Accuracy of mammography and echography versus clinical palpation in the assessment of response to primary chemotherapy in breast cancer patients with operable disease.

Dipartimento di Radiologia, Azienda Ospedaliera Istituti Ospitalieri Cremona, Italy.
Breast Cancer Research and Treatment (Impact Factor: 4.2). 10/2001; 69(2):143-51. DOI: 10.1023/A:1012277325168
Source: PubMed

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: 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 02/2014; 9(2):e88853. DOI:10.1371/journal.pone.0088853 · 3.53 Impact Factor
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    ABSTRACT: Background Neoadjuvant chemotherapy has become an accepted component of the multidisciplinary treatment of clinical stage II and III breast cancer. The response to the neoadjuvant chemotherapy is important indicators of survival. Patients who achieve pathologic complete response (pCR) may not require surgery for optimum local control. However, at present, surgical excision and histological examination of the resected specimen is the only way to reliably identify this small subgroup of patients. More effective imaging strategies that can non-invasively identify complete pathological responders could potentially distinguish a subgroup of patients who need not undergo surgery at all. Aim of the present study was (1) assess the chemotherapeutic response for neoadjuvant chemotherapy by clinical examination, color doppler ultrasonography and mammographic examination. (2) To correlate clinical examination, color doppler ultrasonography and mammographic measurements of breast tumor and regional lymph nodes with that of histopathological findings. Material and methods The present prospective clinical study conducted during December 2009 to May 2011 includes 30 patients of breast cancer. All patients received 3-4 cycles of neoadjuvant chemotherapy CAF (Cyclophosphamide 500mg/m 2 , Doxorubicin 50mg/m 2 and 5-FU 500mg/m 2). Above patients underwent modified radical mastectomy after 10-15 days from last cycle of chemotherapy. The assessment of the chemotherapeutic response in the breast tumor was done by all three methods (Clinical examination, Color Doppler Sonography and Mammography) with respect to the reduction in the calculated volume. Response of the lymph nodes to chemotherapy was determined by Clinical examination and Color Doppler Sonography from the reduction in the largest dimension. Results The correlation between histopathological response with response of the tumor assessed by clinical examination, mammogram and ultrasonography were k=0.219, p=0.017; r=0.570, p=0.009 Vs k=0.077, p=0.628; r=0.449; p=0.047 Vs k=0.538; p=0.000; r=0.714; p=0.001 respectively. The correlation between the chemotherapeutic response assessed by Doppler parameters and histopathological parameters were k=0.339; p=0.04; r=0.075; p=0.77 Vs k=0.440; p=0.765; r=0.297; p=0.207 Vs k=0.44; p=0.767; r=0.114, p=0.633 for RI, PI and Vmax respectively. The percentages of overestimation and underestimation of the tumor in 20 patients compared with the histopathological examination by clinical examination, sonography and mammogram were 75% and 25% Vs 25% and 75% Vs 50% and 50% respectively. The mean of overestimation and underestimation by three methods were 1.22±0.77; 0.75±0.288 Vs 0.957±1.59; 1.07±1.32 Vs 0.538±0.255; 0.943±0.609 respectively. The correlation between clinical examination, sonography and mammogram with that of histopathologial examination as the gold standard on estimation of the tumor size were t=-0.257, p=0.801; r=0.797, p=0.00 Vs t=2.87, p=0.009; r=0.693, p=0.00 Vs t=0.718, p=0.04; r=0.911; p=0.00 respectively Conclusion Mammogram is the best non invasive modality in both assessing the chemotherapeutic response and estimation of size of the residual breast tumor than Clinical examination and Color Doppler Ultrasonography while considering histopathological examination as gold standard. In assessing the chemotherapeutic response of axillary lymph nodes, Clinical examination is a better modality than Color Doppler Ultrasonography.
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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.
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