Monitoring the Size and Response of Locally Advanced Breast Cancers to Neoadjuvant Chemotherapy (Weekly Paclitaxel and Epirubicin) with Serial Enhanced MRI

Cheung, Yun‐Chung; Chen, Shih-Cheh; Su, Min–Ying; See, Lai‐Chu; Hsueh, Swei; Chang, Hsien‐Kun; Lin, Yung‐Chang; Tsai, Chien-Sheng

doi:10.1023/a:1022153327339

Cited by 124 publications

(83 citation statements)

References 19 publications

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“…Other groups have reported correlations of r ¼ 0.6 (Partridge et al, 2002) and r ¼ 0.982 (Cheung et al, 2003).…”

Section: Discussionmentioning

confidence: 92%

“…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%

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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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“…Other groups have reported correlations of r ¼ 0.6 (Partridge et al, 2002) and r ¼ 0.982 (Cheung et al, 2003).…”

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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

et al. 2008

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“…Recent pilot studies in both MRI and Near-Infrared Spectroscopy (NIR) have shown that more global estimates of cancer, such as water content and vascular volume changes, can be good predictors of response in primary breast cancer [14][15][16][17][18]. Total water content and vascular volume are robust signals in that they can be measured with a good signal to noise ratio, and biological variations in these are generally low, except in response to intervention.…”

Section: Introductionmentioning

confidence: 99%

“…Total water content and vascular volume are robust signals in that they can be measured with a good signal to noise ratio, and biological variations in these are generally low, except in response to intervention. Further, and of great potential interest, in pilot studies there is evidence that these biophysical changes occur within the first cycle of chemotherapy [14][15][16][17][18], which could have considerable prognostic value if confirmed with high specificity. Thus a key factor being tested in multi-center trials now is to determine the sensitivity and specificity of NIR or MRI as a measurement of response within the first cycle of NACT, and if this value is sufficient for a cost-effective test.…”

Section: Introductionmentioning

confidence: 99%

Prognostic imaging in neoadjuvant chemotherapy of locally-advanced breast cancer should be cost-effective

Schegerin

Kaufman

Paulsen

et al. 2008

Breast Cancer Res Treat

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Introduction-The use of neoadjuvant chemotherapy in cases of locally advanced breast cancer has been steadily increasing, and is also in wider use for other cancers. As a consequence, a growing number of studies have focused on the question of how best to assess the therapeutic response to various chemotherapy or systemic therapy regimens. Prognostic imaging of response to therapy early in the course of a planned chemotherapy regimen could be of considerable value, particularly if shifting to another therapy regimen would be more effective.

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“…Promising results have been reported for diagnosis (7), therapy response monitoring (8,9), and survival prediction (10)(11)(12). Both semiquantitative (calculated directly from the contrast uptake curves) and pharmacokinetic parameters (based on kinetic modeling of the contrast uptake curves) (13) can be obtained by analyzing MRI data from the breast.…”

mentioning

confidence: 99%

Monitoring neoadjuvant chemotherapy in breast cancer patients: Improved MR assessment at 3 T?

Heldahl

Lundgren

Jensen

et al. 2011

Magnetic Resonance Imaging

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Purpose: To investigate possible improvements in predicting the response to neoadjuvant chemotherapy (NAC) at 3 T for locally advanced breast cancer (LABC). Materials and Methods:Dynamic contrast-enhanced magnetic resonance (DCE-MR) images acquired before and during NAC were retrospectively analyzed in 85 patients. Tumor volume and diameter, three volumes based on the shape of the enhancement curve, relative signal intensity, area under the curve, and the signal-tonoise ratio were extracted. Differences between responders and nonresponders at the same and between MR timepoints during treatment were evaluated.Results: A higher signal-to-noise ratio was observed on 3 T images compared to 1.5 T, and 3 T revealed more significant findings related to response compared to 1.5 T. The DCE-MRI-derived volume parameters were the earliest predictors of response at both 1.5 and 3 T. Conclusion:Our results show that 3 T provides an improved assessment of the response to NAC in LABC patients, where the MR determined tumor volume reduction before the second cycle of NAC was the strongest and earliest predictor of a response.

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Monitoring the Size and Response of Locally Advanced Breast Cancers to Neoadjuvant Chemotherapy (Weekly Paclitaxel and Epirubicin) with Serial Enhanced MRI

Cited by 124 publications

References 19 publications

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

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

Prognostic imaging in neoadjuvant chemotherapy of locally-advanced breast cancer should be cost-effective

Monitoring neoadjuvant chemotherapy in breast cancer patients: Improved MR assessment at 3 T?

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