Development and validation of nomograms for predicting residual tumor size and the probability of successful conservative surgery with neoadjuvant chemotherapy for breast cancer

Abstract Background Breast cancer is a leading cause of death and disability between women, particularly young women, in low- and average -income countries (Porter, 2018). Neoadjuvant chemotherapy (NAC) is increasingly used in management patients with locally advanced breast cancer (LABC) (Mougalian et al., 2015). Mammography and breast ultrasound are the most widest diagnostic techniques used to evaluate primary tumor size and character at the time of diagnosis and monitoring the response to NAC (Kald et al., 2015). Aim of the work The purpose of this study is to assess and evaluate the role and the accuracy of Mammography and breast ultrasound modalities in monitoring the response of the breast cancer to the neoadjuvant chemotherapy. Patients and methods Twenty three patients presenting with pathologically proven malignant mass and conducted for neoadjuvant chemotherapy with age above 40 years-old. They were referred to the radiology department (mammography unit, Ultrasound unit and MRI unit) at El Salam oncology center, during the period between December 2018 to June 2019. Once a patient satisfied the inclusion and exclusion criteria for this study, an elaborate history was taken from all the patients which was followed by a thorough clinical evaluation, in which duration of symptoms, affected side, affected breast and family history. Patients were subjected to evaluation before starting neoadjunant chemotherapy by mammography, ultrasound and MRI as well as after finishing the neoadjuvant cycles which usually was ranging 3-4 cycles. Results Total of 23 patients with breast cancer were enrolled in this study. The patients were in the age group of 41-70 years with mean age of 54 years. Majority of patients had infiltrative ductal carcinoma IDC (16 cases -69.56% and the rest of cases were infiltrative lobular carcinoma (9 cases -39.13 %). After monitoring the response of the cases to neoadjuvant chemotherapy the results showed significant regressive course to the majority of cases ( 17 cases ) (73.91%) with the rest non respondent cases divided to cases with stationary ( 3 cases ) (13.04% ) and cases with progressive course ( 3 cases ) (13.04% ). The comparison between the results of Sonomammographic assessment of the breast lesions before and after the neoadjuvant chemotherapy cycles and also to MRI show close results. There were 5 cases that showed non-respondent (including stationary course and progressive course) in both Sonomammography and MRI and only one case that was respondent according to Sonomammography and non-respondent according to MRI breast (false +e). On the other hand there were 16 cases that had showed respondent fashion in both Sonomammography and MRI. Also there was one case that had showed non-respondent course according to Sonomammography and was respondent according to MRI results (false –ve). Sonomammography sensitivity was 94.12 % and specificity was 83.33% compared to MRI results, with high accuracy value reaching to 91.30 %. Conclusion The ability of mammography and breast ultrasound to accurately measure residual tumor size following neoadjuvant chemotherapy compared to Breast MRI measurement of the residual tumor demonstrated sensitivity of 94.12 % and specificity of 83.33% with high accuracy value reaching to 91.30 %. Even that the MRI is proved to be of high accuracy in detecting residual tumor, sonomammographic imaging isa cost-effective imaging modality than the MRI with sensitivity and specificity near to that of MRI.

Download Full-text

Nomogram for predicting breast-conservation surgery after neoadjuvant chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.1128 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 1128-1128

Author(s):

Min Kyoon Kim ◽

Wonshik Han ◽

Hyeong-Gon Moon ◽

Jisun Kim ◽

Soo Kyung Ahn ◽

...

Keyword(s):

Breast Cancer ◽

Tumor Size ◽

Breast Conservation ◽

Residual Tumor ◽

Breast Conservation Surgery ◽

Residual Tumor Size ◽

Number Of Patients ◽

Initial Tumor ◽

Conservation Surgery ◽

Initial Tumor Size

1128 Background: The indications for neoadjuvant systemic treatment (NST) have broadened to early breast cancer patients and more patients can undergo breast conservation with results in better cosmetic outcomes. However, a significant number of patients with operable breast cancer still require mastectomy after NST with a small number of patients experiencing disease progression which may hinder complete surgical resection. Therefore, accurate prediction of each patient’s likelihood of achieving breast conservation after NST is important for establishing a treatment plan for patients with operable breast cancers. Methods: We identified 534 women from the Seoul National University Hospital Breast Care Center, who were stage II and III, and treated with neoadjuvant chemotherapy and surgery from Jan. 2001 to Dec. 2010. Breast conservation surgery (BCS) and tumor size reduction to less than 3cm were clinical outcome variables for nomograms, and we analyzed the various clinicopathologic factors best predicting these outcomes. To develop well-calibrated and exportable nomograms for BCS and for residual tumor size, we built each model in a training cohort and validated it in an independent validation cohort. Results: Of the 513 patients, pCR was observed in 10.5% and BCS was performed in 50.1%. The nomogram for predicting BCS and tumor size reduction to less than 3cm were constructed using logistic regressing model. Initial tumor size(p<0.001), the distance between the lesion and the nipple (p < 0.001), the presence of suspicious calcifications in the mammography (p = 0.0127) and multicentricity (p = 0.0146) were independently associated with breast conservation surgery. ER status (p = 0.001), initial tumor size (p < 0.001), histologic type (p = 0.012) were independently associated with a residual tumor size <3cm. Mastectomy rate in the larger than 3cm tumors were 72.7%, and breast conservation surgery in smaller than 3cm tumors were 63.2%. (p < 0.001). Conclusions: In conclusion, we have established a new model to predict BCS and residual tumor size after NST. The model showed the outperformed prediction accuracy compared with previous similar models with reflecting novel factors impacting on surgical decision making.

Download Full-text

How do we measure a residual tumor size in Histopathology (the gold standard) after neoadjuvant chemotherapy?

The Breast ◽

10.1016/j.breast.2005.08.002 ◽

2006 ◽

Vol 15 (3) ◽

pp. 370-376 ◽

Cited By ~ 13

Author(s):

S.K. Apple ◽

F. Suthar

Keyword(s):

Neoadjuvant Chemotherapy ◽

Tumor Size ◽

Gold Standard ◽

Residual Tumor ◽

Residual Tumor Size

Download Full-text

Direct comparison of magnetic resonance imaging and pathological shrinkage patterns of triple-negative breast cancer after neoadjuvant chemotherapy

10.21203/rs.3.rs-23891/v1 ◽

2020 ◽

Author(s):

Katsuhiro Yoshikawa ◽

Mitsuaki Ishida ◽

Naoki Kan ◽

Hirotsugu Yanai ◽

Koji Tsuta ◽

...

Keyword(s):

Breast Cancer ◽

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Neoadjuvant Chemotherapy ◽

Triple Negative Breast Cancer ◽

Tumor Size ◽

Triple Negative ◽

Residual Tumor ◽

Predictive Equation ◽

Resonance Imaging

Abstract Background We aimed to investigate the usefulness of magnetic resonance imaging (MRI) and histopathological shrinkage patterns to formulate a predictive equation for estimating residual tumor size after neoadjuvant chemotherapy (NAC) in triple-negative breast cancer (TNBC) patients.Methods We enrolled 34 TNBC patients who underwent MRI before and after NAC. The MRI and histopathological shrinkage patterns were analyzed and classified into five categories—types I and II (concentric shrinkage without or with surrounding lesions, respectively), type III (shrinkage with residual multinodular lesions), type IV (diffuse contrast enhancement in the entire quadrant), and non-visualization. The residual tumor sizes following MRI and histopathological examination were also compared.Results The most common MRI and histopathological shrinkage pattern was type I (41.2% and 38.2%, respectively), followed by non-visualization (26.5% and 32.4%, respectively); the concordance rate between MRI and histopathological shrinkage patterns was 41.2%. There was a strong correlation between MRI tumor size and pathological tumor size (r = 0.89). Based on these findings, a predictive equation for pathological tumor size was formulated as follows: pathological tumor size \left(mm\right) = 1.1502 \times \left(MRI tumor size \right[mm\left]\right) + 8.4277.Conclusions Our equation may aid accurate preoperative assessment. Further studies are needed to determine its predictive value and applicability.

Download Full-text

Dynamic Contrast-enhanced Breast MRI for Evaluating Residual Tumor Size after Neoadjuvant Chemotherapy

Radiology ◽

10.1148/radiol.2018172868 ◽

2018 ◽

Vol 289 (2) ◽

pp. 327-334 ◽

Cited By ~ 14

Author(s):

Soo-Yeon Kim ◽

Nariya Cho ◽

In-Ae Park ◽

Bo Ra Kwon ◽

Sung Ui Shin ◽

...

Keyword(s):

Neoadjuvant Chemotherapy ◽

Tumor Size ◽

Breast Mri ◽

Residual Tumor ◽

Dynamic Contrast Enhanced ◽

Residual Tumor Size ◽

Contrast Enhanced

Download Full-text

Accuracy of contrast-enhanced spectral mammography for estimating residual tumor size after neoadjuvant chemotherapy in patients with breast cancer: a feasibility study

Radiologia Brasileira ◽

10.1590/0100-3984.2016-0029 ◽

2017 ◽

Vol 50 (4) ◽

pp. 224-230 ◽

Cited By ~ 9

Author(s):

Filipe Ramos Barra ◽

Fernanda Freire de Souza ◽

Rosimara Eva Ferreira Almeida Camelo ◽

Andrea Campos de Oliveira Ribeiro ◽

Luciano Farage

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Correlation Coefficient ◽

Tumor Size ◽

Predictive Value ◽

Interobserver Agreement ◽

Intraclass Correlation ◽

Residual Tumor ◽

Pathological Findings ◽

Contrast Enhanced

Abstract Objective: To assess the feasibility of contrast-enhanced spectral mammography (CESM) of the breast for assessing the size of residual tumors after neoadjuvant chemotherapy (NAC). Materials and methods: In breast cancer patients who underwent NAC between 2011 and 2013, we evaluated residual tumor measurements obtained with CESM and full-field digital mammography (FFDM). We determined the concordance between the methods, as well as their level of agreement with the pathology. Three radiologists analyzed eight CESM and FFDM measurements separately, considering the size of the residual tumor at its largest diameter and correlating it with that determined in the pathological analysis. Interobserver agreement was also evaluated. Results: The sensitivity, specificity, positive predictive value, and negative predictive value were higher for CESM than for FFDM (83.33%, 100%, 100%, and 66% vs. 50%, 50%, 50%, and 25%, respectively). The CESM measurements showed a strong, consistent correlation with the pathological findings (correlation coefficient = 0.76-0.92; intraclass correlation coefficient = 0.692-0.886). The correlation between the FFDM measurements and the pathological findings was not statistically significant, with questionable consistency (intraclass correlation coefficient = 0.488-0.598). Agreement with the pathological findings was narrower for CESM measurements than for FFDM measurements. Interobserver agreement was higher for CESM than for FFDM (0.94 vs. 0.88). Conclusion: CESM is a feasible means of evaluating residual tumor size after NAC, showing a good correlation and good agreement with pathological findings. For CESM measurements, the interobserver agreement was excellent.

Download Full-text