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.

Genomic profiling of residual tumor after neoadjuvant chemotherapy for breast cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e12106-e12106
Author(s):  
Masaya Hattori ◽  
Padma Sheila Rajagopal ◽  
Lise Sveen ◽  
Galina Khramtsova ◽  
Toshio Yoshimatsu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Residual Disease ◽  
Tissue Bank ◽  
Residual Tumor ◽  
Cancer Tissue ◽  
Genomic Profiling ◽  
Breast Cancer Patients ◽  
Her2 Positive ◽  
Metastatic Recurrence

e12106 Background: Patients who have residual disease after neoadjuvant chemotherapy (NAC) have a higher risk of metastatic recurrence. Residual disease likely includes therapy-resistant subclones of breast cancer cells, which untreated lead to metastases. The aim of this study was to identify additional adjuvant therapies based on genomic profiling of residual disease post NAC therapy. Methods: Next-generation sequencing of tumor samples from patients (pts) with residual invasive breast cancer after NAC was performed using a Tempus xT, 595 gene panel on matched tumor-normal samples. All samples were obtained from the University of Chicago Breast Cancer tissue bank. Clinical information was obtained from electronic health records and the cancer registry. Results: Of 23 evaluable patients enriched for African Americans, 65% were HER2-positive, 22% TNBC and 13% ER+/HER2-. At a median follow up of 2.9 years, 8 pts (35%) have recurred and 8 were dead. We identified 119 clinically actionable variants in 22 tumors, and the most commonly altered genes were TP53 (18 alterations, 74% of cases), ERBB2 (8, 26%), PIK3CA (7, 30%), CDK4 (4, 17%), MCL1 (4, 17%), and MDM2 (4, 17%). Of significance, 67% of HER2-positive pts had no detectable ERBB2 copy number gain in the residual tumor. 78% of pts had at least one potential druggable target according to CIViC and/or OncoKB: 19 variants in HER2-positive, 8 in HER2-negative. The mean estimated tumor mutation burden (TMB) was 4.34 m/MB (range: 0-26.7), and 13% were considered TMB-high ( > 9 m/MB). No patients had high-microsatellite instability type residual tumors. Conclusions: Many potentially targetable alterations reside in residual disease of both HER2-positive and -negative breast cancer after NAC. Post-NAC treatment targeting these harbored alterations and post-NAC immunotherapy could have impact on the prognosis of breast cancer patients who have residual disease after NAC. [Table: see text]

scholarly journals Diagnostic Value of Contrast-enhanced Digital Mammography Versus Contrast-enhanced MRI for Detecting Residual Disease after Neoadjuvant Chemotherapy for Breast Cancer

2020 ◽  
Author(s):  
Eun Young Kim ◽  
Ji-Sup Yun ◽  
Yong Lai Park ◽  
Chan Heun Park ◽  
Mi-Ri Kwon ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Digital Mammography ◽  
Residual Disease ◽  
Pearson Correlation ◽  
Preoperative Evaluation ◽  
Diagnostic Value ◽  
Breast Cancer Patients ◽  
Residual Lesion ◽  
Contrast Enhanced

Abstract Background: Preoperative evaluation of breast cancer using contrast-enhanced digital mammography (CEDM) as a possible alternative to contrast-enhanced magnetic resonance imaging (CEMRI) has gained acceptance. Our aim is to compare the diagnostic performance of CEDM and CEMRI for chemotherapeutic response in breast cancer patients who underwent neoadjuvant chemotherapy (NAC).Methods: From November 2017 to October 2018, 30 patients with invasive carcinoma who performed both CEDM and CEMRI were included. Residual malignancy sizes after NAC were compared with histopathological results. The diagnostic performances for detecting residual cancers were compared using Lin concordance and Pearson correlation coefficients.Results: Thirty patients were included for the analysis. Mean tumor size after NAC was 1.22 cm (range: 0–7.0 cm) for CEDM and 1.13 cm (range: 0–5.1cm) for CEMRI compared with 1.89 cm (range: 0–12.0 cm) at final pathology measurement. Sensitivity for identifying residual lesion was for CEDM and CEMRI is as follows (CEDM 62.5%, 95% CI 40.6–81.2, CEMRI 66.7%, 95% CI 44.7–84.4). The positive predictive value (PPV) for residual lesion was 93.8% (95% CI 69.8–99.8) for CEDM and 88.9% (95% CI 65.3–98.6) for CEMRI. CEDM had a mean difference from pathology measurement of 0.668 cm, with a concordance coefficient of 0.202 and a Pearson correlation coefficient of 0.231 (p=0.220).Conclusions: Diagnostic value of CEDM for detecting residual tumor extent after NAC was comparable to that of CEMRI.

scholarly journals Radiomics of MRI for the Prediction of the Pathological Response to Neoadjuvant Chemotherapy in Breast Cancer Patients: A Single Referral Centre Analysis

Cancers ◽  
2021 ◽  
Vol 13 (17) ◽  
pp. 4271
Author(s):  
Filippo Pesapane ◽  
Anna Rotili ◽  
Francesca Botta ◽  
Sara Raimondi ◽  
Linda Bianchini ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Multivariable Analysis ◽  
Breast Mri ◽  
Breast Cancer Patients ◽  
Surgical Specimen ◽  
Receiver Operating Characteristic Curves ◽  
Contrast Enhanced ◽  
Treatment Prediction ◽  
Pre Treatment

Objectives: We aimed to determine whether radiomic features extracted from a highly homogeneous database of breast MRI could non-invasively predict pathological complete responses (pCR) to neoadjuvant chemotherapy (NACT) in patients with breast cancer. Methods: One hundred patients with breast cancer receiving NACT in a single center (01/2017–06/2019) and undergoing breast MRI were retrospectively evaluated. For each patient, radiomic features were extracted within the biopsy-proven tumor on T1-weighted (T1-w) contrast-enhanced MRI performed before NACT. The pCR to NACT was determined based on the final surgical specimen. The association of clinical/biological and radiomic features with response to NACT was evaluated by univariate and multivariable analysis by using random forest and logistic regression. The performances of all models were assessed using the areas under the receiver operating characteristic curves (AUC) with 95% confidence intervals (CI). Results: Eighty-three patients (mean (SD) age, 47.26 (8.6) years) were included. Patients with HER2+, basal-like molecular subtypes and Ki67 ≥ 20% presented a pCR to NACT more frequently; the clinical/biological model’s AUC (95% CI) was 0.81 (0.71–0.90). Using 136 representative radiomics features selected through cluster analysis from the 1037 extracted features, a radiomic score was calculated to predict the response to NACT, with AUC (95% CI): 0.64 (0.51–0.75). After combining the clinical/biological and radiomics models, the AUC (95% CI) was 0.83 (0.73–0.92). Conclusions: MRI-based radiomic features slightly improved the pre-treatment prediction of pCR to NACT, in addiction to biological characteristics. If confirmed on larger cohorts, it could be helpful to identify such patients, to avoid unnecessary treatment.

scholarly journals Contrast-enhanced spectral mammography in the radiological assessment of response to neoadjuvant chemotherapy in breast cancer

2021 ◽  
pp. e521
Author(s):  
Anna Grażyńska ◽  
Sofija Antoniuk ◽  
Katarzyna Steinhof-Radwańska
Keyword(s):  
Breast Cancer ◽  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Neoadjuvant Chemotherapy ◽  
Residual Disease ◽  
Tumour Size ◽  
Breast Cancer Diagnosis ◽  
Chemotherapy Response ◽  
Resonance Imaging ◽  
Contrast Enhanced

Accurate morphological assessment and measurement of the residual disease following neoadjuvant chemotherapy are vital for the effective surgical treatment in patients with breast cancer. Neoadjuvant chemotherapy response is measured by RECIST 1.1 criteria (Response Evaluation Criteria in Solid Tumors), and the classification of the specific therapeutic responses is based on the difference in the tumour size prior to and after chemotherapy. There are currently a few methods of imaging used in the assessment of the neoadjuvant chemotherapy response. Conventional mammography remains the most popular method, whereas magnetic resonance imaging is considered the most effective ones. Nonetheless, the available methods tend to be imperfect and limited, and therefore, new methods are constantly investigated. Contrast-enhanced spectral mammography is a relatively new method used in breast cancer diagnosis, which involves the phenomenon of neoangiogenesis of cancerous tumours, allowing contrast enhancement in the areas of vessel proliferation in the background of the surrounding breast tissue. Contrast-enhanced spectral mammography presents sensitivity similar to magnetic resonance imaging in breast cancer detection, and can be an efficient method used in monitoring neoadjuvant chemotherapy response.

Neoadjuvant chemotherapy (NCT) in 710 patients for operable breast cancer: Comparison of 2 pathological classifications

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10502-10502
Author(s):  
F. Penault-Llorca ◽  
C. Abrial ◽  
I. Raoelfils ◽  
S. Amat ◽  
M. Mouret-Reynier ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Tumor Cells ◽  
Residual Disease ◽  
Residual Tumor ◽  
Median Number ◽  
Operable Breast Cancer ◽  
Isolated Tumor Cells ◽  
Actuarial Survival

10502 Background: In a database harbouring the patients of several prospective phase II neoadjuvant trials (avcf, avcfm, fec 50–100, nem, net, tncf, taxotère/tncf, taxotere alone), clinical and pathological responses rates were studied in 710 women with stage II-III operable breast cancer treated 1982–2004. Pathological review was conducted to assess the residual disease in breast and nodes according to the 2 most used classifications in Europe: CHEVALLIER’s and SATALOFF’s (Am J Clin Oncol 1993; J Am Coll Surg 1995). Methods: Median age of the patients was 49.5 years [26–81]. Median diameter of the invasive tumour was 40 mm [10–130]. 555 (78%) patients had a canalar, 90 (13%) a lobular, 18 (2.5%) a mixed or invasive carcinoma, 36 (5%) neoplasic cells only and 11 (1.5%) another carcinoma. 25.6% of the tumours were grade III SBR, 28.3% grade 4 or 5 MSBR. The median number of NCT courses was 6 [1–9] followed by a surgery for 92%, a radiotherapy for 95%, an adjuvant chemotherapy (17%) and/or a hormonotherapy (52%). A breast evaluation was realized before, during and after NCT (Amat et al, Breast Cancer Res Treat 2005). Results: Intent to treat (n = 710), overall response rate was 68% (16% complete). The complete pathological response (pCR) rate was 14.18% according to Chevallier’s and 22.50% according to Sataloff’s classification. On 656 patients operated, 470 (72%) had a conservative surgery. On 520 patients with an axillary dissection, 272 (52.3%) had involved nodes (median number:1 [0–20]). After a median follow-up of 93 months, DFS and actuarial survival at 120 months were 54.9% and 66.5%, respectively.Chevallier’s classification level 1 (pCR in breast and axilla) was the most predictive of a good DFS, with a plateau appearance near 80%. Chevallier’s classification level 2 (in situ only) and Sataloff grade A (pCR and isolated tumor cells) yielded a lesser DFS (p < 0.01). With a long follow-up, a complete pCR is the most favourable prognostic factor, followed by in situ only or isolated tumor cells, then residual tumor. Conclusions: Sataloff’s gives higher pCR figures than Chevallier’s without evidence of superior predictive value. The classification used is important to predict outcome after NCT. No significant financial relationships to disclose.

HER2 evaluation process for neoadjuvant targeted therapies in breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 3034-3034
Author(s):  
Yoshio Mizuno ◽  
Naoko Takeda ◽  
Junichi Yamada ◽  
Hiroaki Abe ◽  
Yuko Inoue ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Targeted Therapies ◽  
False Negative ◽  
Fish Analysis ◽  
Breast Cancer Patients ◽  
Her2 Positive ◽  
Surgical Specimen ◽  
Amplification Ratio ◽  
Her2 Testing

3034 Background: Treatment with a combination of HER2-targeted therapies has emerged as an addition of trastuzumab to neoadjuvant chemotherapy regimens in breast cancer patients and it goes on increasing. For clinical HER2 determination, immunohistochemical (IHC) analysis is an attractive method and all IHC 2+ cases are categorized as equivocal and should be reflexed to fluorescence in situ hybridization (FISH) testing. However, research in recent years with respect to false-negative cases for HER2 testing have been reported, and it comes to the question of what considering the indication for trastuzumab in the neoadjuvant chemotherapy. To clarify these controversial points in applying the results of HER2 testing in the clinical setting, we performed a retrospective analysis of core needle biopsy (CNB) and surgical specimen results. Methods: 422 patients underwent primary operations for early breast cancer at Tokyo-West Tokushukai Hospital (Tokyo, Japan) from October 2008 to December 2012. Among these patients, 262 patients who received CNB prior to operation were enrolled. Those patients who received preoperative chemotherapy or had DCIS were excluded. With regard to diagnostic criteria, HER2 positivity was defined as either 3+ by IHC or FISH analysis amplification ratio of ≥2.2. In addition, if in any cases which CNB samples or surgical specimens showed HER2-positive had defined true HER2-positive cases, we assessed the false-negative results of the HER2 test via IHC using CNB samples and surgical specimens. Results: In a matched cohort of 262 patients, 59 cases showed HER2-positive (five cases were CNBs negative to surgical specimens positive, 14 cases were CNBs positive to surgical specimens negative, and 40 cases were both positive). If we decide for selection of trastuzumab target cases by CNBs only, we make mistakes in indications of trastuzumab for five (8.5%) of 59 HER2-positive cases who were CNBs negative to surgical specimens positive. Conclusions: There are quite a few cases show false negatives for HER2 testing in CNB samples. In cases of considering the indication for trastuzumab in the neoadjuvant chemotherapy, even if the CNB samples resulted in negative, we consider that retesting with FISH analysis should be carried out.

MRI accuracy in residual disease evaluation in breast cancer patients treated with neoadjuvant chemotherapy

2006 ◽  
Vol 61 (11) ◽  
pp. 946-953 ◽  
Author(s):  
P. Belli ◽  
M. Costantini ◽  
C. Malaspina ◽  
A. Magistrelli ◽  
G. LaTorre ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Residual Disease ◽  
Breast Cancer Patients
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