Clinical Application of Magnetic Resonance Imaging in Management of Breast Cancer Patients Receiving Neoadjuvant Chemotherapy

Abstract

Neoadjuvant chemotherapy (NAC), also termed primary, induction, or preoperative chemotherapy, is traditionally used to downstage inoperable breast cancer. In recent years it has been increasingly used for patients who have operable cancers in order to facilitate breast-conserving surgery, achieve better cosmetic outcome, and improve prognosis by reaching pathologic complete response (pCR). Many studies have demonstrated that magnetic resonance imaging (MRI) can assess residual tumor size after NAC, and that provides critical information for planning of the optimal surgery. NAC also allows for timely adjustment of administered drugs based on response, so ineffective regimens could be terminated early to spare patients from unnecessary toxicity while allowing other effective regimens to work sooner. This review article summarizes the clinical application of MRI during NAC. The use of different MR imaging methods, including dynamic contrast-enhanced MRI, proton MR spectroscopy, and diffusion-weighted MRI, to monitor and evaluate the NAC response, as well as how changes of parameters measured at an early time after initiation of a drug regimen can predict final treatment outcome, are reviewed. MRI has been proven a valuable tool and will continue to provide important information facilitating individualized image-guided treatment and personalized management for breast cancer patients undergoing NAC.

Magnetic resonance imaging evaluation of residual tumors in breast cancer after neoadjuvant chemotherapy: surgical implications

“…Consequently, a number of studies have evaluated the capability of imaging for monitoring response to chemotherapy (4)(5)(6)(7). Several studies have reported false positive and false negative results following dynamic contrast-enhanced MRI (DCE-MRI) for detecting residual tumor, or mixed results, as based on the changes that occur in the vascular network and enhancement dynamic of the tumor after treatment (8)(9)(10)(11)(12).…”

Quantitative evaluation of breast cancer response to neoadjuvant chemotherapy by diffusion tensor imaging: Initial results

“…Magnetic resonance imaging (MRI), an important adjuvant tool for the detection and characterization of breast cancer, 3,4 has also been utilized to monitor the effects of NAC, using dynamic contrast enhancement (DCE), as well as diffusion-weighted imaging (DWI) and MR spectroscopy (MRS). [5][6][7][8][9][10][11][12] The MRI evaluation of therapeutic results during the course of NAC, performed in comparison to other methods and to histopathological findings, have shown potential for improving the early assessment and prediction of tumor response and for determining residual tumor size at the end of therapy before surgery. [13][14][15][16] Several studies that compared response evaluation of DCE-MRI to that of DWI [17][18][19] and suggested that the combined use of these two methods has the potential to improve the diagnostic performance in monitoring NAC.…”

Neoadjuvant chemotherapy with MRI monitoring for breast cancer

“…However, in 40 patients (15·6 per cent), further disease was found on MRI, which could potentially lead to a change in the type of surgery chosen. In addition, it has been demonstrated that the vascularity of the tumour on MRI predicts pCR, so the baseline MRI could also be important in providing prognostic information. A systematic review concluded that current evidence on using pretreatment MRI and early response monitoring to predict response to NACT is weak.…”