The effect of chemotherapy on the mammographic appearance of breast cancer and correlation with histopathology

Abstract

Objective: To document the mammographic changes after neoadjuvant chemotherapy with histopathological correlation, to calculate the accuracy of mammography (MG) in predicting residual tumour size and to measure the interobserver agreement in reading mammograms. Methods: In 446 consecutive cases, the pre-and postchemotherapy mammograms were retrospectively evaluated by two blinded observers, and consensus findings were compared with reference standard of surgical specimen. The accuracy of MG in predicting residual tumour size was calculated. Kappa statistics were calculated for measuring the interobserver agreement for reading mammograms. The sensitivity, specificity, positive-predictive value and negative-predictive value for the prediction of residual disease were calculated. Results: The most common primary abnormalities were mass lesions without and with microcalcifications. After chemotherapy, there was decrease in size of most (95.1%) of the measurable masses, with decrease in the mean tumour size from 4.1 to 2.5 cm. The density of the tumour decreased in 66.6% (241/362) cases with residual disease. There was almost perfect interobserver agreement for describing the primary abnormality in the pre-as well as post-chemotherapy mammograms (k 5 0.87 and 0.81, respectively) with substantial agreement for measurement of the mass lesions before and after chemotherapy (k 5 0.69 and 0.68, respectively). MG showed accuracy of 60.0%, sensitivity of 94.4%, specificity of 50.0%, positivepredictive value of 91.3% and negative-predictive value of 61.8%. Conclusion: MG remains a highly sensitive and reproducible investigation for the assessment of residual disease after chemotherapy. Advances in knowledge: There is substantial interobserver agreement in characterizing and measuring breast tumours on mammograms. INTRODUCTIONBreast cancer is the leading cause of cancer-related deaths in females worldwide.1 Its treatment depends upon multiple factors such as the tumour size, chest wall and/or skin invasion, nodal and/or systemic metastases. Neoadjuvant chemotherapy (NACT) was introduced more than four decades ago for the treatment of locally advanced breast cancer (LABC). It refers to the administration of systemic chemotherapy prior to the definitive surgical treatment. It is currently employed in the treatment of tumours .5 cm in size (i.e. T3), LABC and inflammatory breast cancers (IBCs). Its main role in the management of LABC is to enable adequate local control of the disease. It has permitted more patients with large operable breast cancers and LABC to undergo breast-conserving surgeries than radical mastectomies by pre-operatively decreasing the tumour size.2-4 Administration of NACT allows earlier treatment of systemic micrometastasis.5 It is also postulated

RETRACTED ARTICLE: Diffusion-weighted MR imaging of locally advanced breast carcinoma: the optimal time window of predicting the early response to neoadjuvant chemotherapy

“…Neoadjuvant chemotherapy (NAC) has become a standard treatment for locally advanced breast carcinoma. The major clinical benefit of NAC, compared with adjuvant therapy, is the downstaging of large tumor and increased rate of breast-conserving surgery [ 1 , 2 ]. However, some cases are not sensitive to NAC, and have no significant decrease or even enlarge in tumor size after treatment.…”

<p>Construction of Nomograms for Predicting Pathological Complete Response and Tumor Shrinkage Size in Breast Cancer</p>

“…1 The primary clinical benefit of NAC, compared to adjuvant chemotherapy, is the down-staging of a large tumor and an increased rate of breast-conserving surgery. 2 , 3 Besides, luminal breast cancer has been considered resistant to chemotherapy for a long time. 4 NAC can observe the sensitivity of the luminal breast cancer and facilitate timely surgical treatment.…”

Predictive value of ultrasound doppler parameters in neoadjuvant chemotherapy response of breast cancer: Prospective comparison with magnetic resonance and mammography

“…Mammography (MMG) is the most performed test in the staging of breast cancer and has good accuracy in determining the size of the tumor [ 7 ]. However, its effectiveness in assessing the response to NACT is relatively low and varies from 26% to 31.7% [ 6 ] In a retrospective study with 446 patients undergoing NACT, MMG showed a sensitivity of 94% and a specificity of 50% when compared with the histopathological evaluation of the tumor [ 7 ]. Magnetic resonance imaging (MRI) has high specificity, between 89% and 92%, in predicting complete anatomopathological response (pCR) [ 8 ].…”