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

Iotti, Valentina; Ragazzi, Moira; Besutti, Giulia; Marchesi, Vanessa; Ravaioli, Sara; Falco, Giuseppe; Coiro, Saverio; Bisagni, Alessandra; Gasparini, Elisa; Rossi, Paolo Giorgi; Vacondio, Rita; Pattacini, Pierpaolo

doi:10.3390/diagnostics11030435

Cited by 9 publications

(8 citation statements)

References 32 publications

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“…However, the most accurate measurements possible should be made to avoid underestimating the size of the tumor and increasing the extent of the operation. The advantage of CESM over other methods so far available is its precise definition of the tumor before NAC thanks to the directly integrated visualization of suspicious calcifications in the low-energy images and enhancement in the recombined images, which is not possible with MRI [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

Contrast-Enhanced Spectral Mammography Assessment of Patients Treated with Neoadjuvant Chemotherapy for Breast Cancer

et al. 2021

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Background: Evaluating the tumor response to neoadjuvant chemotherapy is key to planning further therapy of breast cancer. Our study aimed to evaluate the effectiveness of low-energy and subtraction contrast-enhanced spectral mammography (CESM) images in the detection of complete response (CR) for neoadjuvant chemotherapy (NAC) in breast cancer. Methods: A total of 63 female patients were qualified for our retrospective analysis. Low-energy and subtraction CESM images just before the beginning of NAC and as a follow-up examination 2 weeks before the end of chemotherapy were compared with one another and assessed for compliance with the postoperative histopathological examination (HP). The response to preoperative chemotherapy was evaluated based on the RECIST 1.1 criteria (Response Evaluation Criteria in Solid Tumors). Results: Low-energy images tend to overestimate residual lesions (6.28 mm) and subtraction images tend to underestimate them (2.75 mm). The sensitivity of low-energy images in forecasting CR amounted to 33.33%, while the specificity was 92.86%. In the case of subtraction CESM, the sensitivity amounted to 85.71% and the specificity to 71.42%. Conclusions: CESM is characterized by high sensitivity in the assessment of CR after NAC. The use of only morphological assessment is insufficient. CESM correlates well with the size of residual lesions on histopathological examination but tends to underestimate the dimensions.

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Section: Discussionmentioning

confidence: 99%

Contrast-Enhanced Spectral Mammography Assessment of Patients Treated with Neoadjuvant Chemotherapy for Breast Cancer

et al. 2021

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“…The current study found that the presence of calcification was significantly associated with discordance between CBBCT and pathology, and that the CBBCT-pathology discrepancy of lesions with calcifications was significantly smaller than the MRI-pathology discrepancy. Breast cancers that show extensive segmental distribution of calcifications on mammography are usually seen as NME on DCE-MRI ( 40 ). In these lesions, although CE-CBBCT can show both calcification and enhancement features, the boundaries of the calcification area are difficult to determine when the lesion is large ( 41 , 42 ).…”

Section: Discussionmentioning

confidence: 99%

Accuracy of cone-beam breast computed tomography for assessing breast cancer tumor size—comparison with breast magnetic resonance imaging

Zhao,

Song,

et al. 2024

Gland Surg

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Background Accurate preoperative assessment of tumor size is important in developing a surgical plan for breast cancer. The purpose of this study was to evaluate the accuracy of cone-beam breast computed tomography (CBBCT) and magnetic resonance imaging (MRI) in the assessment of tumor size and to analyze the factors influencing the discordance. Methods In this retrospective study, patients with breast cancer who underwent preoperative contrast-enhanced CBBCT (CE-CBBCT) and dynamic contrast-enhanced MRI (DCE-MRI) and received a complete pathologic diagnosis from August 2020 to December 2021 were included, using the pathological result as the gold standard. Two radiologists assessed the CBBCT and MRI features and measured the tumor size with a 2-week washout period. Intraclass correlation coefficient (ICC) and Bland-Altman analyses were used to assess inter-observer reproducibility and agreement based on CBBCT, MRI and pathology. Univariate analyses of differences in clinical, pathological and CBBCT/MRI features between the concordant and discordant groups was performed using the t -test, Mann-Whitney U -test, Chi-squared test and Fisher’s exact test. Multivariate analyses were used to identify factors associated with discordance of CBBCT/MRI with pathology. Results A total of 115 female breast cancer patients (115 lesions) were included. All patients had a single malignant tumor of the unilateral breast. The reproducibility and the agreement ranged from moderate to excellent (ICC =0.607–0.983). Receiver operating characteristic (ROC) analyses showed that the cut-off values of CBBCT-pathology and MRI-pathology discordance were 2.25 and 2.65 cm, respectively. CBBCT/MRI-pathology concordance was significantly associated with the extent of pathology, lesion type, presence of calcification, human epidermal growth factor receptor 2 (HER2) status and fatty infiltration (P<0.05). In lesions containing calcification, the difference of CBBCT-pathology was significantly smaller than MRI-pathology (P=0.021). Non-mass enhancement (NME) was the main predictor of CBBCT- or MRI-pathology discordance [odds ratio (OR) =3.293–6.469, P<0.05], and HER2 positivity was a predictor of CBBCT-pathology discordance (OR =3.514, P=0.019). Conclusions CBBCT and MRI have comparable accuracy in measurement of tumor size, and CBBCT is advantageous in assessing the size of calcified lesions. NME and HER2 positivity are significant predictors of CBBCT-pathology discordance. This suggests that CBBCT might serve as an alternative imaging technique to assess tumor size when patients do not tolerate MRI.

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“…Our findings are consistent with those of Iotti et al who report that the addition of a measurement of microcalcification to the diameter of residual enhancement increases sensitivity for detection and accurate measurement of residual disease, though it reduces specificity. 20 Furthermore, it is accepted that the presence of residual mammographic microcalcifications is not consistently related to residual disease, and that even with loss of MRI enhancement it is not possible to predict absence of residual disease with sufficient accuracy to avoid complete excision of tumour bed calcifications. [21][22][23] We suggest that this finding is also true for persistent microcalcifications in the absence of CESM enhancement.…”

Section: Discussionmentioning

confidence: 99%

Predicting the response to Neoadjuvant Chemotherapy. Can the addition of tomosynthesis improve the accuracy of CESM? A comparison with breast MRI

Savaridas

Vinnicombe

Warwick

et al. 2022

Preprint

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BackgroundNeoadjuvant chemotherapy (NACT) is used to downstage breast cancer prior to surgery. Image monitoring is essential to guide treatment and to assess in vivo chemosensitivity. Breast MRI is considered the gold-standard imaging technique; however, it is contraindicated or poorly tolerated in some patients and may be hard to access. Evidence suggests contrast enhanced spectral mammography (CESM) may approach the accuracy of MRI. This novel pilot study investigates whether the addition of digital breast tomosynthesis (DBT) to CESM increases the accuracy of response prediction.ResultsSixteen cancers in fourteen patients were imaged with CESM+DBT and MRI following completion of NACT. Ten cancers demonstrated pathological complete response (pCR) defined as absence of residual invasive disease. Greatest accuracy for predicting pCR was with CESM contrast-enhancement only (accuracy 81.3%, sensitivity 100%, specificity 57.1%), followed by MRI (accuracy 62.5%, sensitivity 44.4%, specificity 85.7%). Concordance with invasive tumour size was greater for CESM than MRI, concordance-coefficients 0.70 vs 0.66 respectively. MRI demonstrated greatest concordance with whole tumour size followed by CESM contrast-enhancement plus microcalcification, concordance-coefficients 0.86 vs 0.69. The addition of DBT did not improve accuracy for prediction of pCR or residual disease size. Whereas CESM+DBT tended to underestimate size of residual disease, MRI tended to overestimate but no significant differences were seen (p>0.05).ConclusionsCESM contrast-enhancement plus microcalcification is similar to MRI for predicting residual disease post-NACT. Size of enhancement alone demonstrates best concordance with invasive disease. Inclusion of residual microcalcification improves concordance with DCIS. The addition of DBT to CESM does not improve accuracy.HighlightsNo benefit of adding DBT to CESM for NACT response predictionCESM appears similar to MRI for predicting response to NACTCESM has greatest accuracy for residual invasive tumour size.CESM+calcification has greater accuracy for predicting residual in situ disease.

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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

Cited by 9 publications

References 32 publications

Contrast-Enhanced Spectral Mammography Assessment of Patients Treated with Neoadjuvant Chemotherapy for Breast Cancer

Contrast-Enhanced Spectral Mammography Assessment of Patients Treated with Neoadjuvant Chemotherapy for Breast Cancer

Accuracy of cone-beam breast computed tomography for assessing breast cancer tumor size—comparison with breast magnetic resonance imaging

Predicting the response to Neoadjuvant Chemotherapy. Can the addition of tomosynthesis improve the accuracy of CESM? A comparison with breast MRI

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