Accuracy of mammography and echography versus clinical palpation in the assessment of response to primary chemotherapy in breast cancer patients with operable disease

Abstract

The response to primary chemotherapy is an important prognostic factor in patients with non metastatic breast cancer. In this study we compared the assessment of response performed by clinical palpation to that performed by echography and mammography in 141 out of 157 consecutive breast cancer patients (T2-4, N0-1, M0) submitted to primary chemotherapy. A low relationship was recorded between tumor size assessed clinically and that evaluated by either mammography: Spearman R = 0.38 or echography: R = 0.24, while a greater correlation was found between the tumor dimension obtained by the two imaging techniques (R = 0.62). According to the WHO criteria, the grade of response of breast cancer to primary chemotherapy, showed by mammography and echography, was less marked than the grade of response seen at clinical examination. Residual tumor size assessed clinically depicted a stronger correlation with pathological findings (R = 0.68) than the residual disease assessed by echography (R = 0.29) and mammography (R = 0.33). Post-chemotherapy histology evaluation revealed pathological complete response in three cases (2.1%). Two of these cases were judged as complete responders by clinical palpation but only one was recognized by mammography, and none by echography. Clinical response, but not the response obtained by the two imaging techniques, was a significant predictor for longer disease free survival (p = 0.04). To conclude, physical examination measurements remain the method of choice in evaluating preoperatively the disease response in trials of primary chemotherapy. Prediction of pathological outcome is not improved by echography and mammography.

Accuracy of unidimensional and volumetric ultrasound measurements in predicting good pathological response to neoadjuvant chemotherapy in breast cancer patients

“…The opposite can also be true as in cases of tumour necrosis without stromal reaction, ultrasound will show rCR whereas pathological examination may reveal residual viable tumour. The correlation coefficient r=0.359 between end-treatment US-assessed LD and pathology in our series similar to the value r=0.29 reported by Fiorentino et al [21] but lower than other reports in the literature (Table 9). Of note, the correlation only marginally improved (r=0.381) when residual in situ carcinoma was taken into account.…”

Evaluation of ER, PgR, HER-2 and Ki-67 as predictors of response to neoadjuvant anthracycline chemotherapy for operable breast cancer

“…Clinical assessment frequently overestimates tumour size (Fornage et al, 1987;Pain et al, 1992;Forouhi et al, 1994;Meden et al, 1995;Allen et al, 2001). Radiological assessment of maximum tumour dimensions by ultrasound or mammography is often performed to assess response and correlates better with histological tumour size than clinical measurements (Allen et al, 2001;Fiorentino et al, 2001). However, complete pathological response is the best predictor of long-term survival .…”

Early changes in apoptosis and proliferation following primary chemotherapy for breast cancer

“…Other measurements of response were not performed in this study. Mammography has been shown to be a poorer than clinical measurement (Florentino et al, 2001), but ultrasound maybe more useful and could have allowed measurement of volume changes, which has been used in other studies with primary endocrine treatment (Miller et al, 2001;Harper-Wynne et al, 2002).…”