Accuracy of contrast-enhanced spectral mammography for estimating residual tumor size after neoadjuvant chemotherapy in patients with breast cancer: a feasibility study

Abstract

ObjectiveTo assess the feasibility of contrast-enhanced spectral mammography (CESM) of the breast for assessing the size of residual tumors after neoadjuvant chemotherapy (NAC).Materials and methodsIn breast cancer patients who underwent NAC between 2011 and 2013, we evaluated residual tumor measurements obtained with CESM and full-field digital mammography (FFDM). We determined the concordance between the methods, as well as their level of agreement with the pathology. Three radiologists analyzed eight CESM and FFDM measurements separately, considering the size of the residual tumor at its largest diameter and correlating it with that determined in the pathological analysis. Interobserver agreement was also evaluated.ResultsThe sensitivity, specificity, positive predictive value, and negative predictive value were higher for CESM than for FFDM (83.33%, 100%, 100%, and 66% vs. 50%, 50%, 50%, and 25%, respectively). The CESM measurements showed a strong, consistent correlation with the pathological findings (correlation coefficient = 0.76-0.92; intraclass correlation coefficient = 0.692-0.886). The correlation between the FFDM measurements and the pathological findings was not statistically significant, with questionable consistency (intraclass correlation coefficient = 0.488-0.598). Agreement with the pathological findings was narrower for CESM measurements than for FFDM measurements. Interobserver agreement was higher for CESM than for FFDM (0.94 vs. 0.88).ConclusionCESM is a feasible means of evaluating residual tumor size after NAC, showing a good correlation and good agreement with pathological findings. For CESM measurements, the interobserver agreement was excellent.

Quantitative mathematical objective evaluation of contrast-enhanced spectral mammogram in the assessment of response to neoadjuvant chemotherapy and prediction of residual disease in breast cancer

“…They even found that CESM can better predict complete pathological response better than MRI (Lin's coefficient: 0.81 for CESM and 0.59 for MRI). In another study, performed by Barra et al, they also proved that CESM measurements showed a strong, steady correlation with the pathology residual tumor size (R: 0.76), a value which is slightly higher than that scored by the RECIST 1.1 criteria in the current study [28] (Fig. 7).…”

“…Previous studies reported nearly similar indices, although they were mainly based on residual tumor size assessment. Barra et al [28] reported no false positive cases and the calculated sensitivity, specificity, PPV, and NPV was 83.33%, 100%, 100%, and 66% respectively. On the other hand, Iotti et al [2] reported no false negative cases with a calculated sensitivity and specificity of 100% and 84%, respectively.…”

Integrating bilingual musculoskeletal imaging education into radiology and diagnostic imaging residency programs

“…English proficiency is crucial for the professional growth of physicians, since it allows adequate access to updated medical information ( 4 , 5 ) , as well as participation in international conferences and meetings. In this context, the main radiology journal in Brazil accepts and had published articles in English ( 6 - 12 ) . Given the lack of studies on bilingual education in radiology, especially musculoskeletal imaging, we were motivated to analyze the integration method of English into radiology instruction.…”

Accuracy and Reproducibility of Contrast-Enhanced Mammography in the Assessment of Response to Neoadjuvant Chemotherapy in Breast Cancer Patients with Calcifications in the Tumor Bed

“…In the detection of residual disease after NAC, a meta-analysis reported a pooled sensitivity with CEM of 80.7% (95% CI 65.5–90.2%) and a pooled specificity of 94.0% (95% CI = 78.3–98.6%) [ 18 ]. The literature investigating the role of CEM in the assessment of residual breast cancer following NAC continues to increase [ 19 , 20 , 21 , 22 , 23 ]; to the best of our knowledge, this is the first study that aims to evaluate the specific contribution of calcifications in this context. The implications of residual calcifications after NAC are still debated; since some calcifications may represent treated cancer with calcified or necrotic tissue and sloughed cells, their persistence in the tumor bed evaluated exclusively with mammography has not correlated with residual neoplasia [ 24 , 25 , 26 , 27 , 28 , 29 , 30 ].…”