Role of contrast enhanced spectral mammography in predicting pathological response of locally advanced breast cancer post neo-adjuvant chemotherapy

Sobrinho

BioMed Research International

et al. 2018

Objective To evaluate the performance of contrast-enhanced mammography (CEM) compared to magnetic resonance imaging (MRI) for estimating residual tumor size after neoadjuvant chemotherapy (NAC) in women with newly diagnosed breast cancer. Methods The institutional review board approved this study. This prospective study included women with newly diagnosed breast cancer who underwent breast CEM and MRI at the end of the last cycle of NAC and before definitive surgery. Size of residual malignancy on post-NAC CEM and MRI was compared with surgical pathology. Agreements and correlations of CEM and MRI measurements with histological size were assessed. Results Thirty-three patients were included with a mean age of 45 years (range 22–76). The sensitivity, specificity, and positive and negative predictive value for detection of residual disease of CEM were 76%, 87.5%, 95%, and 86.4%, and those of MRI were 92%, 75%, 92%, and 75%. Comparing CEM to MRI, the mean difference was −0.8 cm, concordance coefficient was 0.7, and Pearson correlation was 0.7 (p = 0.0003). The concordance coefficient between measurements of each imaging modality and pathologic tumor size was 0.7 for CEM and 0.4 for MRI. Pearson correlation was 0.8 for CEM and 0.5 for MRI. Mean differences between CEM, MRI, and residual histopathological tumor size were 0.8 cm and 1.8 cm, respectively. Conclusions CEM has good correlation and agreement with histopathology for measuring residual disease after NAC. CEM was comparable to MRI, showing high positive predictive value and specificity for detecting residual disease.

Section: Discussionsupporting

confidence: 89%

Contrast-Enhanced Mammography (CEM) for Detecting Residual Disease after Neoadjuvant Chemotherapy: A Comparison with Breast Magnetic Resonance Imaging (MRI)

Sobrinho

BioMed Research International

et al. 2018

“…The low sensitivity of CESM in this study was due to false‐negative enhancement in the chemo‐resistant group of tumours, hypothesised as being due to residual cancer cells receiving nutrition via diffusion rather than vascular perfusion. However, the sensitivity of CESM for detection of complete response was 100% with a specificity of 83%, and similar values have been subsequently quoted by Patel et al . More evidence on the role of CESM in this setting is required.…”

Section: Case 5 Contrast Enhanced Mammography For Assessment Of Lesisupporting

confidence: 77%

“…CESM may also be efficacious in monitoring NAC response. ElSaid et al . evaluated the accuracy of CESM for predicting final pathological response and residual tumour size following NAC and found that the specificity of CESM in predicting all types of tumour response (including complete, partial or poor response, and minimal residual disease) was 91%, sensitivity 40%, NPV 80% and PPV 62.5%.…”

Section: Case 5 Contrast Enhanced Mammography For Assessment Of Lesimentioning

confidence: 99%

See 1 more Smart Citation

Practical uses of contrast‐enhanced spectral mammography in daily work: A pictorial review

et al. 2019

Contrast-enhanced spectral mammography (CESM) has a number of uses including the work-up of inconclusive findings on mammography, assessment of breast symptoms, cancer staging, evaluation of response to neoadjuvant chemotherapy and recently as an alternative to magnetic resonance imaging (MRI) in high-risk screening. CESM can be swiftly incorporated into the workflow of busy breast clinics. We share our experiences with CESM at a large breast assessment centre in Western Australia.

“…Regarding diagnostic performance, CEDM demonstrated better speci city, PPV, and NPV compared to CEMRI, though CEMRI had better sensitivity than CEDM. Similarly, other studies reported comparable speci city and PPV for CEDM [6,25]. All women with radiologic CR on CEMRI had negative CEDM results.…”

Section: Discussionsupporting

confidence: 59%

Diagnostic Value of Contrast-enhanced Digital Mammography Versus Contrast-enhanced MRI for Detecting Residual Disease after Neoadjuvant Chemotherapy for Breast Cancer

Kim

Yun

Park

et al. 2020

Preprint

Background: Preoperative evaluation of breast cancer using contrast-enhanced digital mammography (CEDM) as a possible alternative to contrast-enhanced magnetic resonance imaging (CEMRI) has gained acceptance. Our aim is to compare the diagnostic performance of CEDM and CEMRI for chemotherapeutic response in breast cancer patients who underwent neoadjuvant chemotherapy (NAC).Methods: From November 2017 to October 2018, 30 patients with invasive carcinoma who performed both CEDM and CEMRI were included. Residual malignancy sizes after NAC were compared with histopathological results. The diagnostic performances for detecting residual cancers were compared using Lin concordance and Pearson correlation coefficients.Results: Thirty patients were included for the analysis. Mean tumor size after NAC was 1.22 cm (range: 0–7.0 cm) for CEDM and 1.13 cm (range: 0–5.1cm) for CEMRI compared with 1.89 cm (range: 0–12.0 cm) at final pathology measurement. Sensitivity for identifying residual lesion was for CEDM and CEMRI is as follows (CEDM 62.5%, 95% CI 40.6–81.2, CEMRI 66.7%, 95% CI 44.7–84.4). The positive predictive value (PPV) for residual lesion was 93.8% (95% CI 69.8–99.8) for CEDM and 88.9% (95% CI 65.3–98.6) for CEMRI. CEDM had a mean difference from pathology measurement of 0.668 cm, with a concordance coefficient of 0.202 and a Pearson correlation coefficient of 0.231 (p=0.220).Conclusions: Diagnostic value of CEDM for detecting residual tumor extent after NAC was comparable to that of CEMRI.