Contrast-Enhanced Mammography Versus MRI in the Evaluation of Neoadjuvant Therapy Response in Patients With Breast Cancer: A Prospective Study

Bernardi, Daniela Miotto; Vatteroni, Giulia; Acquaviva, A; Valentini, Marvi; Sabatino, Vincenzo; Bolengo, I; Pellegrini, Marco; Fantò, Carmine; Trimboli, Rubina Manuela

doi:10.2214/ajr.22.27756

Cited by 14 publications

(3 citation statements)

References 45 publications

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“…The three CEM studies included showed the varying presentation of ypTis and discrepancy in comparison to MRI regarding enhancement [31,41,42]. The study by Iotti et al published in 2017 showed that MRI estimated the three patients with ypTis as complete response, while CEM showed residual enhancement in one [41].…”

Section: Post-nstmentioning

confidence: 99%

“…The study by Iotti et al published in 2017 showed that MRI estimated the three patients with ypTis as complete response, while CEM showed residual enhancement in one [41]. The study by Bernardi et al showed that CEM demonstrated enhancement in 7 of 12 patients with ypTis, compared to 8 patients with enhancement on MRI [31]. The other study by Iotti et al published in 2021 demonstrated that on CEM, 3 out of 5 patients with ypTis had no residual enhancement, but all patients had residual pleiomorphic calcifications [42].…”

Section: Post-nstmentioning

confidence: 99%

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Imaging findings for response evaluation of ductal carcinoma in situ in breast cancer patients treated with neoadjuvant systemic therapy: a systematic review and meta-analysis

et al. 2023

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Objectives In approximately 45% of invasive breast cancer (IBC) patients treated with neoadjuvant systemic therapy (NST), ductal carcinoma in situ (DCIS) is present. Recent studies suggest response of DCIS to NST. The aim of this systematic review and meta-analysis was to summarise and examine the current literature on imaging findings for different imaging modalities evaluating DCIS response to NST. More specifically, imaging findings of DCIS pre- and post-NST, and the effect of different pathological complete response (pCR) definitions, will be evaluated on mammography, breast MRI, and contrast-enhanced mammography (CEM). Methods PubMed and Embase databases were searched for studies investigating NST response of IBC, including information on DCIS. Imaging findings and response evaluation of DCIS were assessed for mammography, breast MRI, and CEM. A meta-analysis was conducted per imaging modality to calculate pooled sensitivity and specificity for detecting residual disease between pCR definition no residual invasive disease (ypT0/is) and no residual invasive or in situ disease (ypT0). Results Thirty-one studies were included. Calcifications on mammography are related to DCIS, but can persist despite complete response of DCIS. In 20 breast MRI studies, an average of 57% of residual DCIS showed enhancement. A meta-analysis of 17 breast MRI studies confirmed higher pooled sensitivity (0.86 versus 0.82) and lower pooled specificity (0.61 versus 0.68) for detection of residual disease when DCIS is considered pCR (ypT0/is). Three CEM studies suggest the potential benefit of simultaneous evaluation of calcifications and enhancement. Conclusions and Clinical Relevance Calcifications on mammography can remain despite complete response of DCIS, and residual DCIS does not always show enhancement on breast MRI and CEM. Moreover, pCR definition effects diagnostic performance of breast MRI. Given the lack of evidence on imaging findings of response of the DCIS component to NST, further research is demanded. Key Points • Ductal carcinoma in situ has shown to be responsive to neoadjuvant systemic therapy, but imaging studies mainly focus on response of the invasive tumour. • The 31 included studies demonstrate that after neoadjuvant systemic therapy, calcifications on mammography can remain despite complete response of DCIS and residual DCIS does not always show enhancement on MRI and contrast-enhanced mammography. • The definition of pCR has impact on the diagnostic performance of MRI in detecting residual disease,and when DCIS is considered pCR, pooled sensitivity was slightly higher and pooled specificity slightly lower.

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Section: Post-nstmentioning

confidence: 99%

Section: Post-nstmentioning

confidence: 99%

Imaging findings for response evaluation of ductal carcinoma in situ in breast cancer patients treated with neoadjuvant systemic therapy: a systematic review and meta-analysis

et al. 2023

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“…At present, breast cancer imaging modalities include; Full Field Digital Mammography (FFDM), Ultrasound (US), Magnetic Resonance Imaging (MRI), Digital Breast Tomosynthesis (DBT) and more recently Contrast Enhanced Mammography (CEM). CEM uses a contrast agent to detect abnormal growth in the breast tissue, in addition, it has also been utilised for measuring lesion size and monitoring response to neoadjuvant chemotherapy [4][5][6]. Numerous studies have assessed its diagnostic accuracy, however, few studies have assessed agreement among CEM readers.…”

Section: Introductionmentioning

confidence: 99%

Contrast enhanced mammography (CEM): is experience necessary? an inter and intra-reader agreement study for lesion classification and breast density

Altokhais,

Eiada,

Khoumayies

et al. 2024

Medical Imaging 2024: Image Perception, Observer Performance, and Technology Assessment

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Introduction:The aim of this study is to measure reader agreement for i) lesion classification and ii) breast density in Contrast Enhanced Mammography (CEM). Methods: Two experienced and two inexperienced CEM readers reported 60 examinations. Kappa was used to assess inter-reader agreement between experienced and inexperienced readers for lesion classification (benign/malignant) and breast density (dense/non-dense). Weighted kappa was used to assess agreement for BI-RADS categories (1-5) and BI-RADS density (A-D). Intraclass correlation coefficient (ICC) measured agreement for breast density using Visual Analog scale (VAS). Intra-reader agreement for one experienced and one inexperienced reader was measured after a three month interval. Results: Agreement between experienced readers was substantial (κ=0.66) for benign/malignant, and moderate (κ=0.57) for BI-RADS categories. Agreement for inexperienced readers was moderate for benign/malignant and BI-RADS categories (κ=0.52, κ=0.47 respectively). Breast density (dense/non-dense) agreement was almost perfect for experienced readers (κ=0.83) and substantial for BI-RADS (κ=0.70). Inexperienced reader agreement was moderate for dense/non-dense (κ=0.50) and BI-RADS (κ=0.49). ICC for VAS was moderate for experienced (ICC=0.60) and good (ICC=0.84) for inexperienced readers. Intra-reader agreement for benign/malignant classification was almost perfect for both experienced and inexperienced readers respectively (κ=0.83, κ=0.91). Conclusion: Experienced readers showed substantial agreement for lesion classification and almost perfect agreement for breast density. While inexperienced reader agreement was moderate for both lesion classification and breast density, their agreement for VAS was higher than experienced readers, suggesting that CEM may have a short learning curve and that radiologists could potentially be trained for CEM interpretation, which would help its implementation in other clinical practices in Saudi Arabia.

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Head-to-head comparison of contrast-enhanced mammography and contrast-enhanced MRI for assessing pathological complete response to neoadjuvant therapy in patients with breast cancer: a meta-analysis

Kaiyin,

Lingling,

Leilei

et al. 2023

Breast Cancer Res Treat

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Contrast-Enhanced Mammography Versus MRI in the Evaluation of Neoadjuvant Therapy Response in Patients With Breast Cancer: A Prospective Study

Cited by 14 publications

References 45 publications

Imaging findings for response evaluation of ductal carcinoma in situ in breast cancer patients treated with neoadjuvant systemic therapy: a systematic review and meta-analysis

Imaging findings for response evaluation of ductal carcinoma in situ in breast cancer patients treated with neoadjuvant systemic therapy: a systematic review and meta-analysis

Contrast enhanced mammography (CEM): is experience necessary? an inter and intra-reader agreement study for lesion classification and breast density

Head-to-head comparison of contrast-enhanced mammography and contrast-enhanced MRI for assessing pathological complete response to neoadjuvant therapy in patients with breast cancer: a meta-analysis

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