Primary breast cancer: mammographic changes after neoadjuvant chemotherapy, with pathologic correlation.

Vinnicombe, Sarah; MacVicar, A D; Guy, Rosie; Sloane, J P; Powles, Trevor J.; Knee, G.; Husband, Janet E.

doi:10.1148/radiology.198.2.8596827

Cited by 138 publications

(74 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…8 The presence of fibrotic tissue, 8 high mammographic density, 10 remaining microcalcifications, 10,8 or ill-defined tumors, 7,11 however, makes response more difficult to assess, and several studies have found inadequate correlation with pathology or prognosis. 12,7,9,10,13 Ultrasound may be more accurate than mammography in evaluating true tumor size; 14 however it has limited tumor versus normal contrast. 10 Color Doppler ultrasound may reveal changes in tumor vascularity before alterations in clinical dimensions are detected, 15 but the method is highly operator dependent.…”

Section: Introductionmentioning

confidence: 99%

Monitoring neoadjuvant chemotherapy in breast cancer using quantitative diffuse optical spectroscopy: a case study

et al. 2004

View full text Add to dashboard Cite

Abstract. Presurgical chemotherapy is widely used in the treatment of locally advanced breast cancer. Monitoring the response to therapy can improve survival and reduce morbidity. We employ a noninvasive, near-infrared method based on diffuse optical spectroscopy (DOS) to quantitatively monitor tumor response to neoadjuvant chemotherapy. DOS was used to monitor tumor response in one patient with locally advanced breast cancer throughout the course of her therapy. Measurements were performed prior to doxorubicincyclophosphamide therapy and at several time points over the course of three treatment cycles (68 days). Our results show strong tumor to normal (T/N) tissue contrast in total hemoglobin concentration (T/N =2.4), water fraction (T/N=6.9), tissue hemoglobin oxygen saturation, S t O 2 (T/N=0.9), and lipid fraction (T/N=0.7) prior to treatment. Over a 10-week period, the peak total hemoglobin and water dropped 56 and 67%, respectively. Lipid content nearly returned to baseline (T/N ϭ0.9) while S t O 2 exceeded pretreatment levels (T/N =1.5). Approximately half of the hemoglobin and water changes occurred within 5 days of treatment (26 and 37%, respectively). These data suggest that noninvasive, quantitative optical methods that characterize tumor physiology may be useful in assessing and optimizing individual response to neoadjuvant chemotherapy. © 2004 Society of Photo-Optical Instrumentation Engineers.

show abstract

Section: Introductionmentioning

confidence: 99%

Monitoring neoadjuvant chemotherapy in breast cancer using quantitative diffuse optical spectroscopy: a case study

et al. 2004

View full text Add to dashboard Cite

show abstract

“…Thus one goal of neoadjuvant chemotherapy monitoring is to determine early when a patient will demonstrate cPR. Many studies revealed significant discrepancies between clinical response assessments and final pathology (7)(8)(9).…”

mentioning

confidence: 99%

Predicting response to breast cancer neoadjuvant chemotherapy using diffuse optical spectroscopy

Cerussi

Hsiang

Shah

et al. 2007

Proc. Natl. Acad. Sci. U.S.A.

276

259

View full text Add to dashboard Cite

Diffuse optical spectroscopy (DOS) and imaging are emerging diagnostic techniques that quantitatively measure the concentration of deoxy-hemoglobin (ctHHb), oxy-hemoglobin (ctO 2Hb), water (ctH 2O), and lipid in cm-thick tissues. In early-stage clinical studies, diffuse optical imaging and DOS have been used to characterize breast tumor biochemical composition and monitor therapeutic response in stage II/III neoadjuvant chemotherapy patients. We investigated whether DOS measurements obtained before and 1 week into a 3-month adriamycin/cytoxan neoadjuvant chemotherapy regimen can predict final, postsurgical pathological response. Baseline DOS measurements of 11 patients before therapy revealed significant increases in tumor ctHHb, ctO 2Hb, ctH 2O, and spectral scattering slope, and decreases in bulk lipids, relative to normal breast tissue. Tumor concentrations of ctHHb, ctO 2Hb, and ctH2O dropped 27 ؎ 15%, 33 ؎ 7%, and 11 ؎ 15%, respectively, within 1 week (6.5 ؎ 1.4 days) of the first treatment for pathology-confirmed responders (n ‫؍‬ 6), whereas nonresponders (n ‫؍‬ 5) and normal side controls showed no significant changes in these parameters. The best single predictor of therapeutic response 1 week posttreatment was ctHHb (83% sensitivity, 100% specificity), while discrimination analysis based on combined ctHHb and ctH 2O changes classified responders vs. nonresponders with 100% sensitivity and specificity. In addition, the pretreatment tumor-to-normal ctO 2Hb ratio was significantly higher in responders (2.82 ؎ 0.44) vs. nonresponders (1.82 ؎ 0.49). These results highlight DOS sensitivity to tumor cellular metabolism and biochemical composition and demonstrate its potential for predicting and monitoring an individual's response to treatment.diffuse optical imaging ͉ frequency-domain photon migration ͉ near-infrared ͉ tissue spectroscopy ͉ translational research O ptimal management locally advanced breast cancer (LABC) remains a complex therapeutic problem (1). LABC represents 5-20% of all newly diagnosed breast cancers in the United States with a higher incidence in medically underserved areas (2). Treatment for LABC has evolved from radical mastectomy to preoperative neoadjuvant chemotherapy followed by mastectomy or breast conservation therapy (3). Despite aggressive local therapy, long-term patient survival is still poor. LABC remains controversial because of uncertainties in determining the optimal intensity and duration of neoadjuvant chemotherapy and evaluating therapeutic response (2, 4, 5).Neoadjuvant chemotherapy response is determined by serial physical examination, mammography and/or ultrasound. Complete pathological response (cPR) is an important therapeutic endpoint that is a surrogate for eradicating micrometastases, and strongly correlates with patient survival (6). Thus one goal of neoadjuvant chemotherapy monitoring is to determine early when a patient will demonstrate cPR. Many studies revealed significant discrepancies between clinical response assessments and final pathology (7-9).A rece...

show abstract

“…There is a poor correlation between the histological appearances of the tumour and measurements obtained by physical examination, mammography (MM) or ultrasonography (USS). Radiological assessment is least accurate in younger women who most often desire BCS because their breast tissue is more dense making it more difficult to distinguish invasive cancer from residual in situ carcinoma and chemotherapy-induced fibrosis (Cocconi et al, 1984;Segel et al, 1988, Vinnicombe, 1996.…”

mentioning

confidence: 99%

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

et al. 2008

View full text Add to dashboard Cite

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.

show abstract

Primary breast cancer: mammographic changes after neoadjuvant chemotherapy, with pathologic correlation.

Abstract: Whereas mammograms in most patients showed some response to chemotherapy, prediction of pathologic outcome was not possible.

Cited by 138 publications

References 0 publications

Monitoring neoadjuvant chemotherapy in breast cancer using quantitative diffuse optical spectroscopy: a case study

Monitoring neoadjuvant chemotherapy in breast cancer using quantitative diffuse optical spectroscopy: a case study

Predicting response to breast cancer neoadjuvant chemotherapy using diffuse optical spectroscopy

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

Contact Info

Product

Resources

About