MRI Staging After Neoadjuvant Chemotherapy for Breast Cancer: Does Tumor Biology Affect Accuracy?

McGuire, Kandace P.; Toro-Burguete, Jorge; Dang, Hang T.; Young, Joseph C.; Soran, Atilla; Zuley, Margarita L.; Bhargava, Rohit; Bonaventura, Marguerite; Johnson, R. R.; Ahrendt, Gretchen

doi:10.1245/s10434-011-1912-z

Cited by 116 publications

(77 citation statements)

References 21 publications

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“…Interestingly, no pCRs were observed among the 60 patients evaluable for this analysis, making this endpoint impossible to study. Our institutional average pCR in the ER/PR+ population is 7%, reflecting national data [13]. There were also no instances of disease progression during NCT.…”

Section: Discussionsupporting

confidence: 64%

The impact of Oncotype DX® recurrence score of paraffin-embedded core biopsy tissues in predicting response to neoadjuvant chemotherapy in women with breast cancer

Soran

Bhargava

Johnson

et al. 2016

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Abstract. BACKGROUND: Oncotype DXR test is beneficial in predicting recurrence free survival in estrogen receptor positive (ER+) breast cancer. Ability of the assay to predict response to neoadjuvant chemotherapy (NCT) is less well-studied. OBJECTIVE: We hypothesize a positive association between the Oncotype DX R recurrence score (RS) and the percentage tumor response (%TR) after NCT. METHODS: Pre-therapy RS was measured on core biopsies from 60 patients with ER+, HER2− invasive breast cancer (IBC) who then received NCT. Pre-therapy tumor size was measured using imaging. %TR, partial response (PR; >50%), pathologic complete response (pCR) and breast conserving surgery (BCS) rates were measured. RESULTS: Median RS was 20 (2-69). Median %TR was 42 (0-97)%. PR was observed in 43% of patients. There was no association between %TR and pre-NCT tumor size, age, Nottingham score or nodal status (p > 0.05). No statistically significant association with %TR was seen with RS as a categorical or continuous variable (p = 0.21 and 0.7, respectively). Response to NCT improved as ER (p = 0.02) by RT-PCR decreased. Lower ER expression by IHC correlated with response (p = 0.03). CONCLUSIONS: In patients with ER+ IBC receiving NCT, RS did not predict response to NCT using %TR. The benefit of the assay prior to NCT requires further study.

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Section: Discussionsupporting

confidence: 64%

The impact of Oncotype DX® recurrence score of paraffin-embedded core biopsy tissues in predicting response to neoadjuvant chemotherapy in women with breast cancer

Soran

Bhargava

Johnson

et al. 2016

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“…In addition, among HER2-negative tumors, the accuracy of MRI for predicting pCR was increased in hormone receptor-negative cancers compared with hormone receptor positive-cancers and was also improved in high-proliferation tumors compared with low-proliferation tumors (13). In another study, MRI more accurately predicted tumor sizes following NAC in HER2-positive and triple-nega- Residual DCIS (%) tive tumors compared with luminal tumors (14). By contrast, De Los Santos et al (15) reported that the molecular subtype was not identified to significantly affect the sensitivity, specificity, PPV or NPV of MRI for the prediction of pathological responses.…”

Section: Discussionmentioning

confidence: 95%

Analysis of complete response by MRI following neoadjuvant chemotherapy predicts pathological tumor responses differently for molecular subtypes of breast cancer

et al. 2012

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Abstract. In the present study, clinical tumor response following neoadjuvant chemotherapy (NAC) was diagnosed by magnetic resonance imaging (MRI) and clinicopathological factors, including molecular subtypes at baseline, were analyzed for correlations with pathological tumor responses. In addition, clinicopathological factors were analyzed for a correlation with the MRI capacity to predict pathological complete response (pCR). Clinical tumor response evaluated by MRI following NAC was determined as a clinical CR (cCR) or a residual tumor. cCR was confirmed if no gadolinium enhancement or an enhancement equal to or less than that of glandular tissue was observed in any phase of the MRI. Pathological tumor responses following NAC were classified into grades 0 (no change) to 3 (no residual invasive cancer) according to criteria of the Japanese Breast Cancer Society. pCR was defined as grade 3 in the present study. Of 264 cases of invasive breast cancer in 260 patients (4 synchronous bilateral breast cancer cases), 59 (22%) were diagnosed by MRI following NAC as cCR and 98 (37%) were pathologically diagnosed as pCR. In terms of predicting pCR by MRI, the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were 44, 90, 73, 73 and 73%, respectively. Tumor size, hormone receptor status, human epidermal growth factor receptor 2 (HER2) status, molecular subtype and histological type were significantly correlated with pathological tumor responses. pCR rates increased in the following order: luminal/HER2-negative (14%), luminal/HER2-positive (32%), triple-negative (46%) and non-luminal/HER2-positive (73%) tumors. Sensitivity and specificity were the highest (60 and 100%, respectively) in triple-negative tumors. PPV decreased in the following order: triple-negative (100%), non-luminal/HER2-positive (92%), luminal/HER2-positive (46%) and luminal/HER2-negative (33%) tumors. In conclusion, MRI evaluation is useful for predicting pCR following NAC, particularly for triple-negative tumors.

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“…DCE-MRI precisely defines the disease extent through selected morphokinetic parameters and is considered a good pCR discriminator regardless of the tumor subtype. DCE-MRI provides good correlation, even in cases of lobular carcinoma, multifocal and multicentric disease, allowing for early dynamic and metabolic assessment of tumors: tumor morphology changes, regression and enhancement patterns, and tridimensional and volume evaluation, which all define a specific "MRI phenotype" (19)(20)(21)(22). The morphokinetic features in DCE-MRI examinations are based on recommended oncologic imaging measurement tools (19)(20)(21)(22).…”

Section: Resultsmentioning

confidence: 99%

MRI in the evaluation of breast cancer patient response to neoadjuvant chemotherapy: predictive factors for breast conservative surgery

Zc²,

Plesinac-Karapandzic

et al. 2013

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to prospectively assess the role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the evaluation of predictive factors for breast conservative surgery during neoadjuvant chemotherapy. MATERIALS AND METHODSSixty-six patients were evaluated before the first treatment cycle, after the second cycle, and upon the completion of neoadjuvant chemotherapy according to largest tumor diameter, tumor volume, postcontrast enhancement, and tumor regression pattern. The patients were divided into responders (pathologic complete and near complete response) and nonresponders. Each subgroup was re-evaluated according to morphokinetic criteria for identification of candidates for breast conservative surgery. RESULTSIn responders (n=27), the lesion size upon the completion of neoadjuvant chemotherapy was significantly smaller compared to nonresponders (1.5±0.6 vs. 3.2±0.9 cm; P < 0.001), as was the volume (1.2 vs. 11.0 cm 3 ; P < 0.001). The measured lesion size did not differ from the histologic size (1.5±0.6 vs. 1.2±0.6 cm; P = 0.09) and had a high correlation (r=0.93). In responders, the following parameters were significantly different before and after neoadjuvant chemotherapy: size (3.6±1.4 to 1.5±0.6 cm; P < 0.001), volume (17.6 to 1.2 cm 3 ; P < 0.001), predominant concentric regression, plateau and continuous time-intensity curves (P < 0.001). DCE-MRI has the sensitivity of 87% and the accuracy of 77% to identify candidates for breast conservative surgery. CONCLUSION Selected morphokinetic DCE-MRI parameters may contribute to the multidisciplinary decision when considering the selection of candidates for breast conservative surgery.

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MRI Staging After Neoadjuvant Chemotherapy for Breast Cancer: Does Tumor Biology Affect Accuracy?

Cited by 116 publications

References 21 publications

The impact of Oncotype DX® recurrence score of paraffin-embedded core biopsy tissues in predicting response to neoadjuvant chemotherapy in women with breast cancer

The impact of Oncotype DX® recurrence score of paraffin-embedded core biopsy tissues in predicting response to neoadjuvant chemotherapy in women with breast cancer

Analysis of complete response by MRI following neoadjuvant chemotherapy predicts pathological tumor responses differently for molecular subtypes of breast cancer

MRI in the evaluation of breast cancer patient response to neoadjuvant chemotherapy: predictive factors for breast conservative surgery

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