OBJECTIVE: The aim of this study was to establish changes in contrast-enhanced MRI of breast cancer during neoadjuvant chemotherapy that are indicative of pathology outcome. MATERIALS AND METHODS: In 54 patients with breast cancer, dynamic contrast-enhanced MRI was performed before chemotherapy and after two chemotherapy cycles. Imaging was correlated with final histopathology. Multivariate analysis with cross-validation was performed on MRI features describing kinetics and morphology of contrast uptake in the early and late phases of enhancement. Receiver operating characteristic (ROC) analysis was used to develop a guideline that switches patients at high risk for incomplete remission to a different chemotherapy regimen while maintaining first-line therapy in 95% of patients who are not at risk (i.e., high specificity). RESULTS: Change in largest diameter of late enhancement during chemotherapy was the single most predictive MRI characteristic for tumor response in multivariate analysis (A(z) [area under the ROC curve] = 0.73, p < 0.00001). Insufficient (< 25%) decrease in largest diameter of late enhancement during chemotherapy was most indicative of residual tumor at final pathology. Using this criterion, the fraction of unfavorable responders indicated by MRI was 41% (22/54). Approximately half (44%, 14/32) of the patients who showed favorable response at MRI achieved complete remission at pathology. Conversely, 95% (21/22) of patients who showed unfavorable response at MRI had residual tumor at pathology. CONCLUSION: Reduction of less than 25% in largest diameter of late enhancement during neoadjuvant chemotherapy shows the potential to predict residual tumor after therapy with high specificity.
OBJECTIVE: The aim of this study was to establish changes in contrast-enhanced MRI of breast cancer during neoadjuvant chemotherapy that are indicative of pathology outcome. MATERIALS AND METHODS: In 54 patients with breast cancer, dynamic contrast-enhanced MRI was performed before chemotherapy and after two chemotherapy cycles. Imaging was correlated with final histopathology. Multivariate analysis with cross-validation was performed on MRI features describing kinetics and morphology of contrast uptake in the early and late phases of enhancement. Receiver operating characteristic (ROC) analysis was used to develop a guideline that switches patients at high risk for incomplete remission to a different chemotherapy regimen while maintaining first-line therapy in 95% of patients who are not at risk (i.e., high specificity). RESULTS: Change in largest diameter of late enhancement during chemotherapy was the single most predictive MRI characteristic for tumor response in multivariate analysis (A(z) [area under the ROC curve] = 0.73, p < 0.00001). Insufficient (< 25%) decrease in largest diameter of late enhancement during chemotherapy was most indicative of residual tumor at final pathology. Using this criterion, the fraction of unfavorable responders indicated by MRI was 41% (22/54). Approximately half (44%, 14/32) of the patients who showed favorable response at MRI achieved complete remission at pathology. Conversely, 95% (21/22) of patients who showed unfavorable response at MRI had residual tumor at pathology. CONCLUSION: Reduction of less than 25% in largest diameter of late enhancement during neoadjuvant chemotherapy shows the potential to predict residual tumor after therapy with high specificity.
Authors: Jennifer F De Los Santos; Alan Cantor; Keith D Amos; Andres Forero; Mehra Golshan; Janet K Horton; Clifford A Hudis; Nola M Hylton; Kandace McGuire; Funda Meric-Bernstam; Ingrid M Meszoely; Rita Nanda; E Shelley Hwang Journal: Cancer Date: 2013-02-21 Impact factor: 6.860
Authors: Kenneth E Pengel; Bas B Koolen; Claudette E Loo; Wouter V Vogel; Jelle Wesseling; Esther H Lips; Emiel J Th Rutgers; Renato A Valdés Olmos; Marie Jeanne T F D Vrancken Peeters; Sjoerd Rodenhuis; Kenneth G A Gilhuijs Journal: Eur J Nucl Med Mol Imaging Date: 2014-04-29 Impact factor: 9.236
Authors: Marieke E Straver; Tjeerd S Aukema; Renato A Valdes Olmos; Emiel J T Rutgers; Kenneth G A Gilhuijs; Margaret E Schot; Wouter V Vogel; Marie-Jeanne T F D Vrancken Peeters Journal: Eur J Nucl Med Mol Imaging Date: 2010-02-04 Impact factor: 9.236
Authors: M E Straver; E J Th Rutgers; S Rodenhuis; S C Linn; C E Loo; J Wesseling; N S Russell; H S A Oldenburg; N Antonini; M T F D Vrancken Peeters Journal: Ann Surg Oncol Date: 2010-04-06 Impact factor: 5.344
Authors: Richard G Abramson; Lori R Arlinghaus; Jared A Weis; Xia Li; Adrienne N Dula; Eduard Y Chekmenev; Seth A Smith; Michael I Miga; Vandana G Abramson; Thomas E Yankeelov Journal: Breast Cancer (Dove Med Press) Date: 2012-10