Accuracy of mammography and echography versus clinical palpation in the assessment of response to primary chemotherapy in breast cancer patients with operable disease.
ABSTRACT The response to primary chemotherapy is an important prognostic factor in patients with non metastatic breast cancer. In this study we compared the assessment of response performed by clinical palpation to that performed by echography and mammography in 141 out of 157 consecutive breast cancer patients (T2-4, N0-1, M0) submitted to primary chemotherapy. A low relationship was recorded between tumor size assessed clinically and that evaluated by either mammography: Spearman R = 0.38 or echography: R = 0.24, while a greater correlation was found between the tumor dimension obtained by the two imaging techniques (R = 0.62). According to the WHO criteria, the grade of response of breast cancer to primary chemotherapy, showed by mammography and echography, was less marked than the grade of response seen at clinical examination. Residual tumor size assessed clinically depicted a stronger correlation with pathological findings (R = 0.68) than the residual disease assessed by echography (R = 0.29) and mammography (R = 0.33). Post-chemotherapy histology evaluation revealed pathological complete response in three cases (2.1%). Two of these cases were judged as complete responders by clinical palpation but only one was recognized by mammography, and none by echography. Clinical response, but not the response obtained by the two imaging techniques, was a significant predictor for longer disease free survival (p = 0.04). To conclude, physical examination measurements remain the method of choice in evaluating preoperatively the disease response in trials of primary chemotherapy. Prediction of pathological outcome is not improved by echography and mammography.
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ABSTRACT: The response to preoperative chemotherapy in breast cancer was assessed by magnetic resonance imaging (MRI), and compared to the histological and clinical findings.Forty-two patients with stage II and III breast carcinoma were evaluated prospectively prior to and after preoperative chemotherapy by MRI, clinical and histological examination. Radiological response was assessed using the MRI parameters: total tumor volume (TTV), maximum enhancement index (MEI) and their product (TTV*MEI).A significant reduction in all MRI parameters was observed after chemotherapy. Overall clinical and radiological response rates were comparable (69% vs 73%). MRI was not useful for the prediction of complete pathologic response. A fair correlation between TTV postchemotherapy and final histological diameter was found. A significant difference of residual TTV for patients undergoing breast conservative surgery vs mastectomy was observed.Conclusion: MRI can demonstrate responses induced by preoperative chemotherapy in breast cancer, but it cannot determine complete pathologic responses.Breast. 01/2002; 11(4):306-315.
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ABSTRACT: Investigate the patterns of mammographically detected calcifications before and after neoadjuvant chemotherapy (NACT) to determine their value for efficacy evaluation and surgical decision making. 187 patients with malignant mammographic calcifications were followed to record the appearances and changes in the calcifications and to analyze their responses to NACT. Patients with calcifications had higher rates of hormonal receptor (HR) positive tumors (74.3% versus 64.6%) and HER2 positive tumors (51.3% versus 33.4%, p = 0.004) and a similar pathologic complete response (pCR) rate compared to patients without calcifications (35.4% versus 29.8%). After NACT, the range of calcification decreased in 40% of patients, increased in 7.5% and remained stable in 52.5%; the calcification density decreased in 15% of patients, increased in 7.5% and remained stable in 77.5%; none of these change patterns were related to tumor response rate. No significant correlation was observed between the calcification appearance (morphology, distribution, range, diameter or density) and tumor subtypes or pCR rates. Among patients with malignant calcifications, 54 showed calcifications alone, 40 occurred with an architectural distortion (AD) and 93 with a mass. Calcifications were observed inside the tumor in 44% of patients and outside in 56%, with similar pCR rates and patterns of change. Calcification appearance did not clearly change after NACT, and calcification patterns were not related to pCR rate, suggesting that mammogram may not accurate to evaluate tumor response changes. Microcalcifications visible after NACT is essential for determining the extent of excision, patients with calcifications that occurred outside of the mass still had the opportunity for breast conservation.PLoS ONE 01/2014; 9(2):e88853. · 3.53 Impact Factor
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ABSTRACT: Follow-up by clinical examination and mammography of treated breast cancer patients should begin within 6 months after the end of local treatment. Mammographic or ultrasound assessment of recurrent disease is often difficult in patients with substantial postsurgical and postradiation changes. Reported sensitivity and specificity of MRI are accurate enough and can be used when clinical examination, conventional imaging, or pathological findings remain inconclusive. MRI is also used to monitor response to neoadjuvant chemotherapy and to assess residual disease after partial breast surgery.Imagerie de la Femme 01/2007; 17(1):5-18.