifty-nine patients (68 triple negative breast cancer [TNBC], 45 hormone receptor [HR]+/human epidermal growth factor receptor 2 [HER2]-, and 46 HR-/HER2+) were included. Median age at diagnosis was 50 years, range 30-76. Median tumor size was 3.4 cm, range 0.9-10.4. Pathological complete response/RCB-I rates were 36.8% (25/68) for TNBC patients, 24.4% (11/45) for HR+/HER2- patients, and 71.7% (33/46) for HR-/HER2+ patients. Linear regression analyses demonstrated associations between percent change in tumor ultrasound measurements at mid-treatment with RCB index score in TNBC and HR+/HER2- (p < .05) but not in HR-/HER2+ (p > .05) tumors and an association between axillary ultrasound assessment of number of abnormal nodes at mid-treatment with RCB index score across all subtypes (p < .05). CONCLUSION Performance characteristics of breast ultrasound associated with RCB vary by cancer subtype, whereas the performance characteristics of axillary ultrasound associated with RCB are consistent across cancer subtype. Breast and axillary ultrasound may be valuable in monitoring response to neoadjuvant therapy. The Oncologist 2017;22:394-401 IMPLICATIONS FOR PRACTICE: The differential performance characteristics of breast ultrasound by molecular subtype and the consistent performance characteristics of axillary ultrasound across molecular subtypes can have clinical utility in monitoring response to neoadjuvant therapy.
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Affiliation(s)
| | | | | | | | | | - Henry M Kuerer
- Department of Breast Surgical Oncology, Unit 1434, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alastair M Thompson
- Department of Breast Surgical Oncology, Unit 1434, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Ma Y, Zhang S, Zang L, Li J, Li J, Kang Y, Ren W. Combination of shear wave elastography and Ki-67 index as a novel predictive modality for the pathological response to neoadjuvant chemotherapy in patients with invasive breast cancer. Eur J Cancer 2016; 69:86-101. [PMID: 27821323 DOI: 10.1016/j.ejca.2016.09.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 08/03/2016] [Accepted: 09/26/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE This study evaluated shear wave elastography (SWE) and SWE combined with the Ki-67 index as novel predictive modalities for the pathological response of invasive breast cancer to neoadjuvant chemotherapy (NAC). METHODS The prospective study recruited 66 eligible patients from July 2014 to November 2015. Tumour stiffness, which corresponds with tumour progression and invasiveness, was assessed by quantitative SWE 1 d before biopsy (time point t0, elasticity E0), 1 d before next NAC cycle (t1-t5, E1-E5), and 1 d before surgery (t6, E6). The relative changes in SWE parameters after the first and second NAC cycles were considered as the variables [ΔE (t1), ΔE (t2)]. The pathological response was classified according to the residual cancer burden (RCB) protocol. Correlations between RCB scores and variables were evaluated. The predictive diagnostic performances of SWE parameters, Ki-67 index, and the predictive RCB (predRCB) score determined by a linear regression model were compared. RESULTS Some immunohistochemical and molecular factors and SWE parameters were significantly different among the three RCB groups. The ΔEmean (t2) and Ki-67 had significantly better diagnostic performance than other parameters regarding predicting the pathological response (the RCB-I response and RCB-III resistance). However, the correlation between ΔEmean (t2) and Ki-67 index was significantly weaker as a diagnostic predictor (r = 0.29). We generated a new predictive modality, predRCB, which is a multivariable linear regression model that combines ΔEmean (t2) and the Ki-67 index. The predRCB modality showed better diagnostic performance than SWE parameters and Ki-67 index alone. CONCLUSION Our findings highlight the potential utility for adding the Ki-67 index to the SWE results, which may improve the predictive power of SWE and facilitate personalising the treatment regimens of patients with breast cancer. These results should be validated in the future by performing a multicentre prospective study with a larger cohort.
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Affiliation(s)
- Yan Ma
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Shuo Zhang
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Li Zang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Jing Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Jianyi Li
- Department of Breast Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Ye Kang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China.
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7
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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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Lee MC, Gonzalez SJ, Lin H, Zhao X, Kiluk JV, Laronga C, Mooney B. Prospective Trial of Breast MRI Versus 2D and 3D Ultrasound for Evaluation of Response to Neoadjuvant Chemotherapy. Ann Surg Oncol 2015; 22:2888-2894. [DOI: 10.1245/s10434-014-4357-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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9
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Ramos M, Díez J, Ramos T, Ruano R, Sancho M, González-Orús J. Intraoperative ultrasound in conservative surgery for non-palpable breast cancer after neoadjuvant chemotherapy. Int J Surg 2014; 12:572-7. [DOI: 10.1016/j.ijsu.2014.04.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 04/10/2014] [Indexed: 11/27/2022]
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10
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Meta-analysis of agreement between MRI and pathologic breast tumour size after neoadjuvant chemotherapy. Br J Cancer 2013; 109:1528-36. [PMID: 23963140 PMCID: PMC3776985 DOI: 10.1038/bjc.2013.473] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 07/21/2013] [Accepted: 07/23/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) has been proposed to guide breast cancer surgery by measuring residual tumour after neoadjuvant chemotherapy. This study-level meta-analysis examines MRI's agreement with pathology, compares MRI with alternative tests and investigates consistency between different measures of agreement. METHODS A systematic literature search was undertaken. Mean differences (MDs) in tumour size between MRI or comparator tests and pathology were pooled by assuming a fixed effect. Limits of agreement (LOA) were estimated from a pooled variance by assuming equal variance of the differences across studies. RESULTS Data were extracted from 19 studies (958 patients). The pooled MD between MRI and pathology from six studies was 0.1 cm (95% LOA: -4.2 to 4.4 cm). Similar overestimation for MRI (MD: 0.1 cm) and ultrasound (US) (MD: 0.1 cm) was observed, with comparable LOA (two studies). Overestimation was lower for MRI (MD: 0.1 cm) than mammography (MD: 0.4 cm; two studies). Overestimation by MRI (MD: 0.1 cm) was smaller than underestimation by clinical examination (MD: -0.3 cm). The LOA for mammography and clinical examination were wider than that for MRI. Percentage agreement between MRI and pathology was greater than that of comparator tests (six studies). The range of Pearson's/Spearman's correlations was wide (0.21-0.92; 16 studies). Inconsistencies between MDs, percentage agreement and correlations were common. CONCLUSION Magnetic resonance imaging appears to slightly overestimate pathologic size, but measurement errors may be large enough to be clinically significant. Comparable performance by US was observed, but agreement with pathology was poorer for mammography and clinical examination. Percentage agreement can provide supplementary information to MDs and LOA, but Pearson's/Spearman's correlation does not provide evidence of agreement and should be avoided. Further comparisons of MRI and other tests using the recommended methods are warranted.
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Which imaging modality is superior for prediction of response to neoadjuvant chemotherapy in patients with triple negative breast cancer? JOURNAL OF ONCOLOGY 2013; 2013:964863. [PMID: 23476649 PMCID: PMC3583078 DOI: 10.1155/2013/964863] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 12/16/2012] [Accepted: 01/14/2013] [Indexed: 12/31/2022]
Abstract
Background and Objectives. Triple negative breast cancer (TNBC) has been shown to be generally chemosensitive. We sought to investigate the utility of mammography (MMG), ultrasonography (US), and breast magnetic resonance imaging (MRI) in predicting residual disease following neoadjuvant chemotherapy for TNBC. Methods. We identified 148 patients with 151 Stage I-III TNBC treated with neoadjuvant chemotherapy. Residual tumor size was estimated by MMG, US, and/or MRI prior to surgical intervention and compared to the subsequent pathologic residual tumor size. Data were compared using chi-squared test. Results. Of 151 tumors, 44 (29%) did not have imaging performed prior to surgical treatment. Thirty-eight (25%) tumors underwent a pathologic complete response (pCR), while 113 (75%) had residual invasive disease. The imaging modality was accurate to within 1 cm of the final pathologic residual disease in 74 (69%) cases and within 2 cm in 94 (88%) cases. Groups were similar with regards to patient age, race, tumor size and grade, and clinical stage (P > 0.05). Accuracy to within 1 cm was the highest for US (83%) and the lowest for MMG (56%) (P < 0.05). Conclusions. Breast US and MRI were more accurate than MMG in predicting residual tumor size following neoadjuvant chemotherapy in patients with TNBC. None of the imaging modalities were predictive of a pCR.
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Current World Literature. Curr Opin Obstet Gynecol 2013; 25:81-9. [DOI: 10.1097/gco.0b013e32835cc6b6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lobbes MBI, Prevos R, Smidt M, Tjan-Heijnen VCG, van Goethem M, Schipper R, Beets-Tan RG, Wildberger JE. The role of magnetic resonance imaging in assessing residual disease and pathologic complete response in breast cancer patients receiving neoadjuvant chemotherapy: a systematic review. Insights Imaging 2013; 4:163-75. [PMID: 23359240 PMCID: PMC3609956 DOI: 10.1007/s13244-013-0219-y] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 01/03/2013] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES This systematic review aimed to assess the role of magnetic resonance imaging (MRI) in evaluating residual disease extent and the ability to detect pathologic complete response (pCR) after neoadjuvant chemotherapy for invasive breast cancer. METHODS PubMed, the Cochrane Library, MEDLINE, and Embase databases were searched for relevant studies published until 1 July 2012. After primary selection, two reviewers independently assessed the content of each eligible study using a standardised extraction form and pre-defined inclusion and exclusion criteria. RESULTS A total of 35 eligible studies were selected. Correlation coefficients of residual tumour size assessed by MRI and pathology were good, with a median value of 0.698. Reported sensitivity, specificity, positive predictive value and negative predictive value for predicting pCR with MRI ranged from 25 to 100 %, 50-97 %, 47-73 % and 71-100 %, respectively. Both overestimation and underestimation were observed. MRI proved more accurate in determining residual disease than physical examination, mammography and ultrasound. Diagnostic accuracy of MRI after neoadjuvant chemotherapy could be influenced by treatment regimen and breast cancer subtype. CONCLUSIONS Breast MRI accuracy for assessing residual disease after neoadjuvant chemotherapy is good and surpasses other diagnostic means. However, both overestimation and underestimation of residual disease extent could be observed. MAIN MESSAGES • Breast MRI accuracy for assessing residual disease is good and surpasses other diagnostic means. • Correlation coefficients of residual tumour size assessed by MRI and pathology were considered good. • However, both overestimation and underestimation of residual disease were observed. • Diagnostic accuracy of MRI seems to be affected by treatment regimen and breast cancer subtype.
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Affiliation(s)
- M B I Lobbes
- Department of Radiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands,
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Lobbes M, Prevos R, Smidt M. Response monitoring of breast cancer patientsreceiving neoadjuvant chemotherapy using breast MRI – a review of current knowledge. ACTA ACUST UNITED AC 2012. [DOI: 10.7243/2049-7962-1-34] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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