Can a pathological complete response of breast cancer after neoadjuvant chemotherapy be diagnosed by minimal invasive biopsy?

Heil, Joerg; Schaefgen, Benedikt; Sinn, Hans‐Peter; Richter, Hannah; Harcos, Aba; Gomez, Christina; Stieber, Anne; Hennigs, André; Rauch, Geraldine; Schuetz, Florian; Sohn, Christof; Schneeweiß, Andreas; Golatta, Michael

doi:10.1016/j.ejca.2016.09.034

Cited by 61 publications

(61 citation statements)

References 27 publications

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“…MRI depicts the primary cancer in the breast in up to 60% of cases and allows planning of appropriate treatment. Importantly, when the MRI findings are that pCR is achieved (150,151). MRI has consistently shown high sensitivities (accurate identification of residual cancer) of 83%-92% and intermediate specificities (accurate identification of pCR) of 47%-63% in the prediction of pCR (131,132).…”

Section: Evaluation Of Women Treated With Neoadjuvant Chemotherapymentioning

confidence: 99%

Breast MRI: State of the Art

Mann¹,

Cho²,

Moy³

2019

Radiology

485

325

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reast MRI is an indispensable modality, along with mammography and US. Its main indications are staging of known cancer, screening for breast cancer in women at increased risk, and evaluation of response to neoadjuvant chemotherapy (1-3). As opposed to mammography and US, MRI is a functional technique. Heywang et al (4) and Kaiser and Zeitler (5) independently introduced this technique in the 1980s. Contrast material-enhanced MRI evaluates the permeability of blood vessels by using an intravenous contrast agent (gadolinium chelate) that shortens the local T1 time, leading to a higher signal on T1-weighted images (6). The underlying principle is that neoangiogenesis leads to formation of leaky vessels that allow for faster extravasation of contrast agents (7), thus leading to rapid local enhancement. Despite improvements in the technique of breast MRI, this principle is still the basis of all clinical MRI protocols. However, most MRI protocols nowadays are multiparametric (8,9). This review describes the current state of the art in breast MRI, with a focus on the major indications and the potential indication-based adaptations to the imaging protocol to maximize its value. Requirements for Breast MRI Breast MRI studies should be interpreted by radiologists with expertise in breast imaging, including mammographic and US studies, as these examinations are often complementary. Although empirical data on the learning curve for breast MRI are lacking, some studies showed improved performance of radiologists over time (10), and reporting breast MRI studies requires sufficient exposure to the technique. It is best practice to use a field strength of at least 1.5 T to acquire images at a sufficiently high spatial resolution (1-3). Utilization of a dedicated breast coil is mandatory to obtain images of diagnostic quality. Women lie in the prone position with the breasts hanging free in the recesses of the coil. This design allows the breast tissue to spread, which facilitates detection of abnormalities and prevents motion artifacts induced by respiration (11,12). A breast coil should have at least four channels, but modern designs

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Section: Evaluation Of Women Treated With Neoadjuvant Chemotherapymentioning

confidence: 99%

Breast MRI: State of the Art

Mann¹,

Cho²,

Moy³

2019

Radiology

485

325

View full text Add to dashboard Cite

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“…Kuerer and colleagues have recently shown that it is possible to identify patients with a pCR in whom significant residual disease is unlikely by using improved imaging techniques, such as extensive image‐guided vacuum‐assisted core biopsy and fine‐needle aspiration biopsy of the tumour bed. Similar prospective studies are being initiated internationally. If the concept of omission of surgery in the exceptional NACT responders moves forward into clinical practice, these patients will still receive whole‐breast radiotherapy.…”

Section: Introductionmentioning

confidence: 94%

Baseline factors predicting a response to neoadjuvant chemotherapy with implications for non-surgical management of triple-negative breast cancer

Parra

Tadros

Checka

et al. 2018

British Journal of Surgery

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“…But the accordance between total clinical and radiological response and established fact of pCR in the microscopic examination of removal breast tissue according to biological subtype are not enough studied. [14][15][16][17][18] In our retrospective analysis we found that the rate of tumor response after preoperative chemotherapy in Russian depended not only on the biological subtype, but also on the method of assessing the response (clinical examination, mammography, ultrasound or pathological evaluation).…”

Section: Discussionmentioning

confidence: 84%