Breast cancer is the most common malignancy among women in the world. The role of neoadjuvant chemotherapy (NAC) in the management of breast cancer is increasing. The decision about the management after NAC depends mainly on the tumor response to NAC.
Objectives
The role of the current study is to evaluate the role of the MRI scan in assessing the residual disease after NAC, which would help in decision making regarding the best treatment plan for the patient.
Patients and Methods
We did this retrospective review for all patients who were diagnosed with breast cancer in our center and had NAC over four years. All patients in our study had a post-NAC magnetic resonance imaging (MRI) scan to assess the residual tumor size. A 2×2 table was used to calculate the diagnostic accuracy, and SPSS software version 25 was used to get the correlation coefficients between the post-NAC MRI measurements and pathological size.
Results
28 female patients were included in our study. The average age was 45.25 ± 10 years. We utilized the tumor size on histology as the standard for comparison. We calculated MRI sensitivity, specificity, PPV, and NPV rates of 90.9%, 100%, 100%, and 94.4%, respectively. The correlation coefficient was strong (r = 0.859, P = 0.01).
Conclusion
Magnetic resonance imaging is a good test to assess the residual tumor disease after NAC in breast cancer patients. However, cases of under- and overestimation are still seen, which require more caution when making a decision regarding the management of such cases.
SankatsingVDVvan RavesteynNTHeijnsdijkEAM, et al.The effect of population-based mammography screening in Dutch municipalities on breast cancer mortality: 20 years of follow-up. Int J Cancer. 2017;141:671-677.
4.
MorrellSTaylorRRoderD, et al.Mammography service screening and breast cancer mortality in New Zealand: a National Cohort Study 1999- 2011. Br J Cancer. 2017;116:828-839.
5.
KingTAMorrowM. Surgical issues in patients with breast cancer receiving neoadjuvant chemotherapy. Nat Rev Clin Oncol. 2015;12(6):335-343.
6.
FisherBBrownAMamounasE, et al.Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: Findings from national surgical adjuvant breast and bowel project B-18. J Clin Oncol. 1997;15:2483-2493.
7.
WolmarkNWangJMamounasEBryantJFisherB. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from national surgical adjuvant breast and bowel project B-18. J Natl Cancer Inst Monogr. 2001;30:96-102.
Van GoethemMSchelfoutKKersschotE, et al.MR mammography is useful in the preoperative locoregional staging of breast carcinomas with extensive intraductal component. Eur J Radiol. 2007;62:273-282.
10.
DrewPJChatterjeeSLWet alT. Dynamic contrast enhanced magnetic resonance imaging of the breast is superior to triple assessment for the pre-operative detection of multifocal breast cancer. Ann Surg Oncol. 1999;6:599-603.
11.
CortazarPZhangLUntchM, et al.Pathological complete response and long-term clinical benefit in breast cancer: The CTNeoBC pooled analysis. Lancet. 2014;384:164-172.
12.
BoydNFGuoHMartinLJ, et al.Mammographic density and the risk and detection of breast cancer. N Engl J Med. 2007;356:227-236.
13.
PisanoEDGatsonisCHendrickE, et al.Diagnostic performance of digital versus film mammography for breast-cancer screening. NEngl J Med. 2005;353:1773-1783.
14.
BergWAZhangZLehrerD, et al.Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA. 2012;307:1394-1404.
15.
ChagparABMiddletonLPSahinAA, et al.Accuracy of physical examination, ultrasonography, and mammography in predicting residual pathologic tumour size in patients treated with neoadjuvant chemotherapy. Ann Surg. 2006;243:257-264.
16.
Cancer Genome Atlas Network. Comprehensive molecular portraits of human breast tumours. Nature. 2012;490:61-70.
17.
Ab MuminNRamli HamidMTWongJHDRahmatKNgKH. Magnetic resonance imaging phenotypes of breast cancer molecular subtypes: A systematic review. Acad Radiol. 2022;29(Suppl. 1):S89-S106.
18.
GrimmLJZhangJBakerJASooMSJohnsonKSMazurowskiMA. Relationships between MRI breast imagingreporting and data system (BI-RADS) lexicon descriptors and breast cancer molecular subtypes: Internal enhancement is associated with luminal b subtype. Breast J. 2017;23:579-582.
19.
GoldhirschAWinerEPCoatesASGelberRDPiccart-GebhartMhürlimannBSennHJ. Personalizing the treatment of women with early breast cancer: Highlights of the st gallen international expert consensus on the primary therapy of early breast cancer 2013. Ann. Oncol. 2013;24:2206-2223.
20.
MartincichLDeantoniVBertottoI, et al.Correlation between diffusion-weighted imaging and breast cancer biomarkers. Eur Radiol. 2012;22:1519-1528.
21.
WangYIkedaDMNarasimhanB, et al.Estrogen receptornegative invasive breast cancer: Imaging features of tumors with and without human epidermal growth factor receptor type 2 overexpression. Radiology. 2008;246:367-375.
22.
HoussamiNMacAskillPVon MinckwitzGMarinovichMLMamounasE. Meta-analysis of the association of breast cancer subtype and pathologic complete response to neoadjuvant chemotherapy. Eur J Cancer. 2012;48:3342-3354.
23.
HuangYChenWZhangX, et al.Prediction of tumor shrinkage pattern to neoadjuvant chemotherapy using a multiparametric MRI-based machine learning model in patients with breast cancer. Front Bioeng Biotechnol. 2021;9:662749.
24.
HeywangSHWolfAPrussEHilbertzTEiermannWPermanetterW. MR imaging of the breast with Gd-DTPA: Use and limitations. Radiology. 1989;171:95-103.
25.
KaiserWAZeitlerE. MR imaging of the breast: Fast-imaging sequences with and without Gd- DTPA. Radiology. 1989;170:681-686.
26.
PartridgeSCGibbsJELuYEssermanLJSudilovskyDHyltonNM. Accuracy of MR imaging for revealing residual breast cancer in patients who have undergone neoadjuvant chemotherapy. AJR. 2002;179:1193-1199.
27.
WeatherallPTEvansGFMetzgerGJSaborrianMHLeitchAM. MRI vs. histologic measurement of breast cancer following chemotherapy: Comparison with x-ray mammography and palpation. J Magn Reson Imaging. 2001;13:868-875.
28.
RosenELBlackwellKLBakerJA, et al.Accuracy of MRI in the detection of residual breast cancer after neoadjuvant chemotherapy. AJR Am J Roentgenol. 2003;181(5):1275-1282.
29.
RieberAZeitlerHRosenthalH, et al.MRI of breast cancer: influence of chemotherapy on sensitivity. Br J Radiol. 1997;70:452-458.
30.
RosenELBlackwellKLBakerJA, et al.DewhirstAmerican Journal of Roentgenology2003;181(5):1275-1282.
31.
BelliPCostantiniMMalaspinaCMagistrelliALaTorreGBonomoL. MRI accuracy in residual disease evaluation in breast cancer patients treated with neoadjuvant chemotherapy. Clin. Radiol. 2006;61:946-953.
32.
YehESlanetzPKopansDB, et al.Prospective comparison of mammography, sonography, and MRI in patients undergoing neoadjuvant chemotherapy for palpable breast cancer. Am J Roentgenol. 2005;184:868-877.
33.
Von MinckwitzGUntchMBlohmerJU, et al.Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012;30:1796-1804.
34.
KhazindarARHashemDALAbusanadA, et al.Diagnostic accuracy of MRI in evaluating response after neoadjuvant systemic therapy in operable breast cancer. Cureus. 2021;13:e15516.
35.
BahriSChenJHMehtaRS, et al.Residual breast cancer diagnosed by MRI in patients receiving neoadjuvant chemotherapy with and without bevacizumab. Ann. Surg. Oncol. 2009;16:1619-1628.
36.
DenisFDesbiez-BourcierAVChapironCArbionFBodyGBrunereauL. Contrast enhanced magnetic resonance imaging underestimates residual disease following neoadjuvant docetaxel based chemotherapy for breast cancer. Eur J Surg Oncol. 2004;30:1069-1076.
37.
BocciGDi PaoloADanesiR. The pharmacological bases of the antiangiogenic activity of paclitaxel. Angiogenesis. 2013;16:481-492.
