Predicting Pathologic Response to Neoadjuvant Chemotherapy in Breast Cancer by Using MR Imaging and Quantitative¹H MR Spectroscopy

Abstract

Patients who show greater reduction in tCho compared with changes in tumor size are more likely to achieve pCR. The change in tumor size halfway through therapy was the most accurate predictor of pCR.

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

“…Thus, some of the responders from RECIST were redefined as nonresponders, leading to significant changes in the DCE-MRI-derived parameters for both responders and nonresponders using the modified RECIST. A broad variety of response criteria exists in the literature, concerning both the degree of tumor reduction that defines a responder and the method used to measure the tumor size (8,9,11,14,16,36,37). Therefore, it is important to notice that the different response criteria will have an impact on the interpretation of DCE-MRI-derived parameters.…”

“…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.…”

“…Using a combination of semiquantitative DCE-MRI-derived parameters, pathological complete response can be predicted before treatment (14). Several investigators have found early tumor size reduction to be the strongest predictor of a response to NAC (8,9,11,(15)(16)(17)(18)(19), some after only one cycle of chemotherapy (9,11,15,16). Using pharmacokinetic modeling to analyze DCE-MRI data, responders have been shown to experience a significant reduction in K trans (the transfer constant of contrast agent between the blood plasma and the extravascular extracellular space) (15)(16)(17).…”

1H‐magnetic resonance spectroscopy of the breast at 3.0‐T: Comparison of results obtained before and after administration of gadolinium‐based contrast agent

“…Initially, a simple dichotomous approach based on the presence or absence of the choline peak was shown in some reports (5,6). Furthermore, choline quantification has been proposed using either an internal or an external reference (9,10). Recently, Sardanelli et al (7) showed that breast MRS using the integral value of the choline peak allowed a high level of diagnostic performance, with 84% sensitivity and 89% specificity.…”

“…Recently, MRS has been also applied in other organs such as the prostate and breast (4)(5)(6). Regarding the breast, MRS has been shown to be useful for the differentiation between benign and malignant lesions and for the monitoring of early response to neoadjuvant chemotherapy (7)(8)(9). Its diagnostic value for breast cancer is typically based on the detection of elevated levels of choline compounds, which are markers of active tumors (10,11).…”