Comparison of99mTc-Sestamibi Molecular Breast Imaging and Breast MRI in Patients With Invasive Breast Cancer Receiving Neoadjuvant Chemotherapy

Abstract Molecular breast imaging (MBI) is a nuclear medicine technique that has evolved considerably over the past two decades. Technical advances have allowed reductions in administered doses to the point that they are now acceptable for screening. The most common radiotracer used in MBI, 99mTc-sestamibi, has a long history of safe use. Biopsy capability has become available in recent years, with early clinical experience demonstrating technically successful biopsies of MBI-detected lesions. MBI has been shown to be an effective supplemental screening tool in women with dense breasts and is also utilized for breast cancer staging, assessment of response to neoadjuvant chemotherapy, problem solving, and as an alternative to breast MRI in women who have a contraindication to MRI. The degree of background parenchymal uptake on MBI shows promise as a tool for breast cancer risk stratification. Radiologist interpretation is guided by a validated MBI lexicon that mirrors the BI-RADS lexicon. With short interpretation times, a fast learning curve for radiologists, and a substantially lower cost than breast MRI, MBI provides many benefits in the practices in which it is utilized. This review will discuss the current state of MBI technology, clinical applications of MBI, MBI interpretation, radiation dose associated with MBI, and the future of MBI.

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The clinical impact of molecular breast imaging in women with proven invasive breast cancer scheduled for breast-conserving surgery

Breast Cancer Research and Treatment ◽

10.1007/s10549-018-4706-1 ◽

2018 ◽

Vol 169 (3) ◽

pp. 513-522 ◽

Cited By ~ 1

Author(s):

Angela Collarino ◽

Renato A. Valdés Olmos ◽

Lotta G. A. J. van Berkel ◽

Peter A. Neijenhuis ◽

Lidy M. H. Wijers ◽

...

Keyword(s):

Breast Cancer ◽

Invasive Breast Cancer ◽

Breast Imaging ◽

Breast Conserving Surgery ◽

Clinical Impact ◽

Molecular Breast Imaging

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Direct-Conversion Molecular Breast Imaging of Invasive Breast Cancer: Imaging Features, Extent of Invasive Disease, and Comparison Between Invasive Ductal and Lobular Histology

American Journal of Roentgenology ◽

10.2214/ajr.14.13502 ◽

2015 ◽

Vol 205 (3) ◽

pp. W374-W381 ◽

Cited By ~ 13

Author(s):

Amy Lynn Conners ◽

Katie N. Jones ◽

Carrie B. Hruska ◽

Jennifer R. Geske ◽

Judy C. Boughey ◽

...

Keyword(s):

Breast Cancer ◽

Invasive Breast Cancer ◽

Breast Imaging ◽

Cancer Imaging ◽

Direct Conversion ◽

Invasive Disease ◽

Imaging Features ◽

Breast Cancer Imaging ◽

Molecular Breast Imaging ◽

Lobular Histology

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Complete Breast MRI Response to Neoadjuvant Chemotherapy and Prediction of Pathologic Complete Response

Journal of Breast Imaging ◽

10.1093/jbi/wbz028 ◽

2019 ◽

Vol 1 (3) ◽

pp. 217-222 ◽

Cited By ~ 1

Author(s):

Christina A Chen ◽

Jessica H Hayward ◽

Genevieve A Woodard ◽

Kimberly M Ray ◽

Christopher J Starr ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Invasive Breast Cancer ◽

Pathologic Complete Response ◽

Breast Mri ◽

Complete Response ◽

Routine Practice ◽

Fisher Exact Test ◽

Tumor Subtype ◽

Background Parenchymal Enhancement

Abstract Objective To assess the negative predictive value (NPV) of breast MRI in detecting residual disease after neoadjuvant chemotherapy (NAC) in women with invasive breast cancer, overall and by tumor subtype. Methods An institutional review board approved retrospective study from January 2010 through December 2016 identified patients with invasive breast cancer who achieved complete MRI response to NAC, defined as the absence of residual enhancement in the tumor bed above background parenchymal enhancement. During the study period, it was our routine practice to assign a BI-RADS 1 or 2 assessment to these cases. The NPV was defined as the ability of a complete MRI response to predict pathologic complete response (pCR) at final surgical pathology. Statistical analyses were performed using a Fisher exact test. Results Among 244 patients who underwent MRI to assess NAC response, 38 (16%) were determined to have complete MRI response by the interpreting radiologist. Of these, 20/38 (53%) had pCR. Complete MRI response did not significantly predict pCR for the total group (P < 0.9). However, NPVs significantly varied by molecular subtype (P < 0.004). True negative MRIs by tumor subtype were 2/10 (20%) for hormone receptor (HR)+/HER2–, 3/10 (30%) for HR+/HER2+, 6/8 (75%) for HR–/HER+, and 9/10 (90%) for triple negative (TN) subtypes. Complete MRI response significantly predicted pCR for only the TN subtype (NPV 90%; P < 0.02). Conclusions In patients with complete MRI response, 53% had pCR. While MRI lacks sufficient NPV to obviate the need for surgical excision, it may add prognostic value for certain molecular subtypes. The TN subtype demonstrated the highest NPV.

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Fat-enlarged axillary lymph nodes are associated with node-positive breast cancer in obese patients

Breast Cancer Research and Treatment ◽

10.1007/s10549-021-06262-z ◽

2021 ◽

Author(s):

Roberta M. diFlorio-Alexander ◽

Qingyuan Song ◽

Dennis Dwan ◽

Judith A. Austin-Strohbehn ◽

Kristen E. Muller ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Invasive Breast Cancer ◽

Breast Mri ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Obese Women ◽

Axillary Metastases ◽

Node Positive ◽

Positive Breast Cancer

Abstract Purpose Obesity associated fat infiltration of organ systems is accompanied by organ dysfunction and poor cancer outcomes. Obese women demonstrate variable degrees of fat infiltration of axillary lymph nodes (LNs), and they are at increased risk for node-positive breast cancer. However, the relationship between enlarged axillary nodes and axillary metastases has not been investigated. The purpose of this study is to evaluate the association between axillary metastases and fat-enlarged axillary nodes visualized on mammograms and breast MRI in obese women with a diagnosis of invasive breast cancer. Methods This retrospective case–control study included 431 patients with histologically confirmed invasive breast cancer. The primary analysis of this study included 306 patients with pre-treatment and pre-operative breast MRI and body mass index (BMI) > 30 (201 node-positive cases and 105 randomly selected node-negative controls) diagnosed with invasive breast cancer between April 1, 2011, and March 1, 2020. The largest visible LN was measured in the axilla contralateral to the known breast cancer on breast MRI. Multivariate logistic regression models were used to assess the association between node-positive status and LN size adjusting for age, BMI, tumor size, tumor grade, tumor subtype, and lymphovascular invasion. Results A strong likelihood of node-positive breast cancer was observed among obese women with fat-expanded lymph nodes (adjusted OR for the 4th vs. 1st quartile for contralateral LN size on MRI: 9.70; 95% CI 4.26, 23.50; p < 0.001). The receiver operating characteristic curve for size of fat-enlarged nodes in the contralateral axilla identified on breast MRI had an area under the curve of 0.72 for predicting axillary metastasis, and this increased to 0.77 when combined with patient and tumor characteristics. Conclusion Fat expansion of axillary lymph nodes was associated with a high likelihood of axillary metastases in obese women with invasive breast cancer independent of BMI and tumor characteristics.

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Improved discrimination of molecular subtypes in invasive breast cancer: Comparison of multiple quantitative parameters from breast MRI

Magnetic Resonance Imaging ◽

10.1016/j.mri.2020.12.001 ◽

2021 ◽

Vol 77 ◽

pp. 148-158

Author(s):

Siyao Du ◽

Si Gao ◽

Lina Zhang ◽

Xiaoping Yang ◽

Xixun Qi ◽

...

Keyword(s):

Breast Cancer ◽

Invasive Breast Cancer ◽

Molecular Subtypes ◽

Breast Mri ◽

Quantitative Parameters

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Early assessment of shear wave elastography parameters foresees the response to neoadjuvant chemotherapy in patients with invasive breast cancer

Breast Cancer Research ◽

10.1186/s13058-021-01429-4 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Juanjuan Gu ◽

Eric C. Polley ◽

Max Denis ◽

Jodi M. Carter ◽

Sandhya Pruthi ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Shear Wave ◽

Invasive Breast Cancer ◽

Shear Wave Elastography ◽

Early Prediction ◽

Early Assessment ◽

Significant Difference ◽

Mass Size ◽

Response To Neoadjuvant Chemotherapy

Abstract Background Early prediction of tumor response to neoadjuvant chemotherapy (NACT) is crucial for optimal treatment and improved outcome in breast cancer patients. The purpose of this study is to investigate the role of shear wave elastography (SWE) for early assessment of response to NACT in patients with invasive breast cancer. Methods In a prospective study, 62 patients with biopsy-proven invasive breast cancer were enrolled. Three SWE studies were conducted on each patient: before, at mid-course, and after NACT but before surgery. A new parameter, mass characteristic frequency (fmass), along with SWE measurements and mass size was obtained from each SWE study visit. The clinical biomarkers were acquired from the pre-NACT core-needle biopsy. The efficacy of different models, generated with the leave-one-out cross-validation, in predicting response to NACT was shown by the area under the receiver operating characteristic curve and the corresponding sensitivity and specificity. Results A significant difference was found for SWE parameters measured before, at mid-course, and after NACT between the responders and non-responders. The combination of Emean2 and mass size (s2) gave an AUC of 0.75 (0.95 CI 0.62–0.88). For the ER+ tumors, the combination of Emean_ratio1, s1, and Ki-67 index gave an improved AUC of 0.84 (0.95 CI 0.65–0.96). For responders, fmass was significantly higher during the third visit. Conclusions Our study findings highlight the value of SWE estimation in the mid-course of NACT for the early prediction of treatment response. For ER+ tumors, the addition of Ki-67improves the predictive power of SWE. Moreover, fmass is presented as a new marker in predicting the endpoint of NACT in responders.

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Re-Excision Rates in Breast-Conserving Surgery for Invasive Breast Cancer after Neoadjuvant Chemotherapy with and without the Use of a Radiopaque Tissue Transfer and X-ray System

Breast Care ◽

10.1159/000493017 ◽

2018 ◽

Vol 14 (5) ◽

pp. 302-307

Author(s):

Suniza Jamaris ◽

Leyla Akpolat-Basci ◽

Miltiades Stephanou ◽

Sarah Wetzig ◽

Yueksel Cubuk ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Invasive Breast Cancer ◽

Breast Conserving Surgery ◽

Control Group ◽

Study Group ◽

Transfer System ◽

Tissue Transfer ◽

Resected Tissue ◽

Specimen Radiography

Background: Significant re-excision rates in breast-conserving surgery (BCS) after neoadjuvant systemic chemotherapy may result from difficulties in defining the surgical target particularly in cases with excellent treatment response. Devices allowing an exact topographic localisation of the lesion in the resected tissue could reduce re-excision rates by optimising the intraoperative detection of involved margins. Methods: 80 patients with invasive breast cancer receiving BCS after neoadjuvant chemotherapy were included in this non-randomized case-control study. 40 patients with specimen radiography performed in a standard approach (control group) were compared to 40 patients with use of a radiopaque tissue transfer system (study group). Results: 19/80 (23.75%) patients required re-excision because of involved margins; among those, 14/40 (35%) were in the control group and 5/40 (12.5%) in the study group. The association between the use of the radiopaque tissue transfer system and the lower re-excision rate was statistically significant (p = 0.023). Conclusion: Our analysis provides a rationale for the routine use of a radiopaque tissue transfer system for specimen radiography in BCS after neoadjuvant chemotherapy for invasive breast cancer in order to reduce re-excision rates.

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