Accuracy of clinical evaluation of locally advanced breast cancer in patients receiving neoadjuvant chemotherapy

Abstract

Physical examination (PE), mammography (MG), breast MRI, FDG-PET and pathologic evaluation are used to assess primary breast cancer. Their accuracy has not been well studied in patients receiving neoadjuvant chemotherapy. Accuracies of each modality in tumor and nodal assessment in patients with T3/4 tumors receiving neoadjuvant chemotherapy were compared. METHODS-45 patients of a prospective clinical trial studying T3-T4M0 tumors were included. Patients received neoadjuvant chemotherapy: docetaxel/carboplatin with or without trastuzumab before and/or after surgery (depending on HER-2/neu status and randomization). Tumor measurements by PE, MG, and MRI and nodal status by PE and PET were obtained before and after neoadjuvant chemotherapy. Concordance among different clinical measurements was assessed and compared with the tumor and nodal staging by pathology. Spearman corr (r) and root mean square error (RMSE) were used to measure the accuracy of measurements among all modalities and between modalities and pathological tumor size. RESULTS-Comparing to the tumor size measured by PE, MRI was more accurate than MG at baseline (r 0.559, RMSE 35.4% vs. r 0.046, RMSE 66.1%). After neoadjuvant chemotherapy, PE correlated better with pathology than MG or MRI (r 0.655, RMSE 88.6% vs. r 0.146, RMSE 147.1% and r 0.364, RMSE 92.6%). Axillary nodal assessment after neoadjuvant chemotherapy showed high specificity but low sensitivity by PET and PE. CONCLUSION-Findings suggested that MRI was a more accurate imaging study at baseline for T3/T4 tumor and PE correlated best with pathology finding. PET and PE both correctly predicted positive axillary nodes but not negative nodes.

Variation of Breast Vascular Maps on Dynamic Contrast-Enhanced MRI After Primary Chemotherapy of Locally Advanced Breast Cancer

“…of the extent of residual viable tumor [20][21][22][23]. In addition, preliminary results with bevacizumab in the neoadjuvant setting show that DCE-MRI is a suitable tool for evaluating renormalization of vasculature as a response to antiangiogenic therapy [24].…”

Trastuzumab‐based neoadjuvant therapy in patients with HER2‐positive breast cancer

“…Physical examination of the tumor remains the gold standard for assessing tumor size and the patient's suitability to receive neoadjuvant chemotherapy. 22 Survival-based endpoints are the most important endpoints when assessing the benefit of any therapy. However, accurately assessing the tumor response to neoadjuvant therapy also is critical.…”

“…Compared with pCR, assessment of cCR by clinical examination or mammography may overestimate the response to neoadjuvant therapy, with cCR rates usually higher than pCR rates (unpublished data). 22,23 Physical examination of the axillary lymph nodes is another useful technique that can be used for disease staging in patients who receive neoadjuvant therapy, although the use of positron-emission tomography (PET) for the assessment of metastases to the lymph nodes is increasing. A prospective clinical study of patients with T3 or T4M0 breast tumors (N ¼ 45) indicated that both physical examination and PET had high specificity but low sensitivity, correctly predicting pathologically positive lymph nodes, but not negative lymph nodes, after neoadjuvant therapy.…”

“…A prospective clinical study of patients with T3 or T4M0 breast tumors (N ¼ 45) indicated that both physical examination and PET had high specificity but low sensitivity, correctly predicting pathologically positive lymph nodes, but not negative lymph nodes, after neoadjuvant therapy. 22 Those results suggest that, although these techniques are useful, they should not replace pathologic staging.…”

Primary Study of Lymph Node Metastasis‐Related Serum Biomarkers in Breast Cancer

“…The accuracy of palpation diagnoses depend on the examiner's experience, the size and location of the affected lymph node, and other factors. Prati et al (2009) reported that the accuracy of lymph node metastasis diagnoses by clinical palpation was 65% (sensitivity 74%, specificity 56%). Chae et al (2009) reported lymph node metastasis diagnoses using imaging diagnostics with 77.8%, 76.9%, and 73.2% accuracy and 51.5%, 33.3%, and 48.5% sensitivity by ultrasound, breast X-ray mammography, and positron emission tomography/computed tomography, respectively.…”