Evaluating the role of magnetic resonance imaging post‐neoadjuvant therapy for breast cancer in the <scp>NEONAB</scp> trial

Murphy, Caitlin; Mukaro, Violet; Tobler, Robert; Asher, Rebecca; Gibbs, Emma; West, Linda; Giuffrè, Bruno; Baron‐Hay, Sally; Khasraw, Mustafa

doi:10.1111/imj.13617

Cited by 11 publications

(5 citation statements)

References 30 publications

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“…The Luminal B disease cohort were all hormone receptor (HR) and HER2 positive in our cohort, which may have influenced this outcome. Murphy et al 24 found MRI accuracy to be much higher in HER2-positive breast cancer. Our small HER2/neu sample size (n = 8) limits our ability to comment definitively on this subtype.…”

Section: Discussionmentioning

confidence: 98%

Preoperative Breast Magnetic Resonance Imaging as a Predictor of Response to Neoadjuvant Chemotherapy

Browne

McAnena

O’Halloran

et al. 2022

Breast Cancer�(Auckl)

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Introduction: The ability to accurately predict pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in breast cancer would improve patient selection for specific treatment strategies, would provide important information for patients to aid in the treatment selection process, and could potentially avoid the need for more extensive surgery. The diagnostic performance of magnetic resonance imaging (MRI) in predicting pCR has previously been studied, with mixed results. Magnetic resonance imaging performance may also be influenced by tumour and patient factors. Methods: Eighty-seven breast cancer patients who underwent NAC were studied. Pre-NAC and post-NAC MRI findings were compared with pathologic findings postsurgical excision. The impact of patient and tumour characteristics on MRI accuracy was evaluated. Results: The mean (SD) age of participants was 48.7 (10.3) years. The rate of pCR based on post-NAC MRI was 19.5% overall (19/87). The sensitivity, specificity, positive predictive value (PPV), negative predictive value, and accuracy in predicting pCR were 52.9%, 77.1%, 36.0%, 87.1%, and 72.4%, respectively. Positive predictive value was the highest in nonluminal versus Luminal A disease (45.0% vs 25.0%, P < .001), with higher rates of false positivity in nonluminal subtypes ( P = .002). Tumour grade, T category, and histological subtype were all independent predictors of MRI accuracy regarding post-NAC tumour size. Conclusion: Magnetic resonance imaging alone is insufficient to accurately predict pCR in breast cancer patients post-NAC. Magnetic resonance imaging predictions of pCR are more accurate in nonluminal subtypes. Tumour grade, T category, and histological subtype should be considered when evaluating post-NAC tumour sizes.

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Section: Discussionmentioning

confidence: 98%

Preoperative Breast Magnetic Resonance Imaging as a Predictor of Response to Neoadjuvant Chemotherapy

Browne

McAnena

O’Halloran

et al. 2022

Breast Cancer�(Auckl)

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“…It is interesting to note, however, our results suggested that the odds of imaging-pathological discordance in luminal B and HER2-enriched tumors was about 6 and 12 times higher than in luminal A subtype, respectively. Some authors proposed that MRI accuracy was higher in HER2-positive and triple-negative breast cancer and less in luminal breast cancer (9,19,26), whereas others proposed that MRI accuracy significantly decreased in patients treated with HER2-targeted agents, resulting in an overestimation of the extent of the residual lesions due to the increase in neovascular permeability (27), which may lead to overtreatment in this subtype. A consensus has not yet been reached at present on this issue.…”

Section: Discussionmentioning

confidence: 99%

Pre-operative MRI in evaluating pathologic complete response to neoadjuvant chemotherapy in patients with breast cancer: a study focused on influencing factors of baseline clinical-pathological and imaging features

Hu,

et al. 2024

Front. Oncol.

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PurposeTo investigate what pre-treatment clinical-pathological features and MRI characteristics influence the performance of breast MRI in assessing the pathologic complete response (pCR) of breast cancer patients to Neoadjuvant Chemotherapy (NAC).MethodsA total of 225 patients with pathologically-confirmed breast cancer who underwent pre- and post-NAC breast MRI between January 2020 and April 2023 were retrospectively analyzed. All patients were categorized into radiologic complete response (rCR) and non-rCR groups based on pre-operative MRI. Univariable and multivariable logistic regression were used to identify independent clinicopathological and imaging features associated with imaging-pathological discordance. The performance of pre-operative MRI for predicting pCR to NAC was assessed according to the baseline characteristics of the clinicopathological data and pre-NAC MRI. In addition, the discrepancy between the pre-operative MRI and post-operative pathological findings was further analyzed by a case-control approach.ResultsAmong 225 patients, 99 (44.0%) achieved pCR after NAC. MRI showed the overall sensitivity of 97.6%, specificity of 58.6%, accuracy of 80.4%, a positive predictive value (PPV) of 75.0%, and a negative predictive value (NPV) of 95.1% in identifying pCR. Of baseline features, presence of ductal carcinoma in situ (DCIS) (OR, 3.975 [95% CI: 1.448–10.908], p = 0.007), luminal B (OR, 5.076 [95% CI: 1.401–18.391], p = 0.013), HER2-enriched subtype (OR, 10.949 [95% CI: 3.262–36.747], p < 0.001), multifocal or multicentric lesions (OR, 2.467 [95% CI: 1.067–5.706], p = 0.035), segmental or regional distribution of NME (OR, 8.514 [95% CI: 1.049–69.098], p = 0.045) and rim enhancement of mass (OR, 4.261 [95% CI: 1.347–13.477], p = 0.014) were significantly associated with the discrepancy between MRI and pathology.ConclusionPresence of DCIS, luminal B or HER2-enriched subtype, multicentric or multifocal lesions, segmental or regional distribution of NME and rim enhancement of mass may lead to a decrease in diagnostic accuracy of MRI in patients of breast cancer treated with NAC.

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“…In a study of HER2-positive tumor, the shrinkage pattern has been found to be a stronger predictor of pCR than size changes and absence of residual enhancement with a concentric shrinkage pattern predicting pCR with 96.6% specificity and 59.1% sensitivity [36]. In addition, higher Ki-67 levels and nuclear grade tumors have higher MRI accuracy [31,33,[37][38][39]. Lobular carcinoma or ductal carcinoma mixed with lobular carcinoma components is more likely to cause preoperative MRI false negatives and greater size discrepancy when compared with pathological specimens [40,41].…”

Section: Factors Affecting Mri Accuracy For Pcrmentioning

confidence: 99%

The role of magnetic resonance imaging on evaluating response of neoadjuvant therapy for breast cancer

Guo

Yang

et al. 2020

Chin J Acad Radiol

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Breast magnetic resonance imaging (MRI) is always considered to be more accurate for evaluating neoadjuvant therapy (NAT) response than mammography, ultrasound and clinical examination. Preoperative MRI aims to evaluate residual disease to facilitate surgical planning. MRI scans performed before and/or during NAT aim to predict the treatment response and thus adjust the NAT plan at an early stage. MRI accuracy depends on tumor morphology, histology, shrinkage pattern and molecular subtype. Combining multiparameter functional MRI can improve the prediction accuracy. In addition, radiomics offers high-dimensional and high-throughput signatures and were shown to predict treatment response before NAT. This article reviews the indicators of breast MRI for evaluating NAT response, including morphological MRI features, enhancement and pharmacokinetic parameters, apparent diffusion coefficient (ADC), choline concentration, etc., even radiomic signatures and illustrates their advantages, limitations and future directions.

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Evaluating the role of magnetic resonance imaging post‐neoadjuvant therapy for breast cancer in the NEONAB trial

Cited by 11 publications

References 30 publications

Preoperative Breast Magnetic Resonance Imaging as a Predictor of Response to Neoadjuvant Chemotherapy

Preoperative Breast Magnetic Resonance Imaging as a Predictor of Response to Neoadjuvant Chemotherapy

Pre-operative MRI in evaluating pathologic complete response to neoadjuvant chemotherapy in patients with breast cancer: a study focused on influencing factors of baseline clinical-pathological and imaging features

The role of magnetic resonance imaging on evaluating response of neoadjuvant therapy for breast cancer

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