The purpose of this study was to evaluate the capacity of diffusion-weighted magnetic resonance imaging (DW-MRI) for early prediction of pathological response in breast cancer patients undergoing neoadjuvant chemotherapy (NCT). This prospective unicentric study evaluated 62 patients who underwent NCT. MRI was performed prior to the start of treatment (MR1), after the first NCT cycle (MR2), and upon completion of NCT (MR3). Pathological response was used as the gold-standard. Patients’ median age was 45.5 years and the median tumor size was 40 mm. Twenty-four (38.7%) tumors presented complete pathological response (pCR). The percent increase in apparent diffusion coefficient (ADC) value between MR1 and MR2 was higher in the pCR group (p < 0.001). When the minimum increase in ADC between MR1 and MR2 was set at 25%, sensitivity was 83%, specificity was 84%, positive predictive value was 77%, negative predictive value was 89%, and accuracy was 84% for an early prediction of pCR to NCT. Meanwhile, there were no significant changes in major tumor dimensions between MR1 and MR2. In conclusion, an increase in ADC after the first cycle of NCT correlates well with pCR after the chemotherapy in our cohort, precedes reduction in tumor size on conventional MRI, and may therefore be used as an early predictor of treatment response.

ObjectiveTo assess the role of magnetic resonance imaging (MRI) in the planning of breast cancer treatment strategies.Materials and MethodsThe study included 160 women diagnosed with breast cancer, who underwent breast MRI for preoperative staging. Using Pearson's correlation coefficient (r), we compared the size of the primary tumor, as determined by MRI, by conventional imaging (mammography and ultrasound), and in the pathological examination (gold standard). The identification of lesions not identified in previous examinations was also evaluated, as was its influence on treatment planning.ResultsThe mean age of the patients was 52.2 years (range, 30–81 years), and the most common histological type was invasive ductal carcinoma (in 60.6% of the patients). In terms of the tumor size determined, MRI correlated better with the pathological examination than did mammography (r = 0.872 vs. 0.710) or ultrasound (r = 0.836 vs. 0.704). MRI identified additional lesions in 53 patients (33.1%), including malignant lesions in 20 (12.5%), which led to change in the therapeutic planning in 23 patients (14.4%).ConclusionBreast MRI proved to be more accurate than conventional imaging in determining the dimensions of the main tumor and was able to identify lesions not identified by other methods evaluated, which altered the therapeutic planning in a significant proportion of cases.

SUMMARY:The concern over medicolegal liability is pervasive among physicians. We sought, through an email survey to the members of the ASNR, to assess the experience with and attitudes about the medicolegal environment among neuroradiologists. Of 4357 physicians surveyed, 904 answered at least 1 of the questions in the survey; 449 of 904 (49.7%) had been sued: 180 (44.9%) had been sued once, 114 (28.4%) twice, 60 (15.0%) 3 times, and 47 (11.7%) more than 3 times. The payouts for suits were most commonly in the $50,000 to $150,000 range, except for interventional neuroradiologists, in whom the most common value was $600,000 to $1,200,000. Only 9 of 481 (1.9%) of suits returned a plaintiff verdict. Despite reported outcomes that favored physicians with respect to cases being dropped (270/481 ϭ 56.1%), settled without a payment (11/481 ϭ 2.3%), or a defense verdict (46/481 ϭ 9.6), most respondents (81.1%, 647/798) believed that the medicolegal system was weighted toward plaintiffs. More than half of the neuroradiologists (55.2%, 435/787) reported being mildly to moderately concerned, and 19.1% (150/787) were very or extremely concerned about being sued. ABBREVIATIONS: ASNR

The real benefit of MRI for treatment planning in patients with breast cancer may be different according to the histological type and molecular subtype.

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