Role of Breast MR Imaging in Neoadjuvant Chemotherapy

Department of Radiology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1350, Houston, TX 77030, USA.
Magnetic resonance imaging clinics of North America (Impact Factor: 0.99). 05/2010; 18(2):249-58, viii-ix. DOI: 10.1016/j.mric.2010.02.008
Source: PubMed


Neoadjuvant chemotherapy is now widely used in the management of locally advanced breast cancer (LABC). Early initiation of systemic therapy can improve overall and disease-free survival for patients with LABC or inflammatory cancer. MR imaging with intravenous contrast and advanced MR imaging techniques provide new opportunities for assessing tumor morphologic changes, tumor vascularity, tumor cellularity, and tumor metabolic features. MR imaging is more reliable than the conventional methods in the assessment of tumor size and vascularity changes during and after chemotherapy. The addition of advanced imaging techniques to further characterize tumor cellularity and metabolic features appears promising. However, there is still no consensus on the role of MR imaging for assessing response to neoadjuvant chemotherapy or on a standardized MR imaging examination in patients receiving neoadjuvant chemotherapy.

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    ABSTRACT: The objective of our study was to determine the relative accuracy of mammography, sonography, and MRI in predicting residual tumor after neoadjuvant chemotherapy for breast cancer as compared with the gold standards of physical examination and pathology. Forty-one women with stage IIB-III palpable breast cancer were prospectively enrolled in a study investigating the effects of sequential single-agent chemotherapy (doxorubicin followed by paclitaxel or vice versa) on tumor imaging. The study cohort consisted of the first 31 patients (age range, 31-65 years; mean, 45 years) who completed the protocol. All underwent physical examination, mammography, sonography, and MRI before and after receiving each neoadjuvant chemotherapeutic drug. Imaging studies were reviewed by two radiologists using conventional lexicons for lesion analysis, and the findings were compared with clinical response and pathology results. Complete, partial, and stable clinical response as defined by clinical examination was seen in 15, 14, and two of the 31 patients, respectively. Agreement rates about the degree of response were 32%, 48%, and 55%, respectively, for mammography, sonography, and MRI compared with clinical evaluation and did not differ statistically. Agreement about the rate of response as measured by clinical examination, mammography, sonography, and MRI compared with the gold standard (pathology) was 19%, 26%, 35%, and 71%, respectively. Of the four, MRI agreed with the gold standard significantly more often (p < 0.002 for all three paired comparisons with MRI). When there was disagreement with the gold standard, none of the four exhibited a significant tendency to either under- or overestimate. MRI appears to provide the best correlation with pathology-better than physical examination, mammography, and sonography-in patients undergoing neoadjuvant chemotherapy. However, MRI may overestimate (6%) or underestimate (23%) residual disease in approximately 29% of the patients (95% confidence interval, 14-48%).
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