Breast MRI for monitoring response of primary breast cancer to neo-adjuvant chemotherapy

Abstract

The objective of the present study was to monitor response to preoperative chemotherapy with breast MRI in patients with large breast cancer. Fifty-eight women in whom core biopsy had confirmed the presence of breast carcinoma underwent breast MRI prior to beginning chemotherapy and before surgical excision. In 24 cases patients underwent one or two additional examinations during chemotherapy to monitor their progress. Breast MRI included both T2-weighted spin-echo sequences and T1-weighted gradient-echo sequences before and 1, 2, 3, and 8 min after bolus injection of gadolinium-DTPA. Tumor size and the dynamic contrast medium uptake patterns of the respective carcinomas were evaluated and compared with the final histology findings. Based on their MR tomographic findings (change in tumor size and intensity of contrast media uptake), patients were assigned to groups with non-response (NR), partial response (PR), and complete response (CR). Based on MR tomographic findings, there were 12 patients in the NR group, 34 in the PR group, and 12 in the CR group. In NR group contrast medium uptake tended to increase or show no more than minimal decrease. Diagnostic accuracy for assigning patients to the NR group was 83.3% and to the PR group 82.4%. In patients whose tumors showed only slight response to chemotherapy, breast MRI proved very reliable in determining the size of the lesions. In patients whose tumors displayed significant response and in the CR group, the size of the residual tumor was underestimated in 8 of 12 cases. In 66.7% of patients in the CR group histology revealed residual tumor masses in areas up to 5 cm in diameter. During chemotherapy, intensity of contrast medium uptake decreased in 88.2% of patients with PR and in all patients with CR. Reliable determination of response was possible within 6 weeks following the initiation of chemotherapy. Breast MRI is suitable as a monitoring method. The determination of residual tumor size is unreliable in carcinomas exhibiting significant response to chemotherapy which may lead to false-negative results. The method may be employed for monitoring response to chemotherapy after 6 weeks.

Can breast MRI help in the management of women with breast cancer treated by neoadjuvant chemotherapy?

“…This is demonstrated in Table 5a where it is seen that the commonest limitation of the value of CE MRI is to underestimate residual tumour when compared with final pathology. Several authors (Gilles et al, 1994;Drew et al, 2001;Weatherall et al, 2001;Partridge et al, 2002) have found very good prediction of residual tumour by breast MRI, whereas Rieber in two studies had findings similar to ours (Rieber et al, 1997(Rieber et al, , 2002. We wish to seek the explanation for this in greater detail, and will do so by a separate publication studying the dynamic analysis compared with detailed pathology.…”

Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer

“…Several studies have suggested that MRI is a more accurate method of delineating residual tumour following neoadjuvant chemotherapy than clinical, ultrasound or mammographic assessment (Boetes et al, 1995;Abraham et al, 1996;Drew et al, 1999Drew et al, , 2001Fischer et al, 1999;Balu-Maestro et al, 2002;Rieber et al, 2002;Cheung et al, 2003;Rosen et al, 2003;Martincich et al, 2004;Warren et al, 2004). Chemotherapy-induced fibrosis has been shown to impair the evaluation of tumour by conventional radiological methods and physical examination (Cocconi et al, 1984;Segel et al, 1988).…”

Assessment of residual tumour by FDG-PET: conventional imaging and clinical examination following primary chemotherapy of large and locally advanced breast cancer

“…Breast ultrasound, mammography, and clinical examination tend to overestimate the residual tumour volume because of chemotherapy-induced necrosis and fibrosis (Yeh et al, 2005). Magnetic resonance imaging of the breast has been shown to be a sensitive method for visualisation of residual tumour, but the negative predictive value seems to be limited (Abraham et al, 1996;Rieber et al, 2002;Wasser et al, 2003;Denis et al, 2004;Warren et al, 2004;Belli et al, 2006;Segara et al, 2007). There is little information available on the potential role of FDG-PET in the assessment of residual breast cancer following primary chemotherapy.…”