Imaging breast cancer response during neoadjuvant systemic therapy

Abstract

Neoadjuvant systemic therapy is used to enable breast-conserving surgery in patients with large primary operable breast cancers. It is important to be able to accurately assess response to systemic therapy, both to assist the surgeon and for prognostic purposes. Moreover, a proportion of women will fail to respond to treatment and would potentially benefit from either a change in therapy or earlier surgery rather than continuing completion of the planned course of treatment. Conventional techniques of assessing response (clinical examination, x-ray mammography and breast ultrasound) rely on changes in tumor size, which are often delayed and do not always correlate with pathologic response. This review examines the evidence for functional imaging techniques including scintimammography, functional computed tomography, dynamic magnetic resonance imaging, spectroscopy and positron emission tomography. These techniques measure changes in tumor vasculature, metabolism or proliferation and may prove to be earlier and more sensitive measures of response to systemic therapy, thus enabling tailoring of an individual's treatment.

Does MRI predict pathologic tumor response in women with breast cancer undergoing preoperative chemotherapy?

“…In our study mammography measurements were not routinely recorded after the induction of chemotherapy and correlation between pathology and imaging was not possible. In the setting of neoadjuvant therapy, these measurement discrepancies may be magnified because conventional techniques rely on changes in gross tumor size which may be confounded by a non-uniform pathologic response [23]. In addition, chemotherapy may induce a fibrotic responses in some tumors [24], which may mask the true tumor size when assessed with conventional techniques.…”

Proceedings of the october symposium on mri in oncology: old truths and new trends

“…Contrast enhancement on MRI is related to tumor vascularity, thus, reduction in enhancement is a measure of early response to chemotherapy. Enhancement on MR correlates well with vital tumor (6).…”

Künstliche Intelligenz in der Mammadiagnostik

“…gezielte Biopsie von Lymphknoten hat in den letzten Jahren an Bedeutung gewonnen [16]. Im Fall neoadjuvanter Therapien werden bildgebende Verfahren zur Beurteilung des Therapieansprechens angewendet [37]. Eine akkurate Diagnose der Vitalität residueller Tumoranteile oder ein frühzeitig im Therapieverlauf mittels bildgebender Marker zu diagnostizierendes Therapieversagen wären für die Adaption von Therapiestrategien äußerst wünschenswert [38].…”