MRI, Clinical Examination, and Mammography for Preoperative Assessment of Residual Disease and Pathologic Complete Response After Neoadjuvant Chemotherapy for Breast Cancer: ACRIN 6657 Trial

Scheel, John R.; Kim, Eun‐Hee; Partridge, Savannah C.; Lehman, Constance D.; Rosen, Mark; Bernreuter, Wanda K.; Pisano, Etta D.; Marques, Helga S.; Morris, Elizabeth A.; Weatherall, Paul T.; Polin, Sandra M.; Newstead, Gillian M.; Esserman, Laura J.; Schnall, Mitchell D.; Hylton, Nola M.; Team, Acrin Trial

doi:10.2214/ajr.17.18323

Cited by 104 publications

(52 citation statements)

References 36 publications

(58 reference statements)

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“…To evaluate residual tumor size, physical examination, mammography, US, and MRI have been used. Of these, MRI is the most accurate method, as it is difficult for other modalities to distinguish posttreatment fibrosis or postbiopsy change from residual tumor following NAC (131,132). However, because findings of breast cancers following NAC vary depending on tumor subtype, histologic type, and time points of MRI acquisitions, a refined strategy for accurate interpretation is crucial.…”

Section: Evaluation Of Women Treated With Neoadjuvant Chemotherapymentioning

confidence: 99%

“…For the detection of residual cancer after NAC, a meta-analysis including 44 studies (131) found that the median sensitivity was 92% and the median specificity was 90%. Although MRI has a better correlation with pathologic tumor size after NAC than physical examination, mammography, or US (131,132), underestimation or overestimation can occur because of scattered microscopic foci of residual tumor or fibrosis (144). Tumor size evaluation after NAC is therefore somewhat less reliable than that before NAC.…”

Section: Evaluation Of Women Treated With Neoadjuvant Chemotherapymentioning

confidence: 99%

“…Importantly, when the MRI findings are that pCR is achieved (150,151). MRI has consistently shown high sensitivities (accurate identification of residual cancer) of 83%-92% and intermediate specificities (accurate identification of pCR) of 47%-63% in the prediction of pCR (131,132). Absence of enhancement in the tumor bed at visual assessment is the most commonly used imaging criterion for pCR.…”

Section: Evaluation Of Women Treated With Neoadjuvant Chemotherapymentioning

confidence: 99%

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Breast MRI: State of the Art

Mann¹,

Cho²,

Moy³

2019

Radiology

557

325

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reast MRI is an indispensable modality, along with mammography and US. Its main indications are staging of known cancer, screening for breast cancer in women at increased risk, and evaluation of response to neoadjuvant chemotherapy (1-3). As opposed to mammography and US, MRI is a functional technique. Heywang et al (4) and Kaiser and Zeitler (5) independently introduced this technique in the 1980s. Contrast material-enhanced MRI evaluates the permeability of blood vessels by using an intravenous contrast agent (gadolinium chelate) that shortens the local T1 time, leading to a higher signal on T1-weighted images (6). The underlying principle is that neoangiogenesis leads to formation of leaky vessels that allow for faster extravasation of contrast agents (7), thus leading to rapid local enhancement. Despite improvements in the technique of breast MRI, this principle is still the basis of all clinical MRI protocols. However, most MRI protocols nowadays are multiparametric (8,9). This review describes the current state of the art in breast MRI, with a focus on the major indications and the potential indication-based adaptations to the imaging protocol to maximize its value. Requirements for Breast MRI Breast MRI studies should be interpreted by radiologists with expertise in breast imaging, including mammographic and US studies, as these examinations are often complementary. Although empirical data on the learning curve for breast MRI are lacking, some studies showed improved performance of radiologists over time (10), and reporting breast MRI studies requires sufficient exposure to the technique. It is best practice to use a field strength of at least 1.5 T to acquire images at a sufficiently high spatial resolution (1-3). Utilization of a dedicated breast coil is mandatory to obtain images of diagnostic quality. Women lie in the prone position with the breasts hanging free in the recesses of the coil. This design allows the breast tissue to spread, which facilitates detection of abnormalities and prevents motion artifacts induced by respiration (11,12). A breast coil should have at least four channels, but modern designs

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Section: Evaluation Of Women Treated With Neoadjuvant Chemotherapymentioning

confidence: 99%

Section: Evaluation Of Women Treated With Neoadjuvant Chemotherapymentioning

confidence: 99%

Section: Evaluation Of Women Treated With Neoadjuvant Chemotherapymentioning

confidence: 99%

See 1 more Smart Citation

Breast MRI: State of the Art

Mann¹,

Cho²,

Moy³

2019

Radiology

557

325

View full text Add to dashboard Cite

show abstract

“…For those cases falsely diagnosed as iCR, the residual tumor was generally small [6,18,19]. Volumes of suspicious areas could be acquired preoperatively by MRI prior to pathologic measurements.…”

Section: Discussionmentioning

confidence: 99%

Texture Analysis of Dynamic Contrast-Enhanced MRI in Evaluating Pathologic Complete Response (pCR) of Mass-Like Breast Cancer after Neoadjuvant Therapy

Cao

Zhao

et al. 2019

Journal of Oncology

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Objectives. MRI is the standard imaging method in evaluating treatment response of breast cancer after neoadjuvant therapy (NAT), while identification of pathologic complete response (pCR) remains challenging. Texture analysis (TA) on post-NAT dynamic contrast-enhanced (DCE) MRI was explored to assess the existence of pCR in mass-like cancer. Materials and Methods. A primary cohort of 112 consecutive patients (40 pCR and 72 non-pCR) with mass-like breast cancers who received preoperative NAT were retrospectively enrolled. On post-NAT MRI, volumes of the residual-enhanced areas and TA first-order features (19 for each sequence) of the corresponding areas were achieved for both early- and late-phase DCE using an in-house radiomics software. Groups were divided according to the operational pathology. Receiver operating characteristic curves and binary logistic regression analysis were used to select features and achieve a predicting formula. Overall diagnostic abilities were compared between TA and radiologists’ subjective judgments. Validation was performed on a time-independent cohort of 39 consecutive patients. Results. TA features with high consistency (Cronbach’s alpha >0.9) between 2 observers showed significant differences between pCR and non-pCR groups. Logistic regression using features selected by ROC curves generated a synthesized formula containing 3 variables (volume of residual enhancement, entropy, and robust mean absolute deviation from early-phase) to yield AUC = 0.81, higher than that of using radiologists’ subjective judgment (AUC = 0.72), and entropy was an independent risk factor (P<0.001). Accuracy and sensitivity for identifying pCR were 83.93% and 70.00%. AUC of the validation cohort was 0.80. Conclusions. TA may help to improve the diagnostic ability of post-NAT MRI in identifying pCR in mass-like breast cancer. Entropy, as a first-order feature to depict residual tumor heterogeneity, is an important factor.

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“…Clinical breast exam, mammography, ultrasound, and magnetic resonance imaging (MRI) have been used to evaluate response. Of these, MRI has been found to be the most accurate method, [6][7][8] likely due to its combination of physiologic and morphologic information. A combination of clinical breast exam and imaging may be used to stage the tumor by assigning a category of the extent of disease for the tumor, regional lymph nodes, and distant metastases, as per the American Joint Committee on Cancer 9 (Tables 1-3).…”

Section: Level Of Evidencementioning

confidence: 99%

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

Reig

Heacock

Lewin

et al. 2020

Magnetic Resonance Imaging

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The goals of imaging after neoadjuvant therapy for breast cancer are to monitor the response to therapy and facilitate surgical planning. MRI has been found to be more accurate than mammography, ultrasound, or clinical exam in evaluating treatment response. However, MRI may both overestimate and underestimate residual disease. The accuracy of MRI is dependent on tumor morphology, histology, shrinkage pattern, and molecular subtype. Emerging MRI techniques that combine functional information such as diffusion, metabolism, and hypoxia may improve MR accuracy. In addition, machine-learning techniques including radiomics and radiogenomics are being studied with the goal of predicting View this article online at wileyonlinelibrary.com.

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MRI, Clinical Examination, and Mammography for Preoperative Assessment of Residual Disease and Pathologic Complete Response After Neoadjuvant Chemotherapy for Breast Cancer: ACRIN 6657 Trial

Abstract: Our results indicate that measurement of longest diameter by MRI is more accurate than by mammography and clinical examination for preoperative assessment of tumor residua after NACT and may improve surgical planning.

Cited by 104 publications

References 36 publications

Breast MRI: State of the Art

Breast MRI: State of the Art

Texture Analysis of Dynamic Contrast-Enhanced MRI in Evaluating Pathologic Complete Response (pCR) of Mass-Like Breast Cancer after Neoadjuvant Therapy

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

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