Meta-Analysis of Quantitative Dynamic Contrast-Enhanced MRI for the Assessment of Neoadjuvant Chemotherapy in Breast Cancer

Abstract

The purpose of this meta-analysis was to determine the value of quantitative dynamic contrast-enhanced (DCE) MRI (DCE-MRI) in evaluating the response of breast cancer to neoadjuvant chemotherapy (NAC). PubMed, Embase, and Cochrane Library databases (from building to July 31, 2018) were searched to collect articles about the therapeutic evaluation of NAC using the quantitative DCE-MRI in patients with breast cancer. The sensitivities and specificities of quantitative DCE-MRI in the evaluation of NAC for breast cancer were extracted from the articles. Meta-DiSc1.4 was applied to evaluate the efficacy of the sensitivity and specificity; forest figure and summary receiver operating characteristics (SROC) were created. A total of 356 articles were enrolled in this study, including 739 cases in total, in which 218 cases were effective and the other 521 cases were ineffective to NAC, considering the pathological results as the gold standard. The sensitivity and specificity in the included 14 articles of quantitative DCE-MRI ( Ktrans, kep, and ve) in comprehensively evaluating NAC for breast cancer were 84 per cent (95% confidence interval (CI): 78–88%) and 83 per cent (95% CI: 79–86%), respectively. The area under SROC was 0.899 (95% CI: 0.867–0.943). The sensitivity and specificity in the three articles of Ktrans evaluating NAC for breast cancer were 84.1 per cent (95% CI: 71.0–92.1%) and 81.3 per cent (95% CI: 70.5%-88.5%), respectively. The area under SROC was 0.899 (95% CI: 0.834–0.962). Our study confirmed that the quantitative DCE-MRI is able to monitor NAC treatment for breast cancer because of its high sensitivity and specificity. However, there is a high degree of heterogeneity in published studies, highlighting the lack of standardization in the field.

An MRI-Based Radiomic Prognostic Index Predicts Poor Outcome and Specific Genetic Alterations in Endometrial Cancer

“…Pelvic magnetic resonance imaging (MRI) is the preferred imaging modality for local preoperative staging and routinely guides the choice of surgical procedure for endometrial cancer [ 7 ]. Radiomics involves high-throughput extraction of numerous quantitative imaging features using data-characterization algorithms [ 7 , 8 , 9 , 10 ]. Radiomic tumor features based on MRI have been shown to predict histological subtypes, treatment response, and outcome in various cancers including breast, rectal, cervical, and endometrial cancer [ 8 , 9 , 10 , 11 , 12 ].…”

“…Radiomics involves high-throughput extraction of numerous quantitative imaging features using data-characterization algorithms [ 7 , 8 , 9 , 10 ]. Radiomic tumor features based on MRI have been shown to predict histological subtypes, treatment response, and outcome in various cancers including breast, rectal, cervical, and endometrial cancer [ 8 , 9 , 10 , 11 , 12 ]. Tumor texture analysis based on a manually defined tumor region of interest (ROI) on diagnostic images is a branch of radiomics where, e.g., voxel intensity histogram shapes are assessed [ 13 ].…”

Role of MRI to Assess Response to Neoadjuvant Therapy for Breast Cancer

“…18 A meta-analysis of quantitative DCE-MRI found 84% sensitivity and 83% specificity for predicting response to therapy among the 14 included articles, but noted that the published studies are markedly heterogeneous and there is overall a lack of standardization in the field. 21 When to Assess Tumor Response? Imaging after the completion of neoadjuvant therapy is important, as it evaluates the size and location of residual disease to allow preoperative planning.…”

“…However, these pharmacokinetic parameters have not consistently shown better results than changes in tumor size in predicting response to therapy 20 and 5‐year survival 18 . A meta‐analysis of quantitative DCE‐MRI found 84% sensitivity and 83% specificity for predicting response to therapy among the 14 included articles, but noted that the published studies are markedly heterogeneous and there is overall a lack of standardization in the field 21 …”

Current Landscape of Breast Cancer Imaging and Potential Quantitative Imaging Markers of Response in ER-Positive Breast Cancers Treated with Neoadjuvant Therapy

“…From a collection of studies with small cohorts [76,[84][85][86][87][88][89][90][91], reduction in K trans and k ep values after NAC is generally found in responders, whereas non-responders showed minimal reduction, or, in some cases, an increase in K trans and k ep . In a more recent meta-analysis of 14 quantitative MRI studies of breast tumor response to NAC [92], three studies [85,86,89] with PK measurements were extracted with the combined sensitivity and specificity at 84.1% and 81.3%, respectively. These initial results suggest that K trans and k ep representing perfusion and vascular permeability may be important parameters in identifying responders from non-responders.…”