The additive role of 1H-magnetic resonance spectroscopic imaging to ensure pathological complete response after neoadjuvant chemotherapy in breast cancer patients

Abstract

Purpose:To assess the role of 1 H-magnetic resonance spectroscopy ( 1 H-MRS) in the confirmation of pathological complete response after neoadjuvant chemotherapy in breast cancer. Material and methods:Forty-seven cases (53.72 ± 8.53 years) were evaluated using magnetic resonance imaging (MRI) and 1 H-MRS with choline (Cho) signal-to-noise ratio (SNR) measured followed by histopathology and ROC analyses. Results:Twelve patients had complete response, and 35 patients had residual disease. Mean age was 53.72 ± 8.53 years.The mean tumour size before neoadjuvant chemotherapy (NAC) was 4.21 ± 0.99 cm and after NAC was 0.9 ± 0.44 cm. Positive total choline signal (tCho) was detected in all cases. The mean Cho SNR before NAC was 9.53 ± 1.7 and after NAC was 2.53 ± 1.3. The Cho SNR cut-off point differentiating between pathologic complete response (pCR) and the non pCR was 1.95. Dynamic MRI showed 83.3% sensitivity, 65.7% specificity, 45.5% positive predictive value, 92.0% negative predictive value, and 70.2% diagnostic accuracy. Combined evaluation done by using the dynamic MRI and 1 H-MRS showed 91.5% diagnostic accuracy with 75.0% sensitivity, 97.1% specificity, 75% positive predictive value, and 91.9% negative predictive value. ROC curves of Cho SNR showed statistically significant differences between non pCR and pCR with AUC was 0.955, 82.9% sensitivity, 91.7% specificity, 96.7% positive predictive value, 64.7% negative predictive value, and 85.11% diagnostic accuracy.Conclusions: 1 H-MRS improves the diagnostic accuracy in the prediction of the pCR after NAC.

Advances in Imaging in Evaluating the Efficacy of Neoadjuvant Chemotherapy for Breast Cancer

“…Due to the objective technical difficulties of 1 H-MRS, it is currently less used. The main limitations are: 1) the low choline detection rate currently observed; 2) as the lesions shrink, less tumor tissue can be measured, especially since small lesions less than 1 cm are difficult to quantify in tCho; and 3) the relatively low sensitivity of 1 H-MRS compared to MRI ( 107 , 108 ).…”

Early prediction of pathological response to neoadjuvant chemotherapy of breast tumors: a comparative study using amide proton transfer-weighted, diffusion weighted and dynamic contrast enhanced MRI

“…The 2019 National Comprehensive Cancer Network (NCCN) guidelines for breast cancer suggest magnetic resonance imaging (MRI) may help assess tumor range, remission status after treatment and feasibility of breast-conserving surgery before and after NAC (5). Functional and molecular imaging MRI methods, including dynamic contrast enhanced MRI (DCE-MRI) (6), intravoxel incoherent motion (IVIM) (7), diffusion kurtosis imaging (DKI) (8), and magnetic resonance spectroscopy (MRS) (9), provide insights into the underlying pathophysiology of tissues from morphology to cellular metabolism (10)(11)(12). But, currently, there is still no standard method or imaging biomarker in clinical practice to accurately predict predicting pCR to NAC in patients with breast cancer.…”

Invasive lobular carcinoma mammographic findings: correlation with age, breast composition, and tumour size

“…Breast cancer is the most common cancer in women, representing 30% of malignant tumours [ 1 , 2 ]. Invasive lobular carcinoma (ILC) accounts for 10-15% of all breast cancers and is the second most common histologic type after invasive ductal carcinoma [ 3 ].…”