Dynamic Contrast-Enhanced Magnetic Resonance Imaging in the Assessment of Inflammatory Breast Cancer Prior to and After Neoadjuvant Treatment

Abstract

Background: The aim of this study was to describe the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) features of inflammatory breast cancer (IBC) and to assess the value of DCE-MRI for the prediction of pathological complete response (pCR). Methods: Image analysis was performed in 15 patients with IBC (cT4d) and 12 patients with non-IBC (cT2), and included the assessment of BIRADS characteristics, skin alterations, enhancement characteristics, and changes post chemotherapy. Sensitivity and specificity of DCE-MRI for the presence of residual disease were obtained. Pearson's correlation coefficients were calculated comparing the (preoperative) tumor size with the histological size. Results: Skin thickening/enhancement (80%) and non-mass-like enhancement (66.7%) occurred more often in IBC (16.7 vs. 8.3% in non-IBC). In 2 of 3 cases of IBC, pCR was correctly predicted (sensitivity 92%, specificity 67%), compared to 3 of 5 cases in non-IBC (sensitivity 86%, specificity 40%). Lower peak enhancement might be associated with a higher likelihood of pCR in IBC. No other parameters predicted eventual pCR. In IBC, no correlation between preoperative tumor size and histological size was found (r = 0.22, p = 0.50), whereas in non-IBC, size estimations were more accurate (r = 0.75, p = 0.03). Conclusion: IBC is characterized on MRI by skin changes and non-mass-like enhancement. Radiological complete response seems indicative of pCR in IBC and non-IBC. Size estimation of residual disease in IBC appears to be inaccurate.

Improved Rate of Negative Margins for Inflammatory Breast Cancer Using Intraoperative Frozen Section Analysis

“…This technique potentially provides an additional tool for surgeons because the extent of disease involvement does not always correlate with clinical exams or preoperative image studies [ 22 ]. Even with magnetic resonance imaging, which can delineate thickened skin and breast cancer changes in IBC, it is often difficult to accurately determine residual cancer after neoadjuvant chemotherapy [ 23 ]. In our study, surgical resection without FSA would have underestimated the extent of disease infiltration in 36.8% of the patients.…”

Radiological Clues to Differentiate Benign Mastitis from Breast Cancer

“…İnflamatuar meme kanseri, subkütanöz dokuda deri altı lenfatiklerin tümör hücreleri ile embolize olmasıyla karakterizedir. İnsidansı %2-4 arasındadır, morbidite ve mortalitesi yüksek olup, 5 yıllık genel sağkalım oranı %40,5 olarak bildirilmiştir [27][28][29]. Tanı anında %20-40 arasında metastatik olduğu bildirilmiştir [8].…”

Advanced Imaging for Precision Medicine in Breast Cancer: From Morphology to Function

“…Knogler et al [52] present results on CEDM for breast lesion detection, characterization and comparison to DCE-MRI. The potential of DCE-MRI including quantitative pharmacokinetic modeling for the assessment and prediction of response to neoadjuvant chemotherapy in breast cancer overall (Dietzel et al [53]) and with a special focus on inflammatory breast cancer (van Uden et al [54]) is discussed. In addition, Clauser et al [55] provide data on the usefulness of short-term imaging follow-up in patients with BIRADS 3 and 4a lesions and the benign histopathologic diagnosis of a fibroadenoma at image-guided biopsy.…”