Which Imaging Modality Is Superior for Prediction of Response to Neoadjuvant Chemotherapy in Patients With Triple Negative Breast Cancer?

Abstract

Background and Objectives. Triple negative breast cancer (TNBC) has been shown to be generally chemosensitive. We sought to investigate the utility of mammography (MMG), ultrasonography (US), and breast magnetic resonance imaging (MRI) in predicting residual disease following neoadjuvant chemotherapy for TNBC. Methods. We identified 148 patients with 151 Stage I-III TNBC treated with neoadjuvant chemotherapy. Residual tumor size was estimated by MMG, US, and/or MRI prior to surgical intervention and compared to the subsequent pathologic residual tumor size. Data were compared using chi-squared test. Results. Of 151 tumors, 44 (29%) did not have imaging performed prior to surgical treatment. Thirty-eight (25%) tumors underwent a pathologic complete response (pCR), while 113 (75%) had residual invasive disease. The imaging modality was accurate to within 1 cm of the final pathologic residual disease in 74 (69%) cases and within 2 cm in 94 (88%) cases. Groups were similar with regards to patient age, race, tumor size and grade, and clinical stage ( > 0.05). Accuracy to within 1 cm was the highest for US (83%) and the lowest for MMG (56%) ( < 0.05). Conclusions. Breast US and MRI were more accurate than MMG in predicting residual tumor size following neoadjuvant chemotherapy in patients with TNBC. None of the imaging modalities were predictive of a pCR.

Automated breast ultrasound system (ABUS): reproducibility of mass localization, size measurement, and characterization on serial examinations

“…Consistent recognition of lesions on serial exams is critical, as such recognition is based on the assumption that incidental benign lesions can be successfully followed (16). In addition, as breast ultrasonography has been known to be accurate for monitoring the tumor size following neoadjuvant chemotherapy (17,18), the current ABUS units can also be useful in patients treated with neoadjuvant chemotherapy. We expect high reproducibility for lesion characterization with ABUS, however, these techniques are not standardized.…”

Neoadjuvant breast cancer treatment response; tumor size evaluation through different conventional imaging modalities in the NeoDense study

“…In order to safely omit breast surgery altogether, rCR post-NACT by imaging (possibly in combination with minimal invasive procedures) must accurately mirror pCR, hence prediction of pCR is important. Previous studies [9,12,15] have shown a wide range of sensitivity and specificity for mammography (28-89% and 48-87%, respectively) and ultrasound (36-94% and 33-96%, respectively). Few studies have evaluated the test performance measures of tomosynthesis.…”

“…Ideally, oncological and surgical BC treatment should be performed according to a patient's individual tumor response to NACT through repeated response evaluations; assessed clinically by inspection/palpation of the breast and lymph nodes, by imaging, and ultimately, pathological assessment. Mammography, ultrasound, and/or magnetic resonance imaging (MRI) are the imaging modalities most frequently used, and several studies have investigated the ability of these modalities in measuring tumor response during NACT for predicting residual pathological tumor size post-NACT [9][10][11][12][13][14][15][16]. However, the accuracy of the novel 3D-mammography tomosynthesis relative to other imaging modalities, has been less studied [14].…”

Minkowski functionals: An MRI texture analysis tool for determination of the aggressiveness of breast cancer

“…Due to increased public awareness of symptoms, improvements in detection methods, and more specialized and targeted treatment courses, 5‐year survival rates for breast cancer today are over 85%, a major improvement from the high mortality rates seen at the end of the 1980s . Unfortunately, breast cancer is a heterogeneous disease, presenting with varied pathological makeup and, currently, imprecise prediction of treatment response . For these reasons new detection, monitoring, and treatment methodologies are constantly being investigated to better understand and manage the disease.…”

“…2 Unfortunately, breast cancer is a heterogeneous disease, presenting with varied pathological makeup and, currently, imprecise prediction of treatment response. [3][4][5][6] For these reasons new detection, monitoring, and treatment methodologies are constantly being investigated to better understand and manage the disease.…”