Birgit E P J Vriens1, Bart de Vries2, Marc B I Lobbes3, Saskia M van Gastel4, Franchette W P J van den Berkmortel5, Tineke J Smilde6, Laurence J C van Warmerdam7, Maaike de Boer8, Dick Johan van Spronsen9, Marjolein L Smidt10, Petronella G M Peer11, Maureen J Aarts1, Vivianne C G Tjan-Heijnen12. 1. Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands. 2. Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands. 3. Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands. 4. Comprehensive Cancer Center the Netherlands, Nijmegen, The Netherlands. 5. Department of Internal Medicine, Atrium Medical Center, Heerlen, The Netherlands. 6. Department of Internal Medicine, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands. 7. Department of Internal Medicine, Catharina-Hospital, Eindhoven, The Netherlands. 8. Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. 9. Department of Internal Medicine, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands. 10. Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. 11. Biostatistics, Radboud Institute for Health Sciences, Nijmegen, The Netherlands. 12. Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands. Electronic address: vcg.tjan.heijnen@mumc.nl.
Abstract
BACKGROUND: The aim of this study was to evaluate the accuracy of clinical imaging of the primary breast tumour post-neoadjuvant chemotherapy (NAC) related to the post-neoadjuvant histological tumour size (gold standard) and whether this varies with breast cancer subtype. In this study, results of both magnetic resonance imaging (MRI) and ultrasound (US) were reported. METHODS:Patients with invasive breast cancer were enrolled in the INTENS study between 2006 and 2009. We included 182 patients, of whom data were available for post-NAC MRI (n=155), US (n=123), and histopathological tumour size. RESULTS:MRI estimated residual tumour size with <10-mm discordance in 54% of patients, overestimated size in 28% and underestimated size in 18% of patients. With US, this was 63%, 20% and 17%, respectively. The negative predictive value in hormone receptor-positive tumours for both MRI and US was low, 26% and 33%, respectively. The median deviation in clinical tumour size as percentage of pathological tumour was 63% (P25=26, P75=100) and 49% (P25=22, P75=100) for MRI and US, respectively (P=0.06). CONCLUSIONS: In this study, US was at least as good as breast MRI in providing information on residual tumour size post-neoadjuvant chemotherapy. However, both modalities suffered from a substantial percentage of over- and underestimation of tumour size and in addition both showed a low negative predictive value of pathologic complete remission (Gov nr: NCT00314977).
RCT Entities:
BACKGROUND: The aim of this study was to evaluate the accuracy of clinical imaging of the primary breast tumour post-neoadjuvant chemotherapy (NAC) related to the post-neoadjuvant histological tumour size (gold standard) and whether this varies with breast cancer subtype. In this study, results of both magnetic resonance imaging (MRI) and ultrasound (US) were reported. METHODS:Patients with invasive breast cancer were enrolled in the INTENS study between 2006 and 2009. We included 182 patients, of whom data were available for post-NAC MRI (n=155), US (n=123), and histopathological tumour size. RESULTS: MRI estimated residual tumour size with <10-mm discordance in 54% of patients, overestimated size in 28% and underestimated size in 18% of patients. With US, this was 63%, 20% and 17%, respectively. The negative predictive value in hormone receptor-positive tumours for both MRI and US was low, 26% and 33%, respectively. The median deviation in clinical tumour size as percentage of pathological tumour was 63% (P25=26, P75=100) and 49% (P25=22, P75=100) for MRI and US, respectively (P=0.06). CONCLUSIONS: In this study, US was at least as good as breast MRI in providing information on residual tumour size post-neoadjuvant chemotherapy. However, both modalities suffered from a substantial percentage of over- and underestimation of tumour size and in addition both showed a low negative predictive value of pathologic complete remission (Gov nr: NCT00314977).