BackgroundPatients with early breast cancer (EBC) achieving pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT) have a favorable prognosis. Breast surgery might be avoided in patients in whom the presence of residual tumor can be ruled out with high confidence. Here, we investigated the diagnostic accuracy of contrast-enhanced MRI (CE-MRI) in predicting pCR and long-term outcome after NACT.MethodsPatients with EBC, including patients with locally advanced disease, who had undergone CE-MRI after NACT, were retrospectively analyzed (n = 246). Three radiologists, blinded to clinicopathologic data, reevaluated all MRI scans regarding to the absence (radiologic complete remission; rCR) or presence (no-rCR) of residual contrast enhancement. Clinical and pathologic responses were compared categorically using Cohen’s kappa statistic. The Kaplan-Meier method was used to estimate recurrence-free survival (RFS) and overall survival (OS).ResultsOverall rCR and pCR (no invasive tumor in the breast and axilla (ypT0/is N0)) rates were 45% (111/246) and 29% (71/246), respectively. Only 48% (53/111; 95% CI 38–57%) of rCR corresponded to a pCR (= positive predictive value - PPV). Conversely, in 87% (117/135; 95% CI 79–92%) of patients, residual tumor observed on MRI was pathologically confirmed (= negative predictive value - NPV). Sensitivity to detect a pCR was 75% (53/71; 95% CI 63–84%), while specificity to detect residual tumor and accuracy were 67% (117/175; 95% CI 59–74%) and 69% (170/246; 95% CI 63–75%), respectively. The PPV was significantly lower in hormone-receptor (HR)-positive compared to HR-negative tumors (17/52 = 33% vs. 36/59 = 61%; P = 0.004). The concordance between rCR and pCR was low (Cohen’s kappa − 0.1), however in multivariate analysis both assessments were significantly associated with RFS (rCR P = 0.037; pCR P = 0.033) and OS (rCR P = 0.033; pCR P = 0.043).ConclusionPreoperative CE-MRI did not accurately predict pCR after NACT for EBC, especially not in HR-positive tumors. However, rCR was strongly associated with favorable RFS and OS.Electronic supplementary materialThe online version of this article (10.1186/s13058-018-1091-y) contains supplementary material, which is available to authorized users.
The aim of this publication is to give an answer to the question whether 2D, 3D and 4D sonography of the breast can be replaced by elastography or whether elastography is an adjunct tool to B-mode imaging. The Breast Imaging and Reporting Data System (BI-RADS) ultrasound (US) descriptors of a lesion besides vascularity are based on B-mode imaging. US elastography displays the mechanical tissue properties. This information can be obtained by freehand compression and decompression. Acoustic radiation force impulse imaging (ARFI) produces stress with lowfrequency push pulses. Manual compression by the transducer is not necessary. Shear wave elastography (SWE) is the combination of ARFI and the measurement of the consecutive shear wave propagations in the tissue. A quantification of the elasticity in kilopascal (kPa) is offered. Discussing B-mode imaging and elastography combined with the literature, elastography is seen as an addition to B-mode imaging with the potential to increase the specificity of the B-mode imaging-based BI-RADS assessment. In spite of additional elasticity information, the sensitivity remains high. A time-saving diagnostic algorithm for 2D, 3D US and elastography is described. In conclusion, it must be said that elasticity is not a stand-alone US modality able to replace 2D and 3D sonography.
Sonography can yield indirect visualization only of microcalcifications in the female breast. In order to obtain an image of the echo pattern of the grouped microcalcifications, it is essential that the device employed possesses suitable dynamic characteristics, and it is also necessary to employ the technique of additive tomography. The investigator must familiarize himself with the proper interpretation of reflex patterns. Microcalcifications cannot be detected via sonography with the same degree of accuracy as with the help of mammography. However, sonographic detection is easier if the microcalcifications are more closely grouped. Nevertheless, the authors were able to show in a small comparative series that grouped calcifications can be detected even without previous information of their presence.
VIII.8c Ovarialkarzinom -Radikaloperation 971Berficksichtigt wurden Patientinnen aller Stadien, bei denen keine gyn~&kologischen oder gr6geren chirurgischen abdominalen Voreingriffe erfolgt waren. Alle Patientinnen erhielten eine Hysterektomie, Adnexektomie beidseitig und Omentektomie. Pelvinund paraortal lymphonodektomiert wurden 55% der Patientinnen, ledighch pelvin 13%. Bei 32% wurde keine LNE durchgefithrt. Bei 25% der Patientinnen war im Rahmen der Debulking-Operation eine Darmresektion erforderlich.H~iufigste Komplikation war Blutverlust fiber 1000 ml bei 60% der Patientinnen und Hamweginfekte bei 48%. Eine Temperaturerh6hung fiber 38°C wurde bei 29% der Patientinnen beobachtet, bei t0% trat eine Subileus-Situation auf. Zwei Patientinhen mul3ten wegen eines Ileus relaparotomiert werden. Alle t~brigen Komplikationen, wie Wundheilungsst6rungen, Nachblutungen und Pneumonien waren seltener (< 10%). Ein perioperativer Todesfall trat nicht auf.Bei der statistischen Analyse konnten keine signifikanten Unterschiede in der H~iu-figkeit der Komplikationen gefunden werden, ob eine LNE durchgefiihrt worden war oder nicht. Im Gegenssatz dazu waren die Komplikationsraten yon der Ausdehnung der intraabdominellen Operation abh~ingig. So hatten Patientinnen mit Darmresektion signifikant h~iufiger einen Blutverlust fiber 1000 ml, als solche ohne Darmresektion (85% gegen 50%, p < 0,001) und zwar unabhSngig yon LNE, Tumorrest und Einteilung der Risiko-Gruppen. Fieber und Harnweginfekte traten ebenfalls h~ufiger auf. Allerdings waren diese Unterschiede bei den wenigen Paaren, die analysiert werden konnten, nicht signifikant. Korrespondierend zu diesem Ergebnis war der transfusionspflichtige Blutverlust mit und ohne LNE bei Patientinnen des Stadium I und IImit 40% signifikant geringer als bei solchen des Stadium III und IV mit/2% (p < 0,001). Auch hier waren Harnwegsinfekt und Fieber bei den Patientinnen in h6heren Tumorstadium h~iufiger.Die Komplikationsrate bei der Primer-Operation des Ovarialkarzinoms werden dutch das Ausmal3 des intraperitonealen Befalls und die damit verbundene Ausdehnung des Eingriffs bestimmt. Die zus~itzlich pelvine und paraortale LNE hat keine Erh6hung der Peri-und postoperafiven Komplikationen zur Folge. Dementsprechend sind erh6hte Komplikationsraten kein Argument, um auf die eigentlich notwendige pelvine und paraortale LNE zu verzichten.
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