Postchemotherapy MRI Overestimates Residual Disease Compared with Histopathology in Responders to Neoadjuvant Therapy for Locally Advanced Breast Cancer

Kwong, Myron S; Chung, Gina G.; Horváth, L.; Ward, Barbara A.; Hsu, A.; Carter, Darryl; Tavassoli, F. A.; Haffty, Bruce G.; Burtness, Barbara

doi:10.1097/00130404-200605000-00010

Cited by 55 publications

(40 citation statements)

References 31 publications

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“…Medical neoadjuvant treatments are aimed at downsizing the cancer and exploring the in vivo chemosensitivity of the tumor cells [10,11,15,16]. For patients undergoing primary chemotherapy, the achievement of pathologic complete response is considered a surrogate marker for a favorable long-term clinical outcome [11,[17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

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Variation of Breast Vascular Maps on Dynamic Contrast-Enhanced MRI After Primary Chemotherapy of Locally Advanced Breast Cancer

Martincich

Bertotto

Montemurro

et al. 2011

American Journal of Roentgenology

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Section: Discussionmentioning

confidence: 99%

“…of the extent of residual viable tumor [20][21][22][23]. In addition, preliminary results with bevacizumab in the neoadjuvant setting show that DCE-MRI is a suitable tool for evaluating renormalization of vasculature as a response to antiangiogenic therapy [24].…”

Section: Breast Vascular Maps and Dynamic Contrast-enhanced Mrimentioning

confidence: 99%

Variation of Breast Vascular Maps on Dynamic Contrast-Enhanced MRI After Primary Chemotherapy of Locally Advanced Breast Cancer

Martincich

Bertotto

Montemurro

et al. 2011

American Journal of Roentgenology

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“…Kwong et al [16] reported that MRI frequently overestimated residual disease in responders to chemotherapy treatment. In our study, MRI overestimated residual disease in 19% and underestimated residual disease in 7% of our study patients.…”

Section: Discussionmentioning

confidence: 99%

Correlation of Pathological Complete Response with Radiological Evaluation after Neoadjuvant Chemotherapy of Breast Carcinoma

Razek¹

2013

J Cell Sci Ther

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Introduction: Neoadjuvant chemotherapy is the standard treatment modality in locally advanced breast cancer, and accepted as an alternate modality in operable breast cancer. Pathological Complete Response (pCR) is a surrogate for better outcome. The identification of the most sensitive clinical and radiological method to pCR will be helpful in patient's management. Patients and methods:Multicenterprospective study assessed the correlation between (pCR) and radiological Complete Response (rCR) using different radiological modalities. 125 female with primary measurable stage II or III non inflammatory breast cancer, were enrolled in the study after pathological confirmation using image guided core biopsy. Pathological assessment was done. All eligible cases received neoadjuvant chemotherapy (FEC) IV every 3 weeks for three cycles followed by Docetaxel IV every 3 weeks for three cycles. Trastuzumab was added in Her2neu positive patients concomitantly with docetaxel. Radiological evaluation was done before chemotherapy and prior to definitive surgery. pCR was defined as complete disappearance of invasive tumor cells in both breast surgical specimen and lymph nodes. Patients who achieved pCR were correlated with truly positive rCR by different modalities. The results were statistically analyzed using the Kappa method for agreement.Results: 20% of the patients achieved pCR 25/125. All these patients received 6 cycles of chemotherapy, only 4 patients received Trastuzumab. Conservative surgery was performed in 80% of cases and MRM in 5/25 of them. True radiological Complete Response (rCR) was achieved in 56% of patients by mammography, 17/25 (68%) of patients by ultrasonography who showed complete disappearance of the mass. 23/25 (92%) achieved rCR morphologically by Dynamic MR-Mammography and in 24/25 (96%) of cases using the kinetic data. MR Spectroscopy showed rCR in (92%) cases. In our study, predictions made on the basis of MRI showed a better correlation with the pathological response after neoadjuvant chemotherapy than did estimations made on the basis of mammography or sonography. The sensitivity, specificity, PPV and NPV for Dynamic MRI in predicting complete pathological response were 96%, 94%, 89% and 99% respectively. The sensitivity, specificity, PPV and NPV for MRS were 92%, 92%, 85% and 97% respectively while the sensitivity, specificity, PPV and NPV for Mammography were 44%, 87%, 61% and 87% respectively and the sensitivity, specificity, PPV and NPV for ultrasonography were 68%, 90%, 77% and 92% respectively. Conclusion:The most sensitive radiological methods correlated with pCR were dynamic MR mammography and MR Spectroscopy, further studies using new modalities and larger number of patients is required to confirm our results. and overall survival [3,4]. Based on that, there were many efforts to clinically detect, predict and also assess the sensitivity of clinical and radiological modalities to evaluate pCR. Complete disappearance of the tumor clinically or radiologically is not an indication o...

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“…A complicated part of this strategy is the fact that there are known inaccuracies in predicting the change in size of cancer, either primary or metastatic [4][5][6][7], and the fact that errors in sizing appear to be unexpectedly large. Interestingly, several studies have recently shown that imaging markers with MRI [4,7] or nuclear medicine overestimate the response to therapy [8], as measured by the tumor size. Unfortunately, even assessing cancer response in pathology is not uniformly defined.…”

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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Postchemotherapy MRI Overestimates Residual Disease Compared with Histopathology in Responders to Neoadjuvant Therapy for Locally Advanced Breast Cancer

Cited by 55 publications

References 31 publications

Variation of Breast Vascular Maps on Dynamic Contrast-Enhanced MRI After Primary Chemotherapy of Locally Advanced Breast Cancer

Variation of Breast Vascular Maps on Dynamic Contrast-Enhanced MRI After Primary Chemotherapy of Locally Advanced Breast Cancer

Correlation of Pathological Complete Response with Radiological Evaluation after Neoadjuvant Chemotherapy of Breast Carcinoma

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

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