Locally advanced breast cancer: comparison of mammography, sonography and MR imaging in evaluation of residual disease in women receiving neoadjuvant chemotherapy

Abstract

The accuracy of mammography, sonography and magnetic resonance imaging (MRI) in identifying residual disease after neoadjuvant chemotherapy is evaluated and imaging findings are correlated with pathologic findings. Fifteen patients enrolled in an experimental protocol of preoperative neoadjuvant chemotherapy underwent clinical examination, mammography, sonography and dynamic MRI, performed in this order, before and respectively after 2 and 4 cycles of neoadjuvant chemotherapy. Four radiologists, two for mammography, one for sonography and one for MR, examined the images, blinded to the results of the other examinations. All patients underwent radical or conservative surgery, and imaging findings were compared with pathologic findings. MRI identified 2/15 (13.3.%) clinically complete response (CR), 9/15 (60%) partial response (PR), 3/15 (20%) stable disease (SD) and 1/15 (6.7%) progressive disease. Mammography identified 1/15 (6.7%) clinically CR, 8/15 (53.3%) PR and 4/15 (27%) SD, and was not able to evaluate the disease in 2/15 (13%) cases. Sonography presented the same results as MRI. Therefore, MRI and sonography compared to mammography correctly identified residual disease in 100 vs. 86%. MRI resulted in two false-negative results because of the presence of microfoci of in situ ductal carcinoma (DCIS) and invasive lobular carcinoma (LCI). MRI was superior to mammography in cases of multifocal or multicentric disease (83 vs. 33%). Sonography performed after MRI improves the accuracy in evaluation of uncertain foci of multifocal disease seen on MR images with an increase of diagnostic accuracy from 73 to 84.5%. MRI assesses response to neoadjuvant chemotherapy better than traditional methods of physical examination and mammography.

Trastuzumab‐based neoadjuvant therapy in patients with HER2‐positive breast cancer

“…In addition to treating detectable disease before surgery, neoadjuvant chemotherapy provides the earliest chance to treat micrometastatic disease, saving time that potentially could be lost to local treatment. 18 Unlike adjuvant therapy in which considerable vascular remodeling can occur at the site of tumor excision, neoadjuvant therapy is able to use the tumor's local vasculature, potentially enhancing the local effect of chemotherapy through an undisturbed blood supply. 19,20 Neoadjuvant therapy already is the standard of care in locally advanced BC (LABC) and inflammatory BC (IBC).…”

Meme Manyetik Rezonans Görüntüleme Endikasyonları ve Yorumu Zor Olan Bulgular

“…Ayrıca yanıt durumuna göre bu olgulara mastektomi yerine koruyucu tedavi de uygulanabilir. Tümörün gerçek boyutlarını MRG, tüm yöntemlerden daha üstün olarak belirleyebilmektedir [39][40][41][42][43][44][45]. Kemoterapinin indüklediği fibrozis nedeniyle klinik bakıda tümör normalden daha büyük ölçülmekte, mamografide de yoğun doku değerlendirmeye engel olmaktadır.…”

“…Manyetik rezonans görün-tüleme ile fibrozis ve canlı tümör ayırt edebilir, doğruluğu da meme yapısının yoğunluğundan etkilenmez. Zaman/intensite eğrisi az ve yavaş kontrastlanmanın belirteci olarak tedavide basıklaşır ve sağa kayar [39][40][41][42][43][44][45].…”

1830 Diagnosis of pathological complete response to neoadjuvant chemotherapy in breast cancer by minimal invasive biopsy techniques

“…To assess clinical tumour response, physical examination, breast ultrasound, mammography, and breast magnetic resonance imaging may be used (Fiorentino et al, 2001;Denis et al, 2004;Londero et al, 2004;Yeh et al, 2005), whereas breast MRI was found to be the most accurate to evaluate tumour response to NACT (Croshaw et al, 2011;Marinovich et al, 2013). Definition and assessment of clinical complete response (cCR) differed relevantly among several imaging studies even if the procedures were based on the WHO (Miller et al, 1981) or the EORTC/ RECIST (Eisenhauer et al, 2009) definitions.…”