Accuracy of ultrasonography and mammography in predicting pathologic response after neoadjuvant chemotherapy for breast cancer

Keune, Jason D.; Jeffe, Donna B.; Schootman, Mario; Hoffman, Abigail; Gillanders, William E.; Aft, Rebecca

doi:10.1016/j.amjsurg.2009.03.012

Cited by 114 publications

(75 citation statements)

References 50 publications

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“…The accuracy of MG in measuring the residual tumour to within 1 cm of the histopathological size was 60.0% in our study, which is similar to that calculated by Atkins et al 14 (56.0%) but higher than that found by Keune et al 15 (31.7%) and lower than that found by Chagpar et al 16 (70.0%).…”

Section: Discussionsupporting

confidence: 88%

The effect of chemotherapy on the mammographic appearance of breast cancer and correlation with histopathology

Mistry¹,

Thakur²,

Kembhavi³

2016

BJR

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Objective: To document the mammographic changes after neoadjuvant chemotherapy with histopathological correlation, to calculate the accuracy of mammography (MG) in predicting residual tumour size and to measure the interobserver agreement in reading mammograms. Methods: In 446 consecutive cases, the pre-and postchemotherapy mammograms were retrospectively evaluated by two blinded observers, and consensus findings were compared with reference standard of surgical specimen. The accuracy of MG in predicting residual tumour size was calculated. Kappa statistics were calculated for measuring the interobserver agreement for reading mammograms. The sensitivity, specificity, positive-predictive value and negative-predictive value for the prediction of residual disease were calculated. Results: The most common primary abnormalities were mass lesions without and with microcalcifications. After chemotherapy, there was decrease in size of most (95.1%) of the measurable masses, with decrease in the mean tumour size from 4.1 to 2.5 cm. The density of the tumour decreased in 66.6% (241/362) cases with residual disease. There was almost perfect interobserver agreement for describing the primary abnormality in the pre-as well as post-chemotherapy mammograms (k 5 0.87 and 0.81, respectively) with substantial agreement for measurement of the mass lesions before and after chemotherapy (k 5 0.69 and 0.68, respectively). MG showed accuracy of 60.0%, sensitivity of 94.4%, specificity of 50.0%, positivepredictive value of 91.3% and negative-predictive value of 61.8%. Conclusion: MG remains a highly sensitive and reproducible investigation for the assessment of residual disease after chemotherapy. Advances in knowledge: There is substantial interobserver agreement in characterizing and measuring breast tumours on mammograms. INTRODUCTIONBreast cancer is the leading cause of cancer-related deaths in females worldwide.1 Its treatment depends upon multiple factors such as the tumour size, chest wall and/or skin invasion, nodal and/or systemic metastases. Neoadjuvant chemotherapy (NACT) was introduced more than four decades ago for the treatment of locally advanced breast cancer (LABC). It refers to the administration of systemic chemotherapy prior to the definitive surgical treatment. It is currently employed in the treatment of tumours .5 cm in size (i.e. T3), LABC and inflammatory breast cancers (IBCs). Its main role in the management of LABC is to enable adequate local control of the disease. It has permitted more patients with large operable breast cancers and LABC to undergo breast-conserving surgeries than radical mastectomies by pre-operatively decreasing the tumour size.2-4 Administration of NACT allows earlier treatment of systemic micrometastasis.5 It is also postulated

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Section: Discussionsupporting

confidence: 88%

The effect of chemotherapy on the mammographic appearance of breast cancer and correlation with histopathology

Mistry¹,

Thakur²,

Kembhavi³

2016

BJR

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“…However, studies comparatively analyzing the diagnostic accuracy of MMG and sonography demonstrated that the two modalities perform equally well in detecting primary breast cancer (11,17), or that MMG is superior to breast US in the accurate diagnosis of primary breast cancer (2,18). Although it has been reported that US was more accurate compared with MMG in predicting residual tumor size following neoadjuvant chemotherapy (19), there is no available literature regarding the optimal method for accurate assessment of residual disease following bioptic lumpectomy. Identifying residual tumor following lumpectomy may be even more challenging.…”

Section: Discussionmentioning

confidence: 99%

Comparison of mammography and ultrasound in detecting residual disease following bioptic lumpectomy in breast cancer patients

Lin

et al. 2016

Molecular and Clinical Oncology

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Abstract. Surgical biopsy is a method for diagnosing breast cancer. The aim of this study was to prospectively evaluate the relative accuracies of mammography (MMG) and ultrasound (US) in predicting residual disease following bioptic lumpectomy. Each prediction method was compared with the gold standard of surgical pathology. The results of MMG and US from 312 consecutive breast cancer patients diagnosed by surgical excision were analyzed. All the patients underwent re-excision mastectomy or lumpectomy and the imaging results were compared with the histopathological findings. The accuracy and sensitivity of each modality were investigated. A total of 312 patients with 312 primary breast cancers were investigated. Residual disease was identified in 118 patients. Of the 118 cases with residual disease, MMG and US were able to detect 77 (65.3%) and 32 (27.1%), respectively (Chi-square P<0.001). MMG was also more sensitive compared with US in estimating residual ductal carcinoma in situ (DCIS) (94.2 vs. 33.3%, respectively; P<0.001). MMG was more accurate compared with US in detecting residual disease following bioptic lumpectomy and the diagnostic accuracy of MMG was associated with the presence of residual DCIS.

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“…The use of mammography and ultrasonography for measuring residual tumor size after neoadjuvant chemotherapy has been reported previously [23,24]. Keune et al [25] recently compared the accuracy of mammography and ultrasonography in predicting pathologic response after neoadjuvant chemotherapy. Breast ultrasound was more accurate than mammography; ultrasound was able to size the final disease in 91.3% compared to only 51.9% when mammography was used ( < 0.001).…”

Section: Discussionmentioning

confidence: 99%

Which Imaging Modality Is Superior for Prediction of Response to Neoadjuvant Chemotherapy in Patients With Triple Negative Breast Cancer?

Atkins

Cyr

Appleton

et al. 2012

Journal of Surgical Research

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Background and Objectives. Triple negative breast cancer (TNBC) has been shown to be generally chemosensitive. We sought to investigate the utility of mammography (MMG), ultrasonography (US), and breast magnetic resonance imaging (MRI) in predicting residual disease following neoadjuvant chemotherapy for TNBC. Methods. We identified 148 patients with 151 Stage I-III TNBC treated with neoadjuvant chemotherapy. Residual tumor size was estimated by MMG, US, and/or MRI prior to surgical intervention and compared to the subsequent pathologic residual tumor size. Data were compared using chi-squared test. Results. Of 151 tumors, 44 (29%) did not have imaging performed prior to surgical treatment. Thirty-eight (25%) tumors underwent a pathologic complete response (pCR), while 113 (75%) had residual invasive disease. The imaging modality was accurate to within 1 cm of the final pathologic residual disease in 74 (69%) cases and within 2 cm in 94 (88%) cases. Groups were similar with regards to patient age, race, tumor size and grade, and clinical stage ( > 0.05). Accuracy to within 1 cm was the highest for US (83%) and the lowest for MMG (56%) ( < 0.05). Conclusions. Breast US and MRI were more accurate than MMG in predicting residual tumor size following neoadjuvant chemotherapy in patients with TNBC. None of the imaging modalities were predictive of a pCR.

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Accuracy of ultrasonography and mammography in predicting pathologic response after neoadjuvant chemotherapy for breast cancer

Cited by 114 publications

References 50 publications

The effect of chemotherapy on the mammographic appearance of breast cancer and correlation with histopathology

The effect of chemotherapy on the mammographic appearance of breast cancer and correlation with histopathology

Comparison of mammography and ultrasound in detecting residual disease following bioptic lumpectomy in breast cancer patients

Which Imaging Modality Is Superior for Prediction of Response to Neoadjuvant Chemotherapy in Patients With Triple Negative Breast Cancer?

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