Utility of Magnetic Resonance Imaging in the Management of Breast Cancer: Evidence for Improved Preoperative Staging

Esserman, Laura J.; Hylton, Nola M.; Yassa, Leila; Barclay, John M. G.; Frankel, Steven A.; Sickles, Edward A.

doi:10.1200/jco.1999.17.1.110

Cited by 359 publications

(212 citation statements)

References 23 publications

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“…This is in contrast to previous reports, which found correlation coefficients ranging from 0.70 to 0.98 for MRI (Esserman et al, 1999;Partridge et al, 2002;Rosen et al, 2003;Wasser et al, 2003;Martincich et al, 2004). However, a recent retrospective review of neoadjuvant chemotherapy trials from the MD Anderson Cancer Center also found a poor agreement between tumour size measurements by mammography or ultrasound and histopathology (Chagpar et al, 2006).…”

Section: Discussioncontrasting

confidence: 54%

Assessment of residual tumour by FDG-PET: conventional imaging and clinical examination following primary chemotherapy of large and locally advanced breast cancer

et al. 2009

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BACKGROUND: The aim of this was to evaluate FDG-PET (2-(fluorine-18)-fluoro-2-deoxy-D-glucose positron emission tomography) for assessment of residual tumour after primary chemotherapy of large and locally advanced breast cancer in comparison with conventional imaging modalities. METHODS: In a prospective multicentre trial, 99 patients underwent one or more breast imaging modalities before surgery in addition to clinical examination, namely, FDG-PET (n ¼ 89), mammography (n ¼ 47), ultrasound (n ¼ 46), and magnetic resonance imaging (MRI) (n ¼ 46). The presence of residual tumour by conventional imaging, dichotomised as positive or negative, and the level of FDG uptake (standardised uptake values, SUV) were compared with histopathology, which served as the reference standard. Patients with no residual tumour or only small microscopic foci of residual tumour were classified as having minimal residual disease and those with extensive microscopic and macroscopic residual tumour tissue were classified as having gross residual disease. RESULTS: By applying a threshold SUV of 2.0, the sensitivity of FDG-PET for residual tumour was 32.9% (specificity, 87.5%) and increased to 57.5% (specificity, 62.5%) at a threshold SUV of 1.5. Conventional imaging modalities were more sensitive in identifying residual tumour, but had a low corresponding specificity; sensitivity and specificity were as follows: MRI 97.6 and 40.0%, mammography 92.5 and 57.1%, ultrasound 92.0 and 37.5%, respectively. Breast MRI provided the highest accuracy (91.3%), whereas FDG-PET had the lowest accuracy (42.7%). CONCLUSIONS: FDG-PET does not provide an accurate assessment of residual tumour after primary chemotherapy of breast cancer. Magnetic resonance imaging offers the highest sensitivity, but all imaging modalities have distinct limitations in the assessment of residual tumour tissue when compared with histopathology.

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Section: Discussioncontrasting

confidence: 54%

Assessment of residual tumour by FDG-PET: conventional imaging and clinical examination following primary chemotherapy of large and locally advanced breast cancer

et al. 2009

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“…Magnetic resonance imaging has been shown to correspond better with pathological size measurement than XRM (Esserman et al, 1999;Drew et al, 2001) and to be less obscured by dense breast diseases. Ultrasound measurement is more accurate than XRM, but fails when the tumour to be measured is larger than the field of view or complex in shape.…”

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confidence: 99%

Neoadjuvant chemotherapy in breast cancer: early response prediction with quantitative MR imaging and spectroscopy

et al. 2006

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A prospective study was undertaken in women undergoing neoadjuvant chemotherapy for locally advanced breast cancer in order to determine the ability of quantitative magnetic resonance imaging (MRI) and proton spectroscopy (MRS) to predict ultimate tumour response (percentage decrease in volume) or to detect early response. Magnetic resonance imaging and MRS were carried out before treatment and after the second of six treatment cycles. Pharmacokinetic parameters were derived from T 1 -weighted dynamic contrast-enhanced MRI, water apparent diffusion coefficient (ADC) was measured, and tissue water : fat peak area ratios and water T 2 were measured using unsuppressed one-dimensional proton spectroscopic imaging (30 and 135 ms echo times). Pharmacokinetic parameters and ADC did not detect early response; however, early changes in water : fat ratios and water T 2 (after cycle two) demonstrated substantial prognostic efficacy. Larger decreases in water T 2 accurately predicted final volume response in 69% of cases (11/16) while maintaining 100% specificity and positive predictive value. Small/absent decreases in water : fat ratios accurately predicted final volume non-response in 50% of cases (3/6) while maintaining 100% sensitivity and negative predictive value. This level of accuracy might permit clinical application where early, accurate prediction of non-response would permit an early change to second-line treatment, thus sparing patients unnecessary toxicity, psychological morbidity and delay of initiation of effective treatment.

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“…Widespread detection thanks to mammography and ultrasound allows earlier detection of cancer and has been shown to improve the survival of women with breast cancer (25,26). Early detection of breast cancer allows also conservative surgery as an alternative to mastectomy (27,28). However, breast lesions remain difficult to diagnose and characterize, especially in dense fibroglandular breasts.…”

Section: Discussionmentioning

confidence: 99%

Quantitative diffusion imaging in breast cancer: A clinical prospective study

Rubesova

Grell

Maertelaer

et al. 2006

Magnetic Resonance Imaging

230

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Purpose: To study the correlation between apparent diffusion coefficient (ADC) and pathology in patients with undefined breast lesion, to validate how accurately ADC is related to histology, and to define a threshold value of ADC to distinguish malignant from benign lesions. Materials and Methods:Seventy-eight patients (110 lesions) were referred for positive or dubious findings. Threedimensional fast low-angle shot (3D-FLASH) with contrast injection was applied. EPI diffusion-weighted imaging (DWI) with fat saturation was performed, and ROIs were selected on subtraction 3D-FLASH images before and after contrast injection, and copied on an ADC map. Inter-and intraobserver analyses were performed.Results: At pathology 22 lesions were benign, 65 were malignant, and 23 were excluded. The ADCs of malignant and benign lesions were statistically different. In malignant tumors the ADC was (mean Ϯ SEM) 0.95 Ϯ 0.027 ϫ 10 -3mm 2 /second, and in benign tumors it was 1.51 Ϯ 0.068 ϫ 10 -3 mm 2 /second. According to receiver operating characteristic (ROC) curves, we found a threshold between malignant and benign lesions for highest sensitivity and specificity (both 86%) around 1.13 Ϯ 0.10 ϫ 10 -3 mm 2 /second. For a threshold of 0.95 Ϯ 0.10 ϫ 10 -3 mm 2 /second, specificity was 100% but sensitivity was very low. Inter-and intraobserver studies showed good reproducibility. Conclusion:The ADC may help to differentiate benign and malignant lesions with good specificity, and may increase the overall specificity of breast MRI.

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Utility of Magnetic Resonance Imaging in the Management of Breast Cancer: Evidence for Improved Preoperative Staging

Cited by 359 publications

References 23 publications

Assessment of residual tumour by FDG-PET: conventional imaging and clinical examination following primary chemotherapy of large and locally advanced breast cancer

Assessment of residual tumour by FDG-PET: conventional imaging and clinical examination following primary chemotherapy of large and locally advanced breast cancer

Neoadjuvant chemotherapy in breast cancer: early response prediction with quantitative MR imaging and spectroscopy

Quantitative diffusion imaging in breast cancer: A clinical prospective study

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