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: 3.94). 10/2001; 69(2):143-51. DOI: 10.1023/A:1012277325168
Source: PubMed


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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    • "The pathCR was confined to the cohort C (7 out of 40 cases, 17.5%), with respect to cohort B (2 out of 40 cases, 5.0%) and cohort A (1 out of 40 cases, 2.5%) (P-value for trend o0.04). As previously shown by our group (Fiorentino et al, 2001), the grade of response of breast cancer to primary chemotherapy, showed by mammography and echography (data not shown), was less marked than the grade of response seen at clinical examination. The frequency of early treatment discontinuation, resulting from disease progression and patient refusal, did not occur among the treatment cohorts. "
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    ABSTRACT: Background: The objective of this study was to determine the optimal scheduling of 2.5 mg daily letrozole in neoadjuvant breast cancer patients to obtain pathological complete response (pathCR) and assess Ki-67 expression as an early predictor of response. Patients and methods: This single institution study comprised 120 oestrogen receptor (ER)-positive postmenopausal women with primary breast cancer (clinical stage ⩾T2, N0–1), from three sequential cohorts (cohort A of 40, cohort B of 40 and cohort C of 40 patients, respectively) based on different duration of the neoadjuvant letrozole. Biological markers such as ER, progesterone receptor, HER2 and Ki-67 expression were tested at diagnosis and at definitive surgery. Results: A total of 89 patients (75.4%) achieved an objective response with 44 (37.3%) clinical CRs and 45 (38.1%) partial responses. The clinical CRs were significantly observed in cohort C (23 out of 40 patients, 57.5%) and B (16 out of 38 patients, 42.1%) compared with cohort A (5 out of 40 patients, 12.5%) (P-value for trend <0.001). Letrozole induced a similar significant reduction in Ki-67 index after treatment in all cohorts. The pathCR rate was significantly more frequent in cohort C (7 out of 40 patients, 17.5%) than in cohort A (1 out of 40 patients, 2.5%) and B (2 out of 40 patients, 5.0%) (P-value for trend <0.04). Conclusion: One-year neoadjuvant letrozole therapy leads to a higher pathCR rate and may be the optimal length of drug exposure.
    British Journal of Cancer 04/2013; 108(8). DOI:10.1038/bjc.2013.151 · 4.84 Impact Factor
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    • "Many treatments options are now available, and with in vitro methods of limited reliability in determining chemotherapeutic response [1], as indeed are mammography and echo [2], researchers have applied MRI techniques which are usually based on measures of tissue perfusion (PWI). Loo [3] investigated parameters associated with PWI to predict which tumours with neoadjuvant chemotherapy would achieve remission. "
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    EPMA Journal, The 12/2011; 2(4):403-10. DOI:10.1007/s13167-011-0086-x
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    • "Rational use of neoadjuvant chemotherapy requires objective evaluation of chemotherapeutic response. Response assessment also helps in determining the early termination of ineffective regimens and change in the chemotherapeutic regimen [7]. The methods available are able to assess the response but predictability in an individual patient has not been documented. "
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