Prognostic imaging in neoadjuvant chemotherapy of locally-advanced breast cancer should be cost-effective

Abstract

Introduction-The use of neoadjuvant chemotherapy in cases of locally advanced breast cancer has been steadily increasing, and is also in wider use for other cancers. As a consequence, a growing number of studies have focused on the question of how best to assess the therapeutic response to various chemotherapy or systemic therapy regimens. Prognostic imaging of response to therapy early in the course of a planned chemotherapy regimen could be of considerable value, particularly if shifting to another therapy regimen would be more effective.

Evaluation of the quantitative accuracy of a commercially available positron emission mammography scanner

“…9 For example, scintimammography with technetium-99m ͑Tc-99m͒ sestamibi can detect large multifocal lesions and metastases, 10 but investigational breast-specific gamma imaging devices are necessary to visualize tumors smaller than 1 cm. 11 Positron emission tomography ͑PET͒ is another functional modality that has the added advantage of quantifying radiotracer uptake, allowing accurate diagnosis, staging, and treatment re-sponse evaluation of advanced breast cancers, [12][13][14][15] but the resolution of conventional PET scanners limits the sensitivity of this modality for detecting lesions smaller than 5-10 mm. Positron emission mammography ͑PEM͒ is an emerging functional imaging modality that is dedicated to positron emission imaging of the breast, with the purpose of achieving higher sensitivity than PET to earlier stages of breast cancer.…”

Cost-effectiveness of Fluorine-18-Fluorodeoxyglucose positron emission tomography in tumours other than lung cancer: A systematic review

“…Thirty-three articles were selected and retrieved in fulltext version (Figure 1). One study was found screening the references [6] and 18 articles were subsequently excluded [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] . Finally, 16 studies were included [6,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] .…”

99mTc-Sestamibi Using a Direct Conversion Molecular Breast Imaging System to Assess Tumor Response to Neoadjuvant Chemotherapy in Women With Locally Advanced Breast Cancer

“…Attempting to utilize a single time point in the treatment cycle to predict response may not be the ideal, and repeating the MBI shortly after switching to the second chemotherapeutic agent may be worth evaluating. A cost-effectiveness model reported by Schegerin et al 29 showed that even a small improvement in cure rate with NAC would generally outweigh the cost of prognostic imaging. Direct conversion–MBI is a relatively inexpensive imaging procedure (approximately 1.5 times that of digital mammography).…”