Accuracy of MRI for estimating residual tumor size after neoadjuvant chemotherapy in locally advanced breast cancer: Relation to response patterns on MRI

529 Background: American College of Radiology Imaging Network (ACRIN) trial 6657, the imaging component of the I-SPY trial (CALGB 150007/150012), is testing MRI for predicting response to treatment and stratifying risk-of-recurrence in patients with locally-advanced breast cancer. We report preliminary results evaluating MRI for prediction of pathologic response. Methods: Women with ≥3 cm invasive breast cancer receiving neoadjuvant chemotherapy (NACT) with anthracycline-cyclophosphamide (AC) followed by a taxane (T) were enrolled from May 2002 to March 2006. MRI was performed prior to NACT (t1), after 1 cycle AC (t2), between AC and T (t3), and following T prior to surgery (t4). MRI tumor size assessments included longest diameter (MRLD) and tumor volume (MRVol). Clinical size (clinsize) and mammographic longest diameter (MGLD) were also recorded. Linear dimension was measured by the radiologist for MGLD and MRLD; MRVol was calculated by computer using signal enhancement ratio (SER) thresholds. Change in clinical and MRI variables at t2 were compared for ability to predict pathologic complete response (pCR). Results: 237 patients were enrolled at 9 institutions. 216 patients with complete imaging were analyzed. Of tumor size measurements at t4, MRVol showed the strongest correlation with pathsize among clinsize (r = 0.44), MGLD (ns), MRLD (r = 0.28) and MRVol (r = 0.61). Early change in MRVol measured at t2 was the only variable predictive of pCR among clinsize (p = 0.14, 0.15), MRLD (p = 0.40, 0.07), MRVol (p = 0.02, 0.01) and peak SER (p = 0.53, 0.72) in univariate and multivariate logistic regression, respectively. Conclusions: Tumor response measured volumetrically by MRI is a stronger and earlier predictor of pathologic response after NACT than clinical exam or tumor diameter. This work is funded by NIH/ACRIN U01 CA79778; CALGB CA31946, CA33601; NCI SPORE CA58207. [Table: see text]

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Predicting Response to Neoadjuvant Chemotherapy in Women with Locally Advanced Breast Cancer in Kenya: Utility of Ki67

Annals of African Surgery ◽

10.4314/aas.v18i1.5 ◽

2021 ◽

Vol 18 (1) ◽

pp. 23-28

Author(s):

Edwin Mogere ◽

Joseph Githaiga ◽

Francis Owilla ◽

Mary Mungania ◽

Daniel Ojuka

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Advanced Breast Cancer ◽

Tumor Size ◽

Locally Advanced Breast Cancer ◽

Locally Advanced ◽

Tumor Biology ◽

Advanced Breast ◽

P Value ◽

Response To Neoadjuvant Chemotherapy

Background: Ki67 levels have been shown to have good predictive value in breast cancer treatment. There is paucity of data on Ki67 levels in predicting response to neoadjuvant chemotherapy (NACT) in Kenya. This study evaluated the utility of Ki67 in predicting response to NACT. Methods: This was a prospective observational study carried out at Kenyatta National Hospital between December 2017 and January 2019 onpatients with locally advanced breast cancer. We recruited 61 women through consecutive sampling technique. Data collected included patient demographics, pre-treatment tumor size, Ki67 levels and tumor biology. After 3 cycles of first-line chemotherapy, ultrasonography was used to determine response. Data were analyzed by SPSS for proportion of change in tumor size. The response was correlated with tumor biology and pretreatment levels of Ki67 using chisquare at a 95% confidence interval. A p-value <0.05 was considered statistically significant. Results: The response rate after 3 cycles of NACT was 39.4%, sensitivity and specificity of Ki67 levels were 70.8% and 43.2% respectively with a cut-off value of 32.5%. Conclusions: Ki67 was found to predict response in our context at a rate of 39.4% at 20% cutoff after 3 cycles. Keywords: Ki67, Breast cancer, Neoadjuvant chemotherapy

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