Evaluation of neoadjuvant chemotherapeutic response of locally advanced breast cancer by magnetic resonance imaging

Abraham, Dana C.; Jones, Ronald C.; Jones, Stephen E.; Cheek, J. Harold; Peters, G.; Knox, Sally M.; Grant, Michael D.; Hampe, David W.; Savino, Daniel A.; Harms, Steven E.

doi:10.1002/(sici)1097-0142(19960701)78:1<91::aid-cncr14>3.0.co;2-2

Cited by 222 publications

(120 citation statements)

References 28 publications

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“…Although this study did not focus on the prognostic relationship among these findings, it is in consonance with other studies that have shown that the variety of pathologic responses *chi-square test; p < 0.05 significant **ANOVA one tailed; p < 0.05 significant seen indicates that the entire pre-chemotherapy tumor area should be removed [10,15]. For some authors, the diversity of pathologic findings indicates the need for mastectomy [16,17]. Other authors argue that the low recurrence rates reported in selected cases of T3 and T4 show that these patients could rather undergo conserving surgery [3,18].…”

Section: Discussionsupporting

confidence: 81%

Evaluation of Surgical Outcomes of Oncoplasty Breast Surgery in Locally Advanced Breast Cancer and Comparison with Conventional Breast Conservation Surgery

Chauhan

Sharma

Kumar

2016

Indian J Surg Oncol

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The purpose of this study was to compare early oncologic outcomes of oncoplastic breast surgery and conventional breast conservation surgery in patients of locally advanced breast cancer. A single-center, prospective, nonrandomized study enrolled select cases of locally advanced breast cancer (TNM T3/T4, N0/1/2) who after neoadjuvant chemotherapy, were considered for breast conservation surgery with oncoplasty techniques. The specimen volume resected, the mean margins and mean closest margin obtained were noted. The re-surgery rates, complication rates, and incidence of locoregional recurrence were also noted. Variables were compared with a retrospective cohort of similar patients who had undergone conventional breast conservation surgery. Fifty-seven patients underwent OBS (group 1) and were compared with 43 cases that had undergone conventional BCS (group 2). Majority of the patients in group 1 (73 %) had cT3 with N0 or N+ and a minority (17 %) were with limited skin involvement (cT4 and N0/N+). Relatively larger sized, post-NACT tumors could undergo OBS(4.4 vs 2.3 cm). Relatively greater proportion of tumors in central and lower quadrants were addressed by oncoplasty than traditional BCS (17/57, 29 % vs 4/43, 9 %, p = 0.04). The mean specimen volume excised in group 1 was more than that in group 2. (187.54 vs 125.19; p = 0.01). The mean of the margins were obtained more in group 1 (1.04 vs 0.69 cm); p < 0.01) as also the mean closest margin (0.86 vs 0.49 cm; p < 0.01). The incidence of close or involved margins was lesser in the OBS group (8 vs 24 %). Overall incidence of complications was similar in both groups (8/57, 14 % vs 4/43, 9 %; p = 0.34 NS). The median follow-up period of group 1 is 18 months (range 06-30 months) while group 2 is 34 months (14-44 months. There was no recurrence in group 1, but there were 5 cases (11 %) in group 2. Oncoplasty breast surgery offers more opportunity for breast conservation and oncologic safety than conventional breast conserving surgery.

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Section: Discussionsupporting

confidence: 81%

Evaluation of Surgical Outcomes of Oncoplasty Breast Surgery in Locally Advanced Breast Cancer and Comparison with Conventional Breast Conservation Surgery

Chauhan

Sharma

Kumar

2016

Indian J Surg Oncol

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“…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).…”

Section: Discussionmentioning

confidence: 99%

“…It has been suggested that breast magnetic resonance imaging (MRI) is more accurate in the diagnosis of primary breast cancer (Cocconi et al, 1984;Gilles et al, 1994;Abraham et al, 1996;Drew et al, 1999) and we therefore, wished to assess its use in the evaluation of tumour response and residual tumour size following chemotherapy when compared with conventional imaging. More accurate information may enable appropriate planning of surgery including BCS, minimising re-excision rates while maintaining the efficacy and possibility of cure.…”

mentioning

confidence: 99%

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

et al. 2008

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Contrast-enhanced magnetic resonance imaging (MRI) was used to monitor the response of patients undergoing neoadjuvant chemotherapy for breast cancer with the aim of undergoing breast-conserving surgery (BCS). Patients were prospectively recruited to undergo MRI as well as conventional methods of clinical examination, mammography (MM) and ultrasonography (USS) and response was assessed by each of these methods. Thirty-two patients with primary breast cancer were recruited. Magnetic resonance imaging correlation with histopathological size (r ¼ 0.71) was superior to USS (r ¼ 0.65) and to MM where tumour size was not measurable following chemotherapy in 71% of patients. Magnetic resonance imaging had 87.5% sensitivity (95% CI ¼ 68 -97%) and 50% specificity (95% CI ¼ 16 -84%) for a PPV (positive predictive value) of 99.8% and NPV (negative predictive value) of 80% for the detection of residual invasive cancer. Magnetic resonance imaging displayed 80% sensitivity (95% CI ¼ 28.4 -99.5%) and 89% specificity (95% CI ¼ 71 -98%) to detect pathological pCR in the breast. Eighty-four per cent of recruited patients were identified as potentially suitable candidates for BCS following chemotherapy and of those choosing to accept BCS, breast conservation was achieved in 90.5%, or 65.6% of all patients. Of those who proceeded to BCS, 9.5% required a re-do mastectomy because of positive margins; however, no residual tumour was found on histological examination of mastectomy specimens. Magnetic resonance imaging appears to be superior to conventional methods for assessing pathological response and the low rate of re-operation for positive margins indicates a valuable role in aiding the decision to undergo BCS or mastectomy.

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“…23 With a sensitivity ranging from 63% to 100%, the MRI scan seems to be an accurate method of delineating residual tumor volume after neoadjuvant therapy for large breast tumors. [25][26][27][28][29] In our study, clinicopathologic sizes were well correlated with breast imaging, which was performed to rule out breast-preserving surgery. However, postchemotherapy mammograms could show extensive calcifications or stable disease whereas histopathologic results revealed breast-conserving surgery feasibility.…”

Section: Discussionmentioning

confidence: 75%

Breast‐conserving surgery after neoadjuvant anthracycline‐based chemotherapy for large breast tumors

Rouzier

Mathieu

Sidéris

et al. 2004

Cancer

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BACKGROUNDRandomized trials comparing neoadjuvant versus adjuvant chemotherapy show that primary chemotherapy allows more frequent breast‐preserving surgery even though no survival advantage has been demonstrated. The aim of the current study was to determine the predicting factors and the survival impact of breast conservation in patients with large breast tumors treated with neoadjuvant chemotherapy.METHODSBetween January 1987 and December 2001, 594 patients with invasive T2–3 breast carcinoma who were ineligible for breast‐conserving surgery (the mean initial tumor diameter was 49 mm) were treated with 3 or 4 courses of an anthracycline‐based primary chemotherapy, surgery, and radiotherapy. Various clinicopathologic factors were tested as possible predicting factors of breast‐preserving surgery. Survival analyses were performed to determine the implications of breast‐conserving surgery on outcome.RESULTSAfter primary chemotherapy, 287 (48%) patients were eligible for breast‐conserving surgery and 307 patients underwent a mastectomy. Initial tumor diameter > 5 cm, low histologic grade, lobular histology, and multicentricity were independent predicting factors of breast conservation ineligibility in the multivariate analysis (logistic regression). In the univariate survival analysis, a failure of breast‐preserving surgery was associated with a poor outcome. Local disease recurrence‐free survival rates were similar in patients treated with lumpectomy and mastectomy.CONCLUSIONSThe results reported in the current study suggested that initial diameter, histologic type and grade, and multicentricity are potential prechemotherapy predicting factors of breast conservation. When carefully selected, patients treated with breast conservation had a risk of local disease recurrence similar to the risk of chest wall disease recurrence after mastectomy. Cancer 2004. © 2004 American Cancer Society.

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Evaluation of neoadjuvant chemotherapeutic response of locally advanced breast cancer by magnetic resonance imaging

Cited by 222 publications

References 28 publications

Evaluation of Surgical Outcomes of Oncoplasty Breast Surgery in Locally Advanced Breast Cancer and Comparison with Conventional Breast Conservation Surgery

Evaluation of Surgical Outcomes of Oncoplasty Breast Surgery in Locally Advanced Breast Cancer and Comparison with Conventional Breast Conservation Surgery

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

Breast‐conserving surgery after neoadjuvant anthracycline‐based chemotherapy for large breast tumors

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