The role of magnetic resonance imaging in assessing residual disease and pathologic complete response in breast cancer patients receiving neoadjuvant chemotherapy: a systematic review

Abstract

ObjectivesThis systematic review aimed to assess the role of magnetic resonance imaging (MRI) in evaluating residual disease extent and the ability to detect pathologic complete response (pCR) after neoadjuvant chemotherapy for invasive breast cancer.MethodsPubMed, the Cochrane Library, MEDLINE, and Embase databases were searched for relevant studies published until 1 July 2012. After primary selection, two reviewers independently assessed the content of each eligible study using a standardised extraction form and pre-defined inclusion and exclusion criteria.ResultsA total of 35 eligible studies were selected. Correlation coefficients of residual tumour size assessed by MRI and pathology were good, with a median value of 0.698. Reported sensitivity, specificity, positive predictive value and negative predictive value for predicting pCR with MRI ranged from 25 to 100 %, 50–97 %, 47–73 % and 71–100 %, respectively. Both overestimation and underestimation were observed. MRI proved more accurate in determining residual disease than physical examination, mammography and ultrasound. Diagnostic accuracy of MRI after neoadjuvant chemotherapy could be influenced by treatment regimen and breast cancer subtype.ConclusionsBreast MRI accuracy for assessing residual disease after neoadjuvant chemotherapy is good and surpasses other diagnostic means. However, both overestimation and underestimation of residual disease extent could be observed.Main Messages• Breast MRI accuracy for assessing residual disease is good and surpasses other diagnostic means.• Correlation coefficients of residual tumour size assessed by MRI and pathology were considered good.• However, both overestimation and underestimation of residual disease were observed.• Diagnostic accuracy of MRI seems to be affected by treatment regimen and breast cancer subtype.

AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2016

“…Until now, breast MRI seems to be the best method to predict pathologic complete response (pCR) after NACT. According to an indirect comparison be tween MRI and breast US, US seems to have the same sensi tivity and specificity to predict pCR after NACT [21,[23][24][25][26]. Definition standards of response are required.…”

Tumor RNA disruption predicts survival benefit from breast cancer chemotherapy

“…Similarly, while tumor size, volume, and apparent diffusion coefficient values by magnetic resonance imaging, have shown promise to assess treatment response [17], these studies had variable study designs, variable cut points, and were significantly underpowered [18]. Reduced tumor 18 Fdeoxyglucose (FDG) uptake after chemotherapy administration is also associated with the achievement of a pCR in breast cancer patients [19][20][21], but the sensitivity and specificity of this approach has been low [22]. FDG positron emission tomography (PET) has recently been shown to be effective in identifying non-responders to docetaxel plus trastuzumab in patients with Her2?…”

AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2014

“…Until now, breast MRI seems to be the best method to predict pathologic complete response (pCR) after NACT. According to an indirect comparison between MRI and breast US, US seems to have the same sensitivity and specificity to predict pCR after NACT [21,23,24,25,26]. Definition standards of response are required.…”