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

Abstract

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.

Role of contrast-enhanced spectral mammography in the assessment of residual disease following neoadjuvant chemotherapy in patients with breast cancer

“…We found a high degree of correlation between maximum tumor diameter after NAC by CESM and histopathology similar to a previously published study [2]. A study by Lotti and colleagues [31] reported that CESM showed a better correlation with histopathology compared to MRI with Lin's coefficient of 0.81 and 0.59 for CESM and contrast-enhanced MRI, respectively.…”

“…In the current study, we found high sensitivity, specificity, PPV, and NPV of CESM in predicting CR in patients receiving NAC similar to previously published results [2,[30][31][32]. All the forementioned studies, ours included, showed a high sensitivity and a lower specificity of CESM in the assessment of CR which reflects the inability of contrast-enhanced imaging techniques in distinguishing between residual neoplastic disease and associated inflammation and reactive changes.…”

“…Neoadjuvant chemotherapy (NAC) is currently considered one of the most commonly prescribed therapeutic options for patients with locally advanced as well as operable breast cancer [1]. NAC enables surgical intervention by decreasing the tumor size of previously inoperable Elkassas et al Egypt J Radiol Nucl Med (2022) 53:249 breast cancer lesions [2]. In patients with extensive yet operable breast neoplastic lesions who are candidates for modified radical mastectomy (MRM), NAC allows for conservative breast surgery (CBS) by reducing the tumor extent resulting in less postoperative morbidity as well as enhancing cosmetic and psychological yield [3][4][5].…”

“…In patients with extensive yet operable breast neoplastic lesions who are candidates for modified radical mastectomy (MRM), NAC allows for conservative breast surgery (CBS) by reducing the tumor extent resulting in less postoperative morbidity as well as enhancing cosmetic and psychological yield [3][4][5]. Additionally, NAC offers an unrivaled opportunity for in vivo chemotherapeutic evaluation of cancer cell sensitivity and the development of novel biomarkers of treatment response which in turn can give an indication to patient prognosis [2,6,7]. NAC response differs among patients due to several factors including the stage of the disease, human epidermal growth factor 2 (HER2) status, receptor status as well as tumor heterogeneity resulting from varying molecular characteristics [8].…”

Mammographic and Ultrasonographic Imaging Analysis for Neoadjuvant Chemotherapy Evaluation: Volume Reduction Indexes That Correlate With Pathological Complete Response

“…Hence, imaging methods are crucial to predict pathological complete response (pCR) and help monitor clinical response to NAC [4,5]. The most widely accepted imaging techniques are magnetic resonance imaging (MRI) because of its higher sensitivity and specificity to predict pCR [6][7][8], as well as contrastenhanced spectral mammography (CESM) [9][10][11]. Those techniques are more accurate than digital mammography (DM) and US mainly due to intravenous contrast injection that allows a more sensitive imaging analysis in many ways [12,13].…”