Comparison of mammography, sonography and MRI in patients receiving neoadjuvant chemotherapy for breast cancer: Final results of a prospective study

10538 Background: Imaging techniques used to evaluate response during neoadjuvant chemotherapy for breast cancer include mammography (Mx), sonography (US) and MRI. This study prospectively evaluated the ability of each technique to determine pathologic response in breast cancer patients undergoing neoadjuvant chemotherapy. Methods: Forty women with operable breast cancer (T ≥ 2 cm, N0–1, M0) were treated with four cycles of anthracycline-based and taxane-based neoadjuvant chemotherapy as part of a phase II clinical trial. The longest diameter of each tumor (n = 48 neoplastic foci) was measured by Mx, US and MRI at baseline, after two cycles and after 4 cycles of chemotherapy, before surgery. Tumor size at pathology was determined and considered as gold standard of response. Differences among techniques in measuring tumor diameters were evaluated by means of t-test. Results: At baseline, US provided statistically higher measures than Mx (mean difference: 6.3 mm, p < 0.0001) or MRI (mean difference: 5.6 mm, p < 0.0001). No difference was observed between Mx and MRI (mean difference: 0.59 mm, p = 0.5). After two cycles of chemotherapy, tumor diameter measured by US was significantly longer than that measured by Mx (mean difference: 8.8 mm, p < 0.0001) and significantly shorter than that measured by MRI (mean difference: −5.1 mm, p = 0.0009). Mx provided longer measures than MRI (mean difference: 4.4 mm, p = 0.0034). After four cycles of chemotherapy, US provided significantly shorter measures than Mx (mean difference: 11.8 mm, p < 0.0001) and MRI (mean difference: −3.3 mm, p = 0.007), whereas tumor size measured by Mx was significantly longer than that measured by MRI (mean difference: 6.75 mm, p = 0.0027). In addition, the tumor diameter measured by the pathologist was longer than that measured by US (mean difference: 2.6 mm, p = 0.09) and significantly shorter than that measured by Mx (mean difference: −7.8 mm, p < 0.0001). No statistically significant difference was observed between MRI and pathological measures (mean difference: −1.0, p = 0.5). Conclusions: This study provides further evidence that, among imaging techniques, MRI is the best method to evaluate the tumor size after neoadjuvant chemotherapy for breast cancer. No significant financial relationships to disclose.

Download Full-text

Relationship Between Obesity and Pathologic Response to Neoadjuvant Chemotherapy Among Women With Operable Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2007.14.4527 ◽

2008 ◽

Vol 26 (25) ◽

pp. 4072-4077 ◽

Cited By ~ 106

Author(s):

Jennifer K. Litton ◽

Ana M. Gonzalez-Angulo ◽

Carla L. Warneke ◽

Aman U. Buzdar ◽

Shu-Wan Kau ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Neoadjuvant Chemotherapy ◽

Cancer Patients ◽

Pathologic Complete Response ◽

Operable Breast Cancer ◽

Obese Patients ◽

Breast Cancer Patients ◽

Significant Difference ◽

Response To Neoadjuvant Chemotherapy

Purpose To understand the mechanism through which obesity in breast cancer patients is associated with poorer outcome, we evaluated body mass index (BMI) and response to neoadjuvant chemotherapy (NC) in women with operable breast cancer. Patients and Methods From May 1990 to July 2004, 1,169 patients were diagnosed with invasive breast cancer at M. D. Anderson Cancer Center and received NC before surgery. Patients were categorized as obese (BMI ≥ 30 kg/m2), overweight (BMI of 25 to < 30 kg/m2), or normal/underweight (BMI < 25 kg/m2). Logistic regression was used to examine associations between BMI and pathologic complete response (pCR). Breast cancer–specific, progression-free, and overall survival times were examined using the Kaplan-Meier method and Cox proportional hazards regression analysis. All statistical tests were two-sided. Results Median age was 50 years; 30% of patients were obese, 32% were overweight, and 38% were normal or underweight. In multivariate analysis, there was no significant difference in pCR for obese compared with normal weight patients (odds ratio [OR] = 0.78; 95% CI, 0.49 to 1.26). Overweight and the combination of overweight and obese patients were significantly less likely to have a pCR (OR = 0.59; 95% CI, 0.37 to 0.95; and OR = 0.67; 95% CI, 0.45 to 0.99, respectively). Obese patients were more likely to have hormone-negative tumors (P < .01), stage III tumors (P < .01), and worse overall survival (P = .006) at a median follow-up time of 4.1 years. Conclusion Higher BMI was associated with worse pCR to NC. In addition, its association with worse overall survival suggests that greater attention should be focused on this risk factor to optimize the care of breast cancer patients.

Download Full-text

3-D MRI guided breast conserving surgery

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.610 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 610-610

Author(s):

K. Hisamatsu

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Tumor Size ◽

Breast Conserving Surgery ◽

Resected Specimen ◽

Tumor Diameter ◽

Breast Cancer Patients ◽

3D Mri ◽

Guided Surgery ◽

Mri Guided

610 Background: In breast cancer patients, accurate diagnosis of ductal spreading is of great importanace for deciding sugical procedure. The role of imaging diagnosis using 3D-MRI in deciding of ductal spreading was assessed histologically and efficacy of 3D-MRI guided surgery was evaluated. Methods: Preoperative 3D-MRI was underwent 374 cases of breast cancer patients. Images were obtained 371 cases (99%). These patients could be divided into four groups according to 3D-MRI images: pattern 1) localized type, 2) widely enhanced type A (enhanced area: less than Quadrant) and 3) widely enhanced type B (enhanced area: more than Quadrant) and 4) multifocal type. Diagnosis of ductal spreading was confirmed histologically and relation between 3D-MRI patterns and ductal spreading were assessed retrospectively. Local failure of 3D-MRI guided surgery was assessed by 3D-MRI image patterns Results: The rate of histological confirmed ductal spreading were seen in 59% (125/212cases), 86% (49/57 cases) and 83% (19/23cases) of patients with 3D-MRI pattern 1), 2), and 3), respectively. From April 2005, resected specimen was serially step cut and total specimens were evaluated. Tumor diameter from nipple side to lateral margin were measured by MRI and resected specimens, tumor size was correlated between MRI and resected specimens, significantly (n=80, r=0.790887, P < 0.001). Whole breast examination revealed that only 4 cases were multifocal cancer in 17 cases of multifocal image in 3D-MRI. Patient selection for breast conserving surgery was based by 3D-MRI images. The proportion of breast-conserved surgery were obtained 96% (203/212 cases), 86% (49/57 cases), 26% (6/23cases) and 89% (68/76 cases) of patients with 3D-MRI pattern 1), 2), 3), and 4), respectively. Local failures were seen 2cases in pattern 1), one case in 3) and one case in 4) (2–77 months, median follow up 39 months). Conclusions: These results suggest that MRI will be the useful breast imaging tool in diagnosing ductal spreading and tumor size in breast cancer patients. Safety breast conserving surgery was achieved by MRI guided surgery. No significant financial relationships to disclose.

Download Full-text

Factors associated with axillary conversion after neoadjuvant chemotherapy in initially node positive breast cancer patients: A transSENTINA analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.567 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 567-567

Author(s):

Hans-Christian Kolberg ◽

Thorsten Kühn ◽

Maja Krajewska ◽

Ingo Bauerfeind ◽

Tanja N. Fehm ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Lymph Nodes ◽

Primary Tumor ◽

Tumor Biology ◽

Her2 Status ◽

Tumor Diameter ◽

Breast Cancer Patients ◽

Axillary Surgery ◽

Small Patient Number

567 Background: Current study concepts in early breast cancer after neoadjuvant chemotherapy (NAT) are aiming at reducing morbidity by omission of axillary surgery in selected patients. Selection criteria for this strategy have to include the probability of conversion from cN1 to ycN0. We analyzed the association of clinical/pathological parameters and axillary conversion with data from arms C and D of the SENTINA trial (Kühn T et al., Lancet Oncol 2013). Methods: Patients were recruited to Arms C/D of the SENTINA trial in case they presented with clinically positive nodes before NAT. Based on their response to NAT they were then assigned to either arm C (clinically conversion to ycN0) or arm D (no clinical conversion (ycN+). In both the pre- and post-NAT scenarios, clinically involved lymph nodes were defined as palpable and/or suspect by ultrasound. Univariate logistic regression analyses were carried out to evaluate the association between clinical/pathological parameters and axillary conversion after NAT. Results: Of the 892 patients in arms C and D of the SENTINA trial 716 were evaluable for this analysis. After NAT, 593 patients converted to ycN0 and were therefore assigned to arm C; in contrast, 123 patients still had involved lymph nodes after NAT (ycN+) and were assigned to Arm D. Arms C and D were compared regarding the clinical/pathological parameters tumor diameter by ultrasound before and after NAT, grading, multifocality, ER status, PR status, HER2 status, pathological complete remission in the breast (breast pCR), morphology, lymphovascular invasion (LVI) and hemangiosis. Only small tumor diameter after NAT (p = 0.0038), achievement of breast pCR (p = 0.0001) and lack of LVI (p = 0.0009) were positively associated with axillary conversion from cN1 to ycN0 after NAT. Conclusions: Because of the small patient number in arm D, we were not able to identify an association between parameters of tumor biology (ER, PR, HER2 and TN status) and axillary conversion. However, favorable response of the primary tumor (represented both clinically by tumor diameter after NAT and pathologically by pCR in the breast) were positively associated with conversion from cN1 to ycN0. These results justify including patients with clinical and pathological response of the primary tumor in trials investigating de-escalation of axillary surgery after NAT.

Download Full-text

Postmastectomy radiotherapy after neoadjuvant chemotherapy in cT1-2N+ breast cancer patients: a single center experience and review of current literature

10.21203/rs.3.rs-1201823/v1 ◽

2022 ◽

Author(s):

Meng Luo ◽

Huihui Chen ◽

Hao Deng ◽

Yao Jin ◽

Gui Wang ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Cancer Patients ◽

Cox Regression ◽

Medical Center ◽

Clinical Stage ◽

Disease Free Survival ◽

Her2 Overexpression ◽

Breast Cancer Patients ◽

Significant Difference

Abstract PurposePostmastectomy radiotherapy (PMRT) after NAC in breast cancer patients with initial clinical stage cT1−2N+, especially for those who achieved ypT1−2N0, is still controversial. This study was to evaluate the survival prognosis of cT1−2N+ patients after NAC with or without PMRT, and to discuss the selection of patients who may omit PMRT.Patients and MethodsFrom January 2005 to December 2017, 3055 female breast cancer patients underwent mastectomy in our medical center, among whom 215 patients of cT1−2N+ stage, receiving neoadjuvant chemotherapy (NAC) with or without PMRT were finally analyzed. The median follow-up duration was 72.6 months. The primary endpoint was overall survival, and the secondary endpoint was disease-free survival. Comparison was conducted between PMRT and non-PMRT subgroups.ResultsOf the 215 eligible patients, 35.8% (77/215) cT1−2N+ patients achieved ypT0−2N0 after NAC while 64.2% (138/215) of the patients remained nodal positive (ypT0−2N+). The 5-year DFS of ypT0−2N0 non-PMRT was 79.5% (95% confidence interval [CI] 63.4-95.6%). No statistically significant difference was observed between the ypT0−2N0 PMRT and non-PMRT subgroups for the 5-year DFS (78.5% vs 79.5%, p = 0.673) and OS (88.8% vs 90.8%, p = 0.721). The 5-years DFS didn’t obviously differ between the ypT0−2N0 non-PMRT subgroup and cT1−2N0 subgroup (79.5% vs 93.3%, p = 0.070). By using Cox regression model in multivariate analyses of prognosis in ypT0−2N+ PMRT subgroup, HER2 overexpression and triple-negative breast cancer were significantly poor predictors of DFS and OS, while ypN stage was significant independent predictors of OS.ConclusionAn excellent response to NAC (ypT0−2N0) indicates a sufficiently favorable prognosis, and PMRT might be omitted for cT1−2N+ breast cancer patients with ypT0−2N0 after NAC.

Download Full-text

Comparative study of chemoradiation and neoadjuvant chemotherapy effects before radical hysterectomy in stage IB–IIB bulky cervical cancer and with tumor diameter greater than 4 cm

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200505000-00011 ◽

2005 ◽

Vol 15 (3) ◽

pp. 483-488

Author(s):

M. Modarress ◽

F. Q. Maghami ◽

M. Golnavaz ◽

N. Behtash ◽

A. Mousavi ◽

...

Keyword(s):

Cervical Cancer ◽

Neoadjuvant Chemotherapy ◽

Radical Hysterectomy ◽

Tumor Size ◽

Pathologic Complete Response ◽

Residual Tumor ◽

Preoperative Treatment ◽

Tumor Diameter ◽

Stage Ib ◽

Significant Difference

Tumor size seems to be a determinant in the prognosis of early cervical cancer. Patients with tumor greater than 4 cm (bulky) in diameter have worse outcome. The purpose of this study was to compare the efficacy of preoperative combined chemoradiation and neoadjuvant chemotherapy (NAIC) programs followed by radical hysterectomy in stage IB–IIB bulky cervical cancer. From September 1999 to April 2002, 60 patients with stage IB–IIB bulky cervical cancer were treated with preoperative external-beam radiotherapy to 45 Gy plus weekly cisplatin 50 mg/m2 or preoperative NAIC by cisplatin 50 mg/m2 and vincristin 1 mg/m2 every 7–10 days, for three courses. Surgery was performed 4–6 weeks after the completion of the preoperative treatment. There were no significant difference between age, stage, tumor size, and histopathologic type in two groups (P > 0.05). Toxicity associated with two treatment methods was usually mild. In chemoradiation group, two patients developed vesicovaginal fistula, and four patients developed long-term hydronephrosis that needed urethral stenting. Before surgery, complete and partial clinical response had no significant difference between two groups (P > 0.05). After surgery, lymph node and parametrial involvement had no significant difference between two groups (P > 0.05). In NAIC group, more patients had significantly residual tumor (P = 0.012), but residual tumor size had no significant difference between two groups (P > 0.05). Pathologic complete response was significantly higher in chemoradiation group (P = 0.004). According to the result of this study, it seems that NAIC and chemoradiation had similar effects in survival prognostic factors.

Download Full-text

Efficacy of primary systemic chemotherapy regimen containing anthracyclines with/without taxanes in comparison to CMF in women with early breast cancer

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.11098 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 11098-11098

Author(s):

D. Gschwantler-Kaulich ◽

A. Fink-Retter ◽

T. Bachrich ◽

M. Ledesma ◽

E. Ruecklinger ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Tumor Regression ◽

Locally Advanced Breast Cancer ◽

Locally Advanced ◽

Breast Conservation ◽

Tumor Diameter ◽

Breast Cancer Patients ◽

Multifocal Disease ◽

Anthracycline Dose

11098 Background: Neoadjuvant chemotherapy is the treatment of choice for locally-advanced breast cancer and leads to down staging and improved BCT rates. While its efficacy is well established, considerably less is known about the most effective regimen. Methods: We have performed a retrospective analysis of 132 breast cancer patients who had undergone neoadjuvant chemotherapy at our institution. Patients had either received a) anthracyclines (“A”, n=35), b) anthracyclines and taxanes (“AT”, n=55), or c) neither of the two compounds (“NoA/T”, n=42). Clinical response, pathological response and survival were evaluated in each arm. Results: While all three regimen resulted in significant tumor regression, AT was most effective with a mean tumor shrinkage of 39% (ultrasound) and 41% (mammography) (Kruskal-Wallis, p=0.004, and p=0.027). Breast conservation was achieved in 75% by AT, in 49% by A, and in 19% by NoA/T (Kruskal-Wallis, p<0.001). The treatment groups did not differ in respect to pCR (χ2-test, p=0.068), although higher cumulative anthracycline doses were predictive of pCR in multivariate analyses (p=0.022). While the mammographic and not the ultrasound-determined tumor diameter determined whether a woman underwent BCT, only an ultrasound-determined size reduction was predictive for DFS and OS (log rank, p=0.0093, and p=0.044, respectively). Other parameters that affected BCT rates were age (p= 0.003), year of diagnosis (p=<0.001), presence of multifocal disease (p= 0.032) and the cumulative anthracycline dose (p= <0.001). Conclusions: While the combination of anthracyclines and taxanes is most effective in achieving clinical remission and BCT, the cumulative anthracycline dose appears most important for achieving pCR. No significant financial relationships to disclose.

Download Full-text

MRI tumor volume for predicting response to neoadjuvant chemotherapy in locally advanced breast cancer: Findings from ACRIN 6657/CALGB 150007

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.529 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 529-529

Author(s):

N. Hylton ◽

J. Blume ◽

C. Gatsonis ◽

R. Gomez ◽

W. Bernreuter ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Advanced Breast Cancer ◽

Tumor Size ◽

Tumor Volume ◽

Locally Advanced Breast Cancer ◽

Locally Advanced ◽

Pathologic Response ◽

Advanced Breast ◽

Tumor Diameter

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]

Download Full-text

Nomogram to predict sentinel lymph node involvement in patients with clinically node-negative breast cancer receiving neoadjuvant chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.27_suppl.150 ◽

2012 ◽

Vol 30 (27_suppl) ◽

pp. 150-150 ◽

Cited By ~ 2

Author(s):

Lisa R. Allen ◽

Pranjali V. Gadgil ◽

Roland Bassett ◽

Kelly Hunt ◽

Elizabeth Ann Mittendorf ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Neoadjuvant Chemotherapy ◽

Tumor Size ◽

Multidisciplinary Treatment ◽

Tumor Location ◽

Lymph Node Involvement ◽

Breast Cancer Patients ◽

Node Negative ◽

Node Involvement

150 Background: Sentinel lymph node biopsy (SLNB) has been shown to be an accurate predictor of axillary lymph node involvement in breast cancer patients treated with neoadjuvant chemotherapy (NAC). A predictive model of SLN positivity in clinically node negative patients who completed NAC can assist in preoperative multidisciplinary treatment decision making, such as planning for postmastectomy radiation therapy and breast reconstruction. Methods: We reviewed our prospective database to identifyclinically node negative patients with invasive breast cancer who underwent NAC and SLNB from 1998-2011. Clincopathologic factors including age, tumor location, histology, nuclear grade, tumor size, decrease in tumor size with therapy, multifocality, nodal appearance on preoperative ultrasound, hormone receptor status, and lymphovascular invasion (LVI) were analyzed. A nomogram to predict SLN metastasis was developed using multivariate logistic regression analysis. Results: A total of 836 patients were treated with NAC followed by SLNB. Of these, 160 patients (19.1%) had a positive SLN. All factors were significant predictors of SLN positivity on univariate analysis except tumor location and nodal appearance on preoperative ultrasound. Multivariate analysis showed that young age, invasive lobular histology, tumor size, multifocality, and LVI were independent positive predictors of SLN positivity whereas high grade, response to chemotherapy, and triple negative hormone receptor status were negative predictors. Favorable histologies were strongly associated with a lower rate of SLN positivity but were excluded from the nomogram due to small numbers of patients (N=14). Discrimination of the nomogram to correctly predict SLN positivity was measured using the area under the receiver operating characteristic curve (AUC). The unadjusted AUC was 75.9, while the internally validated 2000 bootstrap sample-adjusted AUC was 74.2. Conclusions: Neoadjuvant chemotherapy is known to decrease the incidence of positive nodes in breast cancer patients. Use of our nomogram preoperatively can assist in decisions regarding multidisciplinary treatment planning.

Download Full-text