Evaluation of the treatment response to neoadjuvant chemotherapy in locally advanced breast cancer using combined magnetic resonance vascular maps and apparent diffusion coefficient

Wu, Lian Ming; Chang, Ruey-Feng; Huang, Chiun‐Sheng; Lu, Yen‐Shen; Chen, Honghao; Chen, Jo-Yu; Chang, Yeun‐Chung

doi:10.1002/jmri.24915

Cited by 24 publications

(14 citation statements)

References 39 publications

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“…Also, the various chemotherapeutic drugs contribute differently to the variation in the primitive lesion, with significant consequences on imaging. Taxanes have been reported to have greater antiangiogenic activity compared to anthracyclines [ 29 ], and this antivascular effect, with the lack of surrounding inflammatory response, lowers the enhancement on tumor tissue, leading to underestimation of tumor size by MRI [ 5 ]. These effects were similar in our patients as the NAC protocol was the same, including both anthracyclines and taxanes.…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced spectral mammography in neoadjuvant chemotherapy monitoring: a comparison with breast magnetic resonance imaging

et al. 2017

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BackgroundNeoadjuvant-chemotherapy (NAC) is considered the standard treatment for locally advanced breast carcinomas. Accurate assessment of disease response is fundamental to increase the chances of successful breast-conserving surgery and to avoid local recurrence. The purpose of this study was to compare contrast-enhanced spectral mammography (CESM) and contrast-enhanced-MRI (MRI) in the evaluation of tumor response to NAC.MethodsThis prospective study was approved by the institutional review board and written informed consent was obtained. Fifty-four consenting women with breast cancer and indication of NAC were consecutively enrolled between October 2012 and December 2014. Patients underwent both CESM and MRI before, during and after NAC. MRI was performed first, followed by CESM within 3 days. Response to therapy was evaluated for each patient, comparing the size of the residual lesion measured on CESM and MRI performed after NAC to the pathological response on surgical specimens (gold standard), independently of and blinded to the results of the other test. The agreement between measurements was evaluated using Lin’s coefficient. The agreement between measurements using CESM and MRI was tested at each step of the study, before, during and after NAC. And last of all, the variation in the largest dimension of the tumor on CESM and MRI was assessed according to the parameters set in RECIST 1.1 criteria, focusing on pathological complete response (pCR).ResultsA total of 46 patients (85%) completed the study. CESM predicted pCR better than MRI (Lin’s coefficient 0.81 and 0.59, respectively). Both methods tend to underestimate the real extent of residual tumor (mean 4.1mm in CESM, 7.5mm in MRI). The agreement between measurements using CESM and MRI was 0.96, 0.94 and 0.76 before, during and after NAC respectively. The distinction between responders and non-responders with CESM and MRI was identical for 45/46 patients. In the assessment of CR, sensitivity and specificity were 100% and 84%, respectively, for CESM, and 87% and 60% for MRI.ConclusionCESM and MRI lesion size measurements were highly correlated. CESM seems at least as reliable as MRI in assessing the response to NAC, and may be an alternative if MRI is contraindicated or its availability is limited.

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Section: Discussionmentioning

confidence: 99%

Contrast-enhanced spectral mammography in neoadjuvant chemotherapy monitoring: a comparison with breast magnetic resonance imaging

et al. 2017

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“…Nevertheless, a pCR is achieved in only 30% of the patients after the completion of NAC and thus determining factors and an accurate means to predict treatment response as early as possible are desirable for identifying patients who do not benefit from NAC (2). Several studies have demonstrated that dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is the most sensitive method for the assessment and prediction of treatment response to NAC (4)(5)(6)(7)(8). In addition, it has been demonstrated that multiparametric MRI (mpMRI) using morphological as well as additional functional parameters such as diffusion-weighted imaging (DWI) has the potential for improving the prediction of treatment response (6,(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Impact of Machine Learning With Multiparametric Magnetic Resonance Imaging of the Breast for Early Prediction of Response to Neoadjuvant Chemotherapy and Survival Outcomes in Breast Cancer Patients

Tahmassebi¹,

et al. 2019

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Purpose: To assess the potential of machine learning with multiparametric MRI (mpMRI) for the early prediction of pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) and of survival outcomes in breast cancer patients. Materials and Methods: This IRB-approved prospective study included 38 women (median age 46.5 years; range 25-70 years) with breast cancer who were scheduled for NAC and underwent mpMRI of the breast at 3T with DCE, DWI and T2-weighted imaging prior to and after two cycles of NAC. For each lesion, 23 features were extracted: qualitative T2-weighted and DCE-MRI features according to BI-RADS, quantitative pharmacokinetic DCE features (mean plasma flow, volume distribution, mean transit time) and DWI apparent diffusion coefficient (ADC) values. To apply machine learning to mpMRI, eight classifiers including linear support vector machine (SVM), linear discriminant analysis (LDA), logistic regression (LR), random forest (RF), stochastic gradient descent (SGD), decision tree, adaptive boosting (AdaBoost) and extreme gradient boosting (XGBoost) were employed to rank the features. Histopathologic Residual Cancer Burden (RCB) class (with RCB 0 being a pCR), recurrence-free survival (RFS) and disease-specific survival (DSS) were used as the standards of reference. Classification accuracy with area under the receiving operating characteristic curve (AUC) was assessed using all the

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“…In breast cancer, MRI performed early in the course of neoadjuvant therapy (NAT) has proven capable of predicting the eventual tumor response before downstream changes in tumor size (11–13). The 2 MRI techniques that have been the most investigated for predicting therapeutic response to breast NAT are diffusion-weighted MRI (14) and dynamic contrast-enhanced MRI (15, 16), as well as their combination (17, 18). MT-MRI has not yet been investigated for evaluating (or predicting) response during therapy in locally advanced breast cancer.…”

Section: Introductionmentioning

confidence: 99%

Magnetization Transfer MRI of Breast Cancer in the Community Setting: Reproducibility and Preliminary Results in Neoadjuvant Therapy

Virostko

Sorace²,

Wu³

et al. 2019

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Repeatability and reproducibility of magnetization transfer magnetic resonance imaging of the breast, and the ability of this technique to assess the response of locally advanced breast cancer to neoadjuvant therapy (NAT), are determined. Reproducibility scans at 3 different 3 T scanners, including 2 scanners in community imaging centers, found a 16.3% difference (n = 3) in magnetization transfer ratio (MTR) in healthy breast fibroglandular tissue. Repeatability scans (n = 10) found a difference of ∼8.1% in the MTR measurement of fibroglandular tissue between the 2 measurements. Thus, MTR is repeatable and reproducible in the breast and can be integrated into community imaging clinics. Serial magnetization transfer magnetic resonance imaging performed at longitudinal time points during NAT indicated no significant change in average tumoral MTR during treatment. However, histogram analysis indicated an increase in the dispersion of MTR values of the tumor during NAT, as quantified by higher standard deviation ( P = .005), higher full width at half maximum ( P = .02), and lower kurtosis ( P = .02). Patients' stratification into those with pathological complete response (pCR; n = 6) at the conclusion of NAT and those with residual disease (n = 9) showed wider distribution of tumor MTR values in patients who achieved pCR after 2–4 cycles of NAT, as quantified by higher standard deviation ( P = .02), higher full width at half maximum ( P = .03), and lower kurtosis ( P = .03). Thus, MTR can be used as an imaging metric to assess response to breast NAT.

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Evaluation of the treatment response to neoadjuvant chemotherapy in locally advanced breast cancer using combined magnetic resonance vascular maps and apparent diffusion coefficient

Abstract: The early changes of MR vascular maps and ADC are associated with the final treatment response of LABC.

Cited by 24 publications

References 39 publications

Contrast-enhanced spectral mammography in neoadjuvant chemotherapy monitoring: a comparison with breast magnetic resonance imaging

Contrast-enhanced spectral mammography in neoadjuvant chemotherapy monitoring: a comparison with breast magnetic resonance imaging

Impact of Machine Learning With Multiparametric Magnetic Resonance Imaging of the Breast for Early Prediction of Response to Neoadjuvant Chemotherapy and Survival Outcomes in Breast Cancer Patients

Magnetization Transfer MRI of Breast Cancer in the Community Setting: Reproducibility and Preliminary Results in Neoadjuvant Therapy

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