John R Scheel1, Eunhee Kim2, Savannah C Partridge1, Constance D Lehman3, Mark A Rosen4, Wanda K Bernreuter5, Etta D Pisano6, Helga S Marques7, Elizabeth A Morris8, Paul T Weatherall9, Sandra M Polin10, Gillian M Newstead11, Laura J Esserman12, Mitchell D Schnall4, Nola M Hylton12. 1. 1 Department of Radiology, University of Washington, Seattle, WA. 2. 2 Merck Research Laboratories, Rahway, NJ. 3. 3 Department of Radiology, Massachusetts General Hospital, Boston, MA. 4. 4 Department of Radiology, University of Pennsylvania, Philadelphia, PA. 5. 5 Department of Radiology, University of Alabama, Birmingham, AL. 6. 6 Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA. 7. 7 Brown University Center for Statistical Sciences, Providence, RI. 8. 8 Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY. 9. 9 Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX. 10. 10 Department of Radiology, Johns Hopkins Medical Center, Baltimore, MD. 11. 11 Department of Radiology, University of Chicago, Chicago, IL. 12. 12 Department of Radiology, University of California, 1600 Divisadero St, C255, Box 1667, San Francisco, CA 94115.
Abstract
OBJECTIVE: The objective of our study was to determine the accuracy of preoperative measurements for detecting pathologic complete response (CR) and assessing residual disease after neoadjuvant chemotherapy (NACT) in patients with locally advanced breast cancer. SUBJECTS AND METHODS: The American College of Radiology Imaging Network 6657 Trial prospectively enrolled women with ≥ 3 cm invasive breast cancer receiving NACT. Preoperative measurements of residual disease included longest diameter by mammography, MRI, and clinical examination and functional volume on MRI. The accuracy of preoperative measurements for detecting pathologic CR and the association with final pathology size were assessed for all lesions, separately for single masses and nonmass enhancements (NMEs), multiple masses, and lesions without ductal carcinoma in situ (DCIS). RESULTS: In the 138 women with all four preoperative measures, longest diameter by MRI showed the highest accuracy for detecting pathologic CR for all lesions and NME (AUC = 0.76 and 0.84, respectively). There was little difference across preoperative measurements in the accuracy of detecting pathologic CR for single masses (AUC = 0.69-0.72). Longest diameter by MRI and longest diameter by clinical examination showed moderate ability for detecting pathologic CR for multiple masses (AUC = 0.78 and 0.74), and longest diameter by MRI and longest diameter by mammography showed moderate ability for detecting pathologic CR for tumors without DCIS (AUC = 0.74 and 0.71). In subjects with residual disease, longest diameter by MRI exhibited the strongest association with pathology size for all lesions and single masses (r = 0.33 and 0.47). Associations between preoperative measures and pathology results were not significantly influenced by tumor subtype or mammographic density. CONCLUSION: Our results indicate that measurement of longest diameter by MRI is more accurate than by mammography and clinical examination for preoperative assessment of tumor residua after NACT and may improve surgical planning.
OBJECTIVE: The objective of our study was to determine the accuracy of preoperative measurements for detecting pathologic complete response (CR) and assessing residual disease after neoadjuvant chemotherapy (NACT) in patients with locally advanced breast cancer. SUBJECTS AND METHODS: The American College of Radiology Imaging Network 6657 Trial prospectively enrolled women with ≥ 3 cm invasive breast cancer receiving NACT. Preoperative measurements of residual disease included longest diameter by mammography, MRI, and clinical examination and functional volume on MRI. The accuracy of preoperative measurements for detecting pathologic CR and the association with final pathology size were assessed for all lesions, separately for single masses and nonmass enhancements (NMEs), multiple masses, and lesions without ductal carcinoma in situ (DCIS). RESULTS: In the 138 women with all four preoperative measures, longest diameter by MRI showed the highest accuracy for detecting pathologic CR for all lesions and NME (AUC = 0.76 and 0.84, respectively). There was little difference across preoperative measurements in the accuracy of detecting pathologic CR for single masses (AUC = 0.69-0.72). Longest diameter by MRI and longest diameter by clinical examination showed moderate ability for detecting pathologic CR for multiple masses (AUC = 0.78 and 0.74), and longest diameter by MRI and longest diameter by mammography showed moderate ability for detecting pathologic CR for tumors without DCIS (AUC = 0.74 and 0.71). In subjects with residual disease, longest diameter by MRI exhibited the strongest association with pathology size for all lesions and single masses (r = 0.33 and 0.47). Associations between preoperative measures and pathology results were not significantly influenced by tumor subtype or mammographic density. CONCLUSION: Our results indicate that measurement of longest diameter by MRI is more accurate than by mammography and clinical examination for preoperative assessment of tumor residua after NACT and may improve surgical planning.
Authors: E Shelley Hwang; Terry Hyslop; Laura H Hendrix; Stephanie Duong; Isabelle Bedrosian; Elissa Price; Abigail Caudle; Tina Hieken; Joseph Guenther; Clifford A Hudis; Eric Winer; Alan P Lyss; Diana Dickson-Witmer; Richard Hoefer; David W Ollila; Timothy Hardman; Jeffrey Marks; Yunn-Yi Chen; Gregor Krings; Laura Esserman; Nola Hylton Journal: J Clin Oncol Date: 2020-03-03 Impact factor: 44.544