Diagnostic Performance of Magnetic Resonance Imaging for Assessing Tumor Response in Patients With HER2-Negative Breast Cancer Receiving Neoadjuvant Chemotherapy is Associated With Molecular Biomarker Profile

Kuzucan, Aida; Chen, Jeon‐Hor; Bahri, Shadfar; Mehta, Rita S.; Carpenter, Philip M.; Fwu, Peter T.; Yu, Hua; Hsiang, David; Lane, Karen; Butler, John; Feig, Stephen A.; Su, Min‐Ying

doi:10.1016/j.clbc.2012.01.009

Cited by 36 publications

(29 citation statements)

References 45 publications

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“…In an additional study by the same group (12) mean MRI-pathological size discrepancy was identified to be smaller in HER2-positive and hormone receptor-negative tumors or tumors with high Ki67 scores compared with their counterparts. In addition, among HER2-negative tumors, the accuracy of MRI for predicting pCR was increased in hormone receptor-negative cancers compared with hormone receptor positive-cancers and was also improved in high-proliferation tumors compared with low-proliferation tumors (13). In another study, MRI more accurately predicted tumor sizes following NAC in HER2-positive and triple-nega- Residual DCIS (%) tive tumors compared with luminal tumors (14).…”

Section: Discussionmentioning

confidence: 88%

Analysis of complete response by MRI following neoadjuvant chemotherapy predicts pathological tumor responses differently for molecular subtypes of breast cancer

et al. 2012

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Abstract. In the present study, clinical tumor response following neoadjuvant chemotherapy (NAC) was diagnosed by magnetic resonance imaging (MRI) and clinicopathological factors, including molecular subtypes at baseline, were analyzed for correlations with pathological tumor responses. In addition, clinicopathological factors were analyzed for a correlation with the MRI capacity to predict pathological complete response (pCR). Clinical tumor response evaluated by MRI following NAC was determined as a clinical CR (cCR) or a residual tumor. cCR was confirmed if no gadolinium enhancement or an enhancement equal to or less than that of glandular tissue was observed in any phase of the MRI. Pathological tumor responses following NAC were classified into grades 0 (no change) to 3 (no residual invasive cancer) according to criteria of the Japanese Breast Cancer Society. pCR was defined as grade 3 in the present study. Of 264 cases of invasive breast cancer in 260 patients (4 synchronous bilateral breast cancer cases), 59 (22%) were diagnosed by MRI following NAC as cCR and 98 (37%) were pathologically diagnosed as pCR. In terms of predicting pCR by MRI, the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were 44, 90, 73, 73 and 73%, respectively. Tumor size, hormone receptor status, human epidermal growth factor receptor 2 (HER2) status, molecular subtype and histological type were significantly correlated with pathological tumor responses. pCR rates increased in the following order: luminal/HER2-negative (14%), luminal/HER2-positive (32%), triple-negative (46%) and non-luminal/HER2-positive (73%) tumors. Sensitivity and specificity were the highest (60 and 100%, respectively) in triple-negative tumors. PPV decreased in the following order: triple-negative (100%), non-luminal/HER2-positive (92%), luminal/HER2-positive (46%) and luminal/HER2-negative (33%) tumors. In conclusion, MRI evaluation is useful for predicting pCR following NAC, particularly for triple-negative tumors.

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Section: Discussionmentioning

confidence: 88%

Analysis of complete response by MRI following neoadjuvant chemotherapy predicts pathological tumor responses differently for molecular subtypes of breast cancer

et al. 2012

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“…The biologic explanation for this may be that HER2-negative breast cancer is associated with decreased angiogenesis, resulting in impaired tumor tissue perfusion of MRI contrast (26). Also, hormone receptor-positive tumors have a different growth pattern than hormone receptor-negative tumors, with less often (unifocal) mass-like lesions, making it more difficult to accurately determine the residual tumor diameter (8,27).…”

Section: Discussionmentioning

confidence: 99%

Optical Mammography Using Diffuse Optical Spectroscopy for Monitoring Tumor Response to Neoadjuvant Chemotherapy in Women with Locally Advanced Breast Cancer

Schaafsma

Giessen

Charehbili

et al. 2015

Clinical Cancer Research

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Purpose: Diffuse optical spectroscopy (DOS) has the potential to enable monitoring of tumor response during chemotherapy, particularly in the early stages of treatment. This study aims to assess feasibility of DOS for monitoring treatment response in HER2-negative breast cancer patients receiving neoadjuvant chemotherapy (NAC) and compare DOS with tumor response assessment by MRI.Experimental Design: Patients received NAC in six cycles of 3 weeks. In addition to standard treatment monitoring by dynamic contrast enhanced MRI (DCE-MRI), DOS scans were acquired after the first, third, and last cycle of chemotherapy. The primary goal was to assess feasibility of DOS for early assessment of tumor response. The predictive value of DOS and DCE-MRI compared with pathologic response was assessed.Results: Of the 22 patients, 18 patients had a partial or complete tumor response at pathologic examination, whereas 4 patients were nonresponders. As early as after the first chemotherapy cycle, a significant difference between responders and nonresponders was found using DOS (HbO 2 86% AE 25 vs. 136% AE 25, P ¼ 0.023). The differences between responders and nonresponders continued during treatment (halfway treatment, HbO 2 68% AE 22 vs. 110% AE 10, P ¼ 0.010). Using DCE-MRI, a difference between responders and nonresponders was found halfway treatment (P ¼ 0.005) using tumor volume measurement calculations.Conclusions: DOS allows for tumor response assessment and is able to differentiate between responders and nonresponders after the first chemotherapy cycle and halfway treatment. In this study, DOS was equally effective in predicting tumor response halfway treatment compared with DCE-MRI. Therefore, DOS may be used as a novel imaging modality for (early) treatment monitoring of NAC.

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“…Previously published datasets have shown that MRI most accurately predicts the amount of residual pathologic disease in HR-negative subtypes rather than HR-positive subtypes (11,(16)(17)(18)(19). The concept of variation in clinical response evaluation accuracy by breast cancer subtype is important for the design of future response-guided NACT trials.…”

Section: Figure 2 Positive Predictive Value (Ppv) (A) and False-posimentioning

confidence: 99%

“…Recent studies have shown that the accuracy of imaging in clinical response evaluation varies by breast cancer subtype according to HR and HER2 status (11)(12)(13)(14)(15)(16)(17)(18)(19). Specifically, MRI more accurately predicts pathologic response in HR-negative subtypes rather than HRpositive stubtypes (11,(16)(17)(18)(19).…”

mentioning

confidence: 99%

Breast Cancer Subtype Influences the Accuracy of Predicting Pathologic Response by Imaging and Clinical Breast Exam After Neoadjuvant Chemotherapy

Waldrep

Avery

Rose

et al. 2016

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Abstract. Background/Aim: Clinical response evaluation after neoadjuvant chemotherapy (NACT) for breast cancer could include various imaging methods, as well as clinical breast exam (CBE).Neoadjuvant chemotherapy (NACT) for early breast cancer is equivalent to adjuvant chemotherapy in terms of disease-free survival and overall survival (1). The major difference between NACT and adjuvant chemotherapy is the ability to directly observe the treatment effect on the tumor. Clinical response can be assessed throughout the administration of NACT, while pathologic response is revealed upon breast surgery after completion of NACT. A pathologic complete response (pCR) after NACT, defined as no residual invasive breast cancer, translates into an improved long-term prognosis (2, 3).The use of NACT also provides the opportunity to explore the potential value of response-guided therapy for early nonresponders (4-6). An improvement in disease-free survival for hormone receptor (HR)-positive breast cancer using a response-guided NACT regimen has been reported previously (4). On the other end of the spectrum, it could hypothetically be beneficial to identify early responders, who may have reached a complete remission after a shorter duration of therapy than planned. For these patients, completing NACT to the planned number of cycles could be unnecessary and potentially detrimental in terms of toxicity and cost.Routine clinical breast exam (CBE), as well as imaging modalities, such as mammography (MG), ultrasound (US) and magnetic resonance imaging (MRI), have been used to assess clinical response in an attempt to predict pathological response. A meta-analysis revealed that MRI most accurately predicts the amount of residual pathologic disease in nonsubtyped early breast cancer patients when compared to CBE, MG and US (7). Yet, there have been conflicting reports on whether MRI typically underestimates or overestimates the amount of residual disease after NACT (8,9). The routine use of MRI in clinical practice may at times be challenged by a patient's pre-existing conditions, technical feasibility and 5389

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Diagnostic Performance of Magnetic Resonance Imaging for Assessing Tumor Response in Patients With HER2-Negative Breast Cancer Receiving Neoadjuvant Chemotherapy is Associated With Molecular Biomarker Profile

Cited by 36 publications

References 45 publications

Analysis of complete response by MRI following neoadjuvant chemotherapy predicts pathological tumor responses differently for molecular subtypes of breast cancer

Analysis of complete response by MRI following neoadjuvant chemotherapy predicts pathological tumor responses differently for molecular subtypes of breast cancer

Optical Mammography Using Diffuse Optical Spectroscopy for Monitoring Tumor Response to Neoadjuvant Chemotherapy in Women with Locally Advanced Breast Cancer

Breast Cancer Subtype Influences the Accuracy of Predicting Pathologic Response by Imaging and Clinical Breast Exam After Neoadjuvant Chemotherapy

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