Accuracy of MRI in the Detection of Residual Breast Cancer After Neoadjuvant Chemotherapy

Rosen, Eric L.; Blackwell, Kimberly; Baker, Jay A.; Soo, Mary Scott; Bentley, Rex C.; Yu, Daohai; Samulski, Thaddeus V.; Dewhirst, Mark W.

doi:10.2214/ajr.181.5.1811275

Cited by 260 publications

(149 citation statements)

References 26 publications

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“…The MRI correlation with histopathological size (r ¼ 0.71) is similar to that found previously with correlations of r ¼ 0.75 (Rosen et al, 2003) and 0.72 (Martincich et al, 2004) reported. Other groups have reported correlations of r ¼ 0.6 (Partridge et al, 2002) and r ¼ 0.982 (Cheung et al, 2003).…”

Section: Discussionsupporting

confidence: 89%

“…Several studies have suggested that MRI is a more accurate method of delineating residual tumour following neoadjuvant chemotherapy than clinical, ultrasound or mammographic assessment (Boetes et al, 1995;Abraham et al, 1996;Drew et al, 1999Drew et al, , 2001Fischer et al, 1999;Balu-Maestro et al, 2002;Rieber et al, 2002;Cheung et al, 2003;Rosen et al, 2003;Martincich et al, 2004;Warren et al, 2004). Chemotherapy-induced fibrosis has been shown to impair the evaluation of tumour by conventional radiological methods and physical examination (Cocconi et al, 1984;Segel et al, 1988).…”

Section: Discussionmentioning

confidence: 99%

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Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer

et al. 2008

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Contrast-enhanced magnetic resonance imaging (MRI) was used to monitor the response of patients undergoing neoadjuvant chemotherapy for breast cancer with the aim of undergoing breast-conserving surgery (BCS). Patients were prospectively recruited to undergo MRI as well as conventional methods of clinical examination, mammography (MM) and ultrasonography (USS) and response was assessed by each of these methods. Thirty-two patients with primary breast cancer were recruited. Magnetic resonance imaging correlation with histopathological size (r ¼ 0.71) was superior to USS (r ¼ 0.65) and to MM where tumour size was not measurable following chemotherapy in 71% of patients. Magnetic resonance imaging had 87.5% sensitivity (95% CI ¼ 68 -97%) and 50% specificity (95% CI ¼ 16 -84%) for a PPV (positive predictive value) of 99.8% and NPV (negative predictive value) of 80% for the detection of residual invasive cancer. Magnetic resonance imaging displayed 80% sensitivity (95% CI ¼ 28.4 -99.5%) and 89% specificity (95% CI ¼ 71 -98%) to detect pathological pCR in the breast. Eighty-four per cent of recruited patients were identified as potentially suitable candidates for BCS following chemotherapy and of those choosing to accept BCS, breast conservation was achieved in 90.5%, or 65.6% of all patients. Of those who proceeded to BCS, 9.5% required a re-do mastectomy because of positive margins; however, no residual tumour was found on histological examination of mastectomy specimens. Magnetic resonance imaging appears to be superior to conventional methods for assessing pathological response and the low rate of re-operation for positive margins indicates a valuable role in aiding the decision to undergo BCS or mastectomy.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer

et al. 2008

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“…This is in contrast to previous reports, which found correlation coefficients ranging from 0.70 to 0.98 for MRI (Esserman et al, 1999;Partridge et al, 2002;Rosen et al, 2003;Wasser et al, 2003;Martincich et al, 2004). However, a recent retrospective review of neoadjuvant chemotherapy trials from the MD Anderson Cancer Center also found a poor agreement between tumour size measurements by mammography or ultrasound and histopathology (Chagpar et al, 2006).…”

Section: Discussionmentioning

confidence: 61%

Assessment of residual tumour by FDG-PET: conventional imaging and clinical examination following primary chemotherapy of large and locally advanced breast cancer

et al. 2009

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BACKGROUND: The aim of this was to evaluate FDG-PET (2-(fluorine-18)-fluoro-2-deoxy-D-glucose positron emission tomography) for assessment of residual tumour after primary chemotherapy of large and locally advanced breast cancer in comparison with conventional imaging modalities. METHODS: In a prospective multicentre trial, 99 patients underwent one or more breast imaging modalities before surgery in addition to clinical examination, namely, FDG-PET (n ¼ 89), mammography (n ¼ 47), ultrasound (n ¼ 46), and magnetic resonance imaging (MRI) (n ¼ 46). The presence of residual tumour by conventional imaging, dichotomised as positive or negative, and the level of FDG uptake (standardised uptake values, SUV) were compared with histopathology, which served as the reference standard. Patients with no residual tumour or only small microscopic foci of residual tumour were classified as having minimal residual disease and those with extensive microscopic and macroscopic residual tumour tissue were classified as having gross residual disease. RESULTS: By applying a threshold SUV of 2.0, the sensitivity of FDG-PET for residual tumour was 32.9% (specificity, 87.5%) and increased to 57.5% (specificity, 62.5%) at a threshold SUV of 1.5. Conventional imaging modalities were more sensitive in identifying residual tumour, but had a low corresponding specificity; sensitivity and specificity were as follows: MRI 97.6 and 40.0%, mammography 92.5 and 57.1%, ultrasound 92.0 and 37.5%, respectively. Breast MRI provided the highest accuracy (91.3%), whereas FDG-PET had the lowest accuracy (42.7%). CONCLUSIONS: FDG-PET does not provide an accurate assessment of residual tumour after primary chemotherapy of breast cancer. Magnetic resonance imaging offers the highest sensitivity, but all imaging modalities have distinct limitations in the assessment of residual tumour tissue when compared with histopathology.

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“…Among the various tools for monitoring the response to NAC for breast cancer, contrast-enhanced magnetic resonance imaging (MRI) is considered to be superior to any other imaging modality due to its high spatial resolution (1)(2)(3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Diffusion-weighted magnetic resonance imaging for assessment after neoadjuvant chemotherapy in breast cancer, based on morphological concepts

Murata

Kubota²,

Hamada³

et al. 2010

Oncology Letters

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Abstract. The study aimed to evaluate the utility of diffusionweighted imaging (DWI) and to assess the response of breast cancer patients to neoadjuvant chemotherapy (NAC), based on morphological concepts. This retrospective study included 35 breast cancer patients (36 lesions) who had conventional magnetic resonance imaging (MRI), with DWI acquired before and after NAC. The morphological pattern of delayed enhancement on MRI before NAC was classified into two types: focal mass (FM), and multiple masses and/or non-mass like (MM/NM), based on Breast Imaging Reporting and Data System (BI-RADS). Of the 36 tumors, 26 were classified as FM and 10 as MM/NM. Tumors were clearly visualized on the initial DWI although one case of suspected MM/NM was not observed on DWI following NAC. A correlation was found between changes in the apparent diffusion coefficient and response rates to NAC in FM tumors (r=0.608, p<0.001), but not in MM/NM tumors (r=0.141, p=0.717). There was agreement between MRI findings after NAC and pathological findings in 30 of the 36 tumors (83.3%). Thus, we concluded that DWI is potentially useful in assessing the response to NAC for breast cancer for tumors diagnosed as FM on the initial conventional MRI.

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Accuracy of MRI in the Detection of Residual Breast Cancer After Neoadjuvant Chemotherapy

Abstract: MRI can show residual malignancy after neoadjuvant chemotherapy better than physical examination, particularly in patients who have not had a complete clinical response to therapy.

Cited by 260 publications

References 26 publications

Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer

Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer

Assessment of residual tumour by FDG-PET: conventional imaging and clinical examination following primary chemotherapy of large and locally advanced breast cancer

Diffusion-weighted magnetic resonance imaging for assessment after neoadjuvant chemotherapy in breast cancer, based on morphological concepts

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