Contrast-Enhanced Spectral Mammography is Comparable to MRI in the Assessment of Residual Breast Cancer Following Neoadjuvant Systemic Therapy

Sobrinho

BioMed Research International

et al. 2018

Objective To evaluate the performance of contrast-enhanced mammography (CEM) compared to magnetic resonance imaging (MRI) for estimating residual tumor size after neoadjuvant chemotherapy (NAC) in women with newly diagnosed breast cancer. Methods The institutional review board approved this study. This prospective study included women with newly diagnosed breast cancer who underwent breast CEM and MRI at the end of the last cycle of NAC and before definitive surgery. Size of residual malignancy on post-NAC CEM and MRI was compared with surgical pathology. Agreements and correlations of CEM and MRI measurements with histological size were assessed. Results Thirty-three patients were included with a mean age of 45 years (range 22–76). The sensitivity, specificity, and positive and negative predictive value for detection of residual disease of CEM were 76%, 87.5%, 95%, and 86.4%, and those of MRI were 92%, 75%, 92%, and 75%. Comparing CEM to MRI, the mean difference was −0.8 cm, concordance coefficient was 0.7, and Pearson correlation was 0.7 (p = 0.0003). The concordance coefficient between measurements of each imaging modality and pathologic tumor size was 0.7 for CEM and 0.4 for MRI. Pearson correlation was 0.8 for CEM and 0.5 for MRI. Mean differences between CEM, MRI, and residual histopathological tumor size were 0.8 cm and 1.8 cm, respectively. Conclusions CEM has good correlation and agreement with histopathology for measuring residual disease after NAC. CEM was comparable to MRI, showing high positive predictive value and specificity for detecting residual disease.

Section: Discussionsupporting

confidence: 87%

Contrast-Enhanced Mammography (CEM) for Detecting Residual Disease after Neoadjuvant Chemotherapy: A Comparison with Breast Magnetic Resonance Imaging (MRI)

Sobrinho

BioMed Research International

et al. 2018

Egypt J Radiol Nucl Med

“…They reported good correlation between both modalities (agreement: 0.76) and thus they concluded that CESM is as reliable as MRI and may be used as an adequate alternative [2]. In another study, Patel et al concluded that the accuracy of CESM was equivalent to MRI in assessing residual disease after NAC [13]. However, these two studies depend on residual tumor size assessment.…”

Section: Discussionmentioning

confidence: 98%

“…To our knowledge, this work is the first research that uses objective and quantitative mathematical evaluation using CESM. Previous published articles in literature in the same setting have only used subjective qualitative assessment methods and quantitative assessments only relied on measuring change in tumor size based on RECIST and measuring size of residual disease which is liable to over or under estimation [2,13]. None of these researches discussed quantitative change in intensity of contrast uptake which reflects actual change in tumor cell activity.…”

Section: Introductionmentioning

confidence: 99%

Quantitative mathematical objective evaluation of contrast-enhanced spectral mammogram in the assessment of response to neoadjuvant chemotherapy and prediction of residual disease in breast cancer

Moustafa

Kamal

Gomaa

et al. 2019

Background: The aim of the study is to initiate a new quantitative mathematical objective tool for evaluation of response to neoadjuvant chemotherapy (NAC) and prediction of residual disease in breast cancer using contrastenhanced spectral mammography (CESM). Forty-two breast cancer patients scheduled for receiving NAC were included. All patients underwent two CESM examinations: pre and post NAC. To assess the response to neoadjuvant chemotherapy, we used a mathematical image analysis software that can calculate the difference in the intensity of enhancement between the pre and post neoadjuvant contrast images (MATLAB and Simulink) (Release 2013b). The proposed technique used the pre and post neoadjuvant contrast images as inputs. The technique consists of three main steps: (1) preprocessing, (2) extracting the region of interest (ROI), and (3) assessment of the response to chemotherapy by measuring the percentage of change in the intensity of enhancement of malignant lesions in the pre and post neoadjuvant CESM studies using a quantitative mathematical technique. This technique depends on the analysis of number of pixels included within the ROI. We compared this technique with the currently used method of evaluation: RECIST 1.1 (response evaluation criteria in solid tumors 1.1) and using another combined response evaluation approach using both RECIST 1.1 in addition to a subjective visual evaluation. Results were then correlated with the postoperative pathology evaluation using Miller-Payne grades. For statistical evaluation, patients were classified into responders and non-responders in all evaluation methods.

Journal of Surgical Oncology

“…Contrast (iohexol)‐enhanced spectral mammography (CESM) was compared to MRI by Patel et al in the assessment of tumor response for 65 patients after NAC. There were 34 rCRs for CESM and 33 for MRI.…”

Section: Discussionmentioning

confidence: 99%

MRI does not predict pathologic complete response after neoadjuvant chemotherapy for breast cancer

Sener

Sargent

Lee

et al. 2019

Background This study assessed whether magnetic resonance imaging (MRI) could accurately predict pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) for patients receiving standardized treatment, pre‐ and post‐NAC MRI on the same instrumentation using a consistent imaging protocol, interpreted by a single breast fellowship‐trained radiologist. Methods A single‐institution retrospective analysis was performed including clinical, radiographic, and pathologic parameters for all patients with breast cancer treated with NAC from 2015 to 2018. Radiographic complete response (rCR) was defined as absence of suspicious MRI findings in the ipsilateral breast or lymph nodes. pCR was defined as the absence of invasive cancer or ductal carcinoma in‐situ in breast or lymph nodes after operation (ypT0N0M0). Results Data for 102 consecutive patients demonstrated that 44 (43.1%) had rCR and 41 (40.1%) had pCR. pCR occurred in 12 (25.0%) of 48 estrogen receptor positive (ER+) patients, 29 (53.7%) of 54 ER− patients, and 25 (52.1%) of 48 human epidermal growth factor receptor 2 positive patients. The positive predictive value for MRI after NAC was 84.5% and the negative predictive value was 72.7%. The accuracy rate for MRI was 78.6%. Of the 44 patients with rCR, 12 (27.3%) had residual cancer on the pathologic specimen after surgical excision. Conclusion rCR is not accurate enough to serve as a surrogate marker for pCR on MRI after NAC.