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Browne R, McAnena P, O'Halloran N, Moloney BM, Crilly E, Kerin MJ, Lowery AJ. Preoperative Breast Magnetic Resonance Imaging as a Predictor of Response to Neoadjuvant Chemotherapy. Breast Cancer (Auckl) 2022; 16:11782234221103504. [PMID: 35769423 PMCID: PMC9234834 DOI: 10.1177/11782234221103504] [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: 01/15/2022] [Accepted: 04/28/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction: The ability to accurately predict pathologic complete response (pCR) after
neoadjuvant chemotherapy (NAC) in breast cancer would improve patient
selection for specific treatment strategies, would provide important
information for patients to aid in the treatment selection process, and
could potentially avoid the need for more extensive surgery. The diagnostic
performance of magnetic resonance imaging (MRI) in predicting pCR has
previously been studied, with mixed results. Magnetic resonance imaging
performance may also be influenced by tumour and patient factors. Methods: Eighty-seven breast cancer patients who underwent NAC were studied. Pre-NAC
and post-NAC MRI findings were compared with pathologic findings
postsurgical excision. The impact of patient and tumour characteristics on
MRI accuracy was evaluated. Results: The mean (SD) age of participants was 48.7 (10.3) years. The rate of pCR
based on post-NAC MRI was 19.5% overall (19/87). The sensitivity,
specificity, positive predictive value (PPV), negative predictive value, and
accuracy in predicting pCR were 52.9%, 77.1%, 36.0%, 87.1%, and 72.4%,
respectively. Positive predictive value was the highest in nonluminal versus
Luminal A disease (45.0% vs 25.0%, P < .001), with
higher rates of false positivity in nonluminal subtypes
(P = .002). Tumour grade, T category, and histological
subtype were all independent predictors of MRI accuracy regarding post-NAC
tumour size. Conclusion: Magnetic resonance imaging alone is insufficient to accurately predict pCR in
breast cancer patients post-NAC. Magnetic resonance imaging predictions of
pCR are more accurate in nonluminal subtypes. Tumour grade, T category, and
histological subtype should be considered when evaluating post-NAC tumour
sizes.
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Affiliation(s)
- Robert Browne
- Department of Surgery, University Hospital Galway, Galway, Ireland
| | - Peter McAnena
- Department of Surgery, University Hospital Galway, Galway, Ireland
| | - Niamh O'Halloran
- Department of Radiology, University Hospital Galway, Galway, Ireland
| | - Brian M Moloney
- Department of Radiology, University Hospital Galway, Galway, Ireland
| | - Emily Crilly
- Department of Surgery, University Hospital Galway, Galway, Ireland
| | - Michael J Kerin
- Department of Surgery, University Hospital Galway, Galway, Ireland.,Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland
| | - Aoife J Lowery
- Department of Surgery, University Hospital Galway, Galway, Ireland.,Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland
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2
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Kong X, Zhang Q, Wu X, Zou T, Duan J, Song S, Nie J, Tao C, Tang M, Wang M, Zou J, Xie Y, Li Z, Li Z. Advances in Imaging in Evaluating the Efficacy of Neoadjuvant Chemotherapy for Breast Cancer. Front Oncol 2022; 12:816297. [PMID: 35669440 PMCID: PMC9163342 DOI: 10.3389/fonc.2022.816297] [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: 11/16/2021] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Neoadjuvant chemotherapy (NAC) is increasingly widely used in breast cancer treatment, and accurate evaluation of its response provides essential information for treatment and prognosis. Thus, the imaging tools used to quantify the disease response are critical in evaluating and managing patients treated with NAC. We discussed the recent progress, advantages, and disadvantages of common imaging methods in assessing the efficacy of NAC for breast cancer.
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Affiliation(s)
- Xianshu Kong
- Third Department of the Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Qian Zhang
- Third Department of the Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Xuemei Wu
- Third Department of the Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Tianning Zou
- Third Department of the Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Jiajun Duan
- Third Department of the Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Shujie Song
- Department of Pathology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Jianyun Nie
- Third Department of the Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Chu Tao
- Third Department of the Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Mi Tang
- Department of Pathology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Maohua Wang
- First Department of the Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Jieya Zou
- Third Department of the Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Yu Xie
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Zhenhui Li
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Zhen Li
- Third Department of the Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
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Murakami R, Tani H, Kumita S, Uchiyama N. Diagnostic performance of digital breast tomosynthesis for predicting response to neoadjuvant systemic therapy in breast cancer patients: A comparison with magnetic resonance imaging, ultrasound, and full-field digital mammography. Acta Radiol Open 2022; 10:20584601211063746. [PMID: 34992793 PMCID: PMC8725236 DOI: 10.1177/20584601211063746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background The goals of neoadjuvant systemic therapy (NST) are to reduce tumor volume
and to provide a prognostic indicator in assessing treatment response.
Digital breast tomosynthesis (DBT) was developed and has increased interest
in clinical settings due to its higher sensitivity for breast cancer
detection compared to full-field digital mammography (FFDM). Purpose To evaluate the accuracy of DBT in assessing response to NST compared to
FFDM, ultrasound (US), and magnetic resonance imaging (MRI) in breast cancer
patients. Material and Methods In this retrospective study, 95 stages II–III breast cancer patients
undergoing NST and subsequent surgeries were enrolled. After NST, the
longest diameter of residual tumor measured by DBT, FFDM, US, and MRI was
compared with pathology. Agreements and correlations of tumor size were
assessed, and the diagnostic performance for predicting pathologic complete
response (pCR) was evaluated. Results Mean residual tumor size after NST was 19.9 mm for DBT, 18.7 mm for FFDM,
16.0 mm for US, and 18.4 mm for MRI, compared with 17.9 mm on pathology. DBT
and MRI correlated better with pathology than that of FFDM and US. The ICC
values were 0.85, 0.87, 0.74, and 0.77, respectively. Twenty-five patients
(26.3%) achieved pCR after NST. For predicting pCR, area under the receiver
operating characteristic (ROC) curve for DBT, FFDM, US, and MRI were 0.79,
0.66, 0.68, and 0.77, respectively. Conclusion DBT has good correlation with histopathology for measuring residual tumor
size after NST. DBT was comparable to MRI in assessing tumor response after
completion of NST.
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Affiliation(s)
- Ryusuke Murakami
- Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan
| | - Hitomi Tani
- Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan
| | - Shinichiro Kumita
- Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan
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Palshof FK, Lanng C, Kroman N, Benian C, Vejborg I, Bak A, Talman ML, Balslev E, Tvedskov TF. Prediction of Pathologic Complete Response in Breast Cancer Patients Comparing Magnetic Resonance Imaging with Ultrasound in Neoadjuvant Setting. Ann Surg Oncol 2021; 28:7421-7429. [PMID: 34043094 DOI: 10.1245/s10434-021-10117-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/19/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Some subgroups of breast cancer patients receiving neoadjuvant chemotherapy (NACT) show high rates of pathologic complete response (pCR) in the breast, proposing the possibility of omitting surgery. Prediction of pCR is dependent on accurate imaging methods. This study investigated whether magnetic resonance imaging (MRI) is better than ultrasound (US) in predicting pCR in breast cancer patients receiving NACT. METHODS This institutional, retrospective study enrolled breast cancer patients receiving NACT who were examined by either MRI or combined US and mammography before surgery from 2016 to 2019. Imaging findings were compared with pathologic response evaluation of the tumor. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for prediction of pCR were calculated and compared between MRI and US. RESULTS Among 307 patients, 151 were examined by MRI and 156 by US. In the MRI group, 37 patients (24.5 %) had a pCR compared with 51 patients (32.7 %) in the US group. Radiologic complete response (rCR) was found in 35 patients (23.2 %) in the MRI group and 26 patients (16.7 %) in the US group. In the MRI and US groups, estimates were calculated respectively for sensitivity (87.7 % vs 91.4 %), specificity (56.8 % vs 33.3 %), PPV (86.2 % vs 73.8 %), NPV (60.0 % vs 65.4 %), and accuracy (80.1 % vs 72.4 %). CONCLUSIONS In predicting pCR, MRI was more specific than US, but not sufficiently specific enough to be a valid predictor of pCR for omission of surgery. As an imaging method, MRI should be preferred when future studies investigating prediction of pCR in NACT patients are planned.
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Affiliation(s)
| | - Charlotte Lanng
- Department of Breast Surgery, Rigshospitalet/Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Kroman
- Department of Breast Surgery, Rigshospitalet/Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Cemil Benian
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ilse Vejborg
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Bak
- Department of Radiology, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Maj-Lis Talman
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eva Balslev
- Department of Pathology, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Tove Filtenborg Tvedskov
- Department of Breast Surgery, Rigshospitalet/Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
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5
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Reig B, Lewin AA, Du L, Heacock L, Toth HK, Heller SL, Gao Y, Moy L. Breast MRI for Evaluation of Response to Neoadjuvant Therapy. Radiographics 2021; 41:665-679. [PMID: 33939542 DOI: 10.1148/rg.2021200134] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Neoadjuvant therapy is increasingly being used to treat early-stage triple-negative and human epidermal growth factor 2-overexpressing breast cancers, as well as locally advanced and inflammatory breast cancers. The rationales for neoadjuvant therapy are to shrink tumor size and potentially decrease the extent of surgery, to serve as an in vivo test of response to therapy, and to reveal prognostic information for the patient. MRI is the most accurate modality to demonstrate response to therapy and to help ensure accurate presurgical planning. Changes in lesion diameter, volume, and enhancement are used to predict complete response, partial response, or nonresponse to therapy. However, residual disease may be overestimated or underestimated at MRI. Fibrosis, necrotic tumors, and residual benign masses may be causes of overestimation of residual disease. Nonmass lesions, invasive lobular carcinoma, hormone receptor-positive tumors, nonconcentric shrinkage patterns, the use of antiangiogenic therapy, and late-enhancing foci may be causes of underestimation of residual disease. In patients with known axillary lymph node metastasis, neoadjuvant therapy may be followed by targeted axillary dissection to avoid the potential morbidity associated with an axillary lymph node dissection. Diffusion-weighted imaging, radiomics, machine learning, and deep learning methods are under investigation to improve MRI accuracy in predicting treatment response.©RSNA, 2021.
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Affiliation(s)
- Beatriu Reig
- From the Department of Radiology (B.R., A.A.L., L.H., H.K.T., S.L.H., Y.G., L.M.), Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology (L.M.), and Center for Advanced Imaging Innovation and Research (CAI2R) (L.M.), New York University Grossman School of Medicine, 160 E 34th St, New York, NY 10016; and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (L.D.)
| | - Alana A Lewin
- From the Department of Radiology (B.R., A.A.L., L.H., H.K.T., S.L.H., Y.G., L.M.), Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology (L.M.), and Center for Advanced Imaging Innovation and Research (CAI2R) (L.M.), New York University Grossman School of Medicine, 160 E 34th St, New York, NY 10016; and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (L.D.)
| | - Linda Du
- From the Department of Radiology (B.R., A.A.L., L.H., H.K.T., S.L.H., Y.G., L.M.), Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology (L.M.), and Center for Advanced Imaging Innovation and Research (CAI2R) (L.M.), New York University Grossman School of Medicine, 160 E 34th St, New York, NY 10016; and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (L.D.)
| | - Laura Heacock
- From the Department of Radiology (B.R., A.A.L., L.H., H.K.T., S.L.H., Y.G., L.M.), Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology (L.M.), and Center for Advanced Imaging Innovation and Research (CAI2R) (L.M.), New York University Grossman School of Medicine, 160 E 34th St, New York, NY 10016; and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (L.D.)
| | - Hildegard K Toth
- From the Department of Radiology (B.R., A.A.L., L.H., H.K.T., S.L.H., Y.G., L.M.), Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology (L.M.), and Center for Advanced Imaging Innovation and Research (CAI2R) (L.M.), New York University Grossman School of Medicine, 160 E 34th St, New York, NY 10016; and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (L.D.)
| | - Samantha L Heller
- From the Department of Radiology (B.R., A.A.L., L.H., H.K.T., S.L.H., Y.G., L.M.), Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology (L.M.), and Center for Advanced Imaging Innovation and Research (CAI2R) (L.M.), New York University Grossman School of Medicine, 160 E 34th St, New York, NY 10016; and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (L.D.)
| | - Yiming Gao
- From the Department of Radiology (B.R., A.A.L., L.H., H.K.T., S.L.H., Y.G., L.M.), Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology (L.M.), and Center for Advanced Imaging Innovation and Research (CAI2R) (L.M.), New York University Grossman School of Medicine, 160 E 34th St, New York, NY 10016; and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (L.D.)
| | - Linda Moy
- From the Department of Radiology (B.R., A.A.L., L.H., H.K.T., S.L.H., Y.G., L.M.), Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology (L.M.), and Center for Advanced Imaging Innovation and Research (CAI2R) (L.M.), New York University Grossman School of Medicine, 160 E 34th St, New York, NY 10016; and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (L.D.)
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6
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Reig B, Heacock L, Lewin A, Cho N, Moy L. Role of MRI to Assess Response to Neoadjuvant Therapy for Breast Cancer. J Magn Reson Imaging 2020; 52. [DOI: 10.1002/jmri.27145] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Beatriu Reig
- Department of Radiology New York University Grossman School of Medicine New York New York USA
- New York University Laura and Isaac Perlmutter Cancer Center New York New York USA
| | - Laura Heacock
- Department of Radiology New York University Grossman School of Medicine New York New York USA
- New York University Laura and Isaac Perlmutter Cancer Center New York New York USA
| | - Alana Lewin
- Department of Radiology New York University Grossman School of Medicine New York New York USA
- New York University Laura and Isaac Perlmutter Cancer Center New York New York USA
| | - Nariya Cho
- Department of Radiology Seoul National University Hospital Seoul Republic of Korea
- Department of Radiology Seoul National University College of Medicine Seoul Republic of Korea
| | - Linda Moy
- Department of Radiology New York University Grossman School of Medicine New York New York USA
- New York University Laura and Isaac Perlmutter Cancer Center New York New York USA
- Bernard and Irene Schwartz Center for Biomedical Imaging Department of Radiology, New York University Grossman School of Medicine New York New York USA
- Center for Advanced Imaging Innovation and Research (CAI2 R) New York University Grossman School of Medicine New York New York USA
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