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

2017 ◽  
Vol 50 (4) ◽  
pp. 224-230 ◽  
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.

ROLE OF SONOMAMMOGRAPHY IN MONITORING THE RESPONSE OF NEOADJUVANT CHEMOTHERAPY IN MALIGNANT BREAST MASSES

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Sherine George Moftah ◽  
Essam Mohamed Hafez ◽  
Walid Dahy Zidan
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Tumor Size ◽  
Locally Advanced ◽  
Residual Tumor ◽  
High Accuracy ◽  
Breast Ultrasound ◽  
Radiology Department ◽  
Duration Of Symptoms ◽  
Progressive Course

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.

Real-time ultrasound elastography for monitoring tumor response to neoadjuvant chemotherapy in primary breast cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 14023-14023 ◽  
Author(s):  
H. Bando ◽  
M. Ishii ◽  
E. Tohno ◽  
E. Ueno
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Real Time ◽  
Predictive Value ◽  
Primary Breast Cancer ◽  
Tumor Response ◽  
Residual Tumor ◽  
Term Survival ◽  
Pathological Cr ◽  
Response To Neoadjuvant Chemotherapy

14023 Background: Response to neoadjuvant treatment is vital to predict a patient’s long-term survival. Precise detection of residual tumor cells after neoadjuvant chemotherapy would allow a better cosmetic results avoiding over surgery and reduce second operation due to positive margin status. Moreover, accurate prediction of pathological CR will yield no surgical intervention in certain population. Recently, a new generation of ultrasound platforms with real-time freehand elastography that enables the imaging of elasticity of the lesion by using the extended combined autocorrelation method (CAM) has become available. We are currently applying this technology to our patients with primary breast cancer in an attempt to assess response to neoadjuvant chemotherapy in comparison with MRI, conventional ultrasound and pathological findings. Methods: A total of 38 patients with primary breast cancer who underwent neoadjuvant chemotherapy and following surgical resection From May 2005 to Dec 2006 were included in this study. Board certified radiologists assessed the tumor response by MRI, US and US Elastography prior to surgery. Positive predictive value (PPV), and negative predictive value (NPV) for pathological CR (pCR) was assessed. Tsukuba Elastography score was applied for the assessment of Elastography. Results: 11/38 patients (28.9%) achieved a pCR in breast to neoadjuvant chemotherapy while no patients demonstrated progressive disease. The PPV for pCR of MRI and US was 54.5% and 36.3% respectively. The NPV of MRI and US was both 90.9%. None of the residual tumor mass with score 4 or 5 cases diagnosed by Elastography achieved pCR. When residual tumor image was detected by US, pCR was present in all 4 cases with score 1 or 2 Elatography. If the cut-off line is determined between score 3 and 4, the PPV and NPV for pCR by Elastography was 100% and 66.6% respectively. Conclusions: Elastography is easy to perform and it can provide an inexpensive, non-invasive, real-time tool for assessment of response to neoadjuvant chemotherapy among patients with primary breast cancer. In particular, Elastography might more effectively diagnose pathological CR. More patients are needed to evaluate the sensitivity and specificity of this new technology. No significant financial relationships to disclose.

scholarly journals Prognostic and predictive value of circulating tumor DNA during neoadjuvant chemotherapy for triple negative breast cancer

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Luca Cavallone ◽  
Adriana Aguilar-Mahecha ◽  
Josiane Lafleur ◽  
Susie Brousse ◽  
Mohammed Aldamry ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Triple Negative Breast Cancer ◽  
Predictive Value ◽  
Triple Negative ◽  
Residual Tumor ◽  
Complete Response ◽  
Circulating Tumor Dna ◽  
Droplet Pcr ◽  
Tumor Dna

Abstract Response to neoadjuvant chemotherapy (NAC) in triple negative breast cancer (TNBC) is highly prognostic and determines whether adjuvant chemotherapy is needed if residual tumor is found at surgery. To evaluate the predictive and prognostic values of circulating tumor DNA (ctDNA) in this setting, we analyzed tumor and serial bloods from 26 TNBC patients collected prior, during, and after NAC. Individual digital droplet PCR assays were developed for 121 variants (average 5/patient) identified from tumor sequencing, enabling ctDNA detection in 96% of patients at baseline. Mutant allele frequency at baseline was associated with clinical characteristics. Levels drastically fell after one cycle of NAC, especially in patients whose tumors would go on to have a pathological complete response (pCR), but then rose significantly before surgery in patients with significant residual tumor at surgery (p = 0.0001). The detection of ctDNA early during treatment and also late at the end of NAC before surgery was strongly predictive of residual tumor at surgery, but its absence was less predictive of pCR, especially when only TP53 variants are considered. ctDNA detection at the end of neoadjuvant chemotherapy indicated significantly worse relapse-free survival (HR = 0.29 (95% CI 0.08–0.98), p = 0.046), and overall survival (HR = 0.27 95% CI 0.075–0.96), p = 0.043). Hence, individualized multi-variant ctDNA testing during and after NAC prior to surgery has prognostic and predictive value in early TNBC patients.

scholarly journals Accuracy and Reproducibility of Contrast-Enhanced Mammography in the Assessment of Response to Neoadjuvant Chemotherapy in Breast Cancer Patients with Calcifications in the Tumor Bed

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 435
Author(s):  
Valentina Iotti ◽  
Moira Ragazzi ◽  
Giulia Besutti ◽  
Vanessa Marchesi ◽  
Sara Ravaioli ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Residual Disease ◽  
Residual Tumor ◽  
False Positives ◽  
Breast Cancer Patients ◽  
Surgical Specimen ◽  
Tumor Bed ◽  
Contrast Enhanced

This study aimed to evaluate contrast-enhanced mammography (CEM) accuracy and reproducibility in the detection and measurement of residual tumor after neoadjuvant chemotherapy (NAC) in breast cancer (BC) patients with calcifications, using surgical specimen pathology as the reference. Pre- and post-NAC CEM images of 36 consecutive BC patients receiving NAC in 2012–2020, with calcifications in the tumor bed at diagnosis, were retrospectively reviewed by two radiologists; described were absence/presence and size of residual disease based on contrast enhancement (CE) only and CE plus calcifications. Twenty-eight patients (77.8%) had invasive and 5 (13.9%) in situ-only residual disease at surgical specimen pathology. Considering CE plus calcifications instead of CE only, CEM sensitivity for invasive residual tumor increased from 85.7% (95% CI = 67.3–96%) to 96.4% (95% CI = 81.7–99.9) and specificity decreased from 5/8 (62.5%; 95% CI = 24.5–91.5%) to 1/8 (14.3%; 95% CI = 0.4–57.9%). For in situ-only residual disease, false negatives decreased from 3 to 0 and false positives increased from 1 to 2. CEM pathology concordance in residual disease measurement increased (R squared from 0.38 to 0.45); inter-reader concordance decreased (R squared from 0.79 to 0.66). Considering CE plus calcifications to evaluate NAC response in BC patients increases sensitivity in detection and accuracy in measurement of residual disease but increases false positives.

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

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.

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

Radiology ◽  
2018 ◽  
Vol 289 (2) ◽  
pp. 327-334 ◽  
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

Accuracy of MRI, mammography (MG), and 2D and 3D ultrasound (2DUS/3DUS) in determining the pathologic tumor response after neoadjuvant chemotherapy (NACT) in breast cancer patients.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1067-1067
Author(s):  
Markus Hahn ◽  
Katja C. Siegmann ◽  
Christoph Meisner ◽  
Ann-Katrin Steinhoff ◽  
Valerie Hattermann ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Tumor Size ◽  
Predictive Value ◽  
Tumor Response ◽  
Therapy Monitoring ◽  
Pathological Response ◽  
Size Difference ◽  
The Mean ◽  
Sensitivity Specificity

1067 Background: The pathological tumor response in patients with locally advanced breast cancer to NACT is essential for survival and for surgical strategies. Therapy monitoring based on German recommendations is routinely performed by clinical examination, MG and 2DUS. The clinical value of MRI and 3DUS has not been established yet. The aim of the study was to determine the accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) between the different imaging techniques in predicting postoperative histological tumor response after NACT. Methods: Patients with primary breast cancer (cT1-T4, cN0-1, M0) undergoing neoadjuvant chemotherapy between 2005 and 2010 were eligible for this prospective trial. The response was measured by MRI, MG, 2DUS and 3DUS for complete or partial remission versus stable disease after the last cycle of treatment and compared with the final pathological response. Patients with progressive disease were excluded from the study. Statistical analysis was done by calculating the accuracy of each imaging technique and the size difference between imaging and histological tumor size. Sensitivity, specificity, PPV and NPV were calculated for complete or partial pathological response. The study was approved by the local ethic committee (BCD001 194/2004). Results: 103 patients with the mean age of 47.7 (range 24.5 – 71.4) years were evaluated. The accuracy was 0.680 (95%CI: 0.580 -0.768) for MRI, 0.563 (95%CI: 0.453-0.669) for MG, 0.724 (95%CI: 0.618 -0.815) for 2DUS and 0.710 (95%CI: 0.588-0.813) for 3DUS. Sensitivity, specificity, PPV and NPV were 78%, 47%, 75% and 52% for MRI, 61%, 45%, 69% and 36% for MG, 93%, 23%, 74% and 60% for 2DUS, 94%, 19%, 73% and 57% for 3DUS. The mean (standard deviation) size difference was -1.8 mm (14.8) on MRI, 1.5 mm (26.0) on MG, -9.1mm (19.1) on 2DUS and for the volume difference -6916mm3 (15831) on 3DUS. Conclusions: The data suggest that 2DUS is sufficient in predicting tumor response between NACT treatment. MRI and MG are more accurate the 2DUS in predicting the tumor size for surgical planning.

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