TY - JOUR
T1 - MRI, clinical examination, and mammography for preoperative assessment of residual disease and pathologic complete response after neoadjuvant chemotherapy for breast cancer
T2 - ACRIN 6657 trial
AU - ACRIN 6657 Trial Team and I-SPY Investigators Network
AU - Scheel, John R.
AU - Kim, Eunhee
AU - Partridge, Savannah C.
AU - Lehman, Constance D.
AU - Rosen, Mark A.
AU - Bernreuter, Wanda K.
AU - Pisano, Etta D.
AU - Marques, Helga S.
AU - Morris, Elizabeth A.
AU - Weatherall, Paul T.
AU - Polin, Sandra M.
AU - Newstead, Gillian M.
AU - Esserman, Laura J.
AU - Schnall, Mitchell D.
AU - Hylton, Nola M.
N1 - Publisher Copyright:
© American Roentgen Ray Society.
PY - 2018/6
Y1 - 2018/6
N2 - OBJECTIVE. The objective of our study was to determine the accuracy of preoperative measurements for detecting pathologic complete response (CR) and assessing residual disease after neoadjuvant chemotherapy (NACT) in patients with locally advanced breast cancer. SUBJECTS AND METHODS. The American College of Radiology Imaging Network 6657 Trial prospectively enrolled women with = 3 cm invasive breast cancer receiving NACT. Preoperative measurements of residual disease included longest diameter by mammography, MRI, and clinical examination and functional volume on MRI. The accuracy of preoperative measurements for detecting pathologic CR and the association with final pathology size were assessed for all lesions, separately for single masses and nonmass enhancements (NMEs), multiple masses, and lesions without ductal carcinoma in situ (DCIS). RESULTS. In the 138 women with all four preoperative measures, longest diameter by MRI showed the highest accuracy for detecting pathologic CR for all lesions and NME (AUC = 0.76 and 0.84, respectively). There was little difference across preoperative measurements in the accuracy of detecting pathologic CR for single masses (AUC = 0.69–0.72). Longest diameter by MRI and longest diameter by clinical examination showed moderate ability for detecting pathologic CR for multiple masses (AUC = 0.78 and 0.74), and longest diameter by MRI and longest diameter by mammography showed moderate ability for detecting pathologic CR for tumors without DCIS (AUC = 0.74 and 0.71). In subjects with residual disease, longest diameter by MRI exhibited the strongest association with pathology size for all lesions and single masses (r = 0.33 and 0.47). Associations between preoperative measures and pathology results were not significantly influenced by tumor subtype or mammographic density. CONCLUSION. Our results indicate that measurement of longest diameter by MRI is more accurate than by mammography and clinical examination for preoperative assessment of tumor residua after NACT and may improve surgical planning.
AB - OBJECTIVE. The objective of our study was to determine the accuracy of preoperative measurements for detecting pathologic complete response (CR) and assessing residual disease after neoadjuvant chemotherapy (NACT) in patients with locally advanced breast cancer. SUBJECTS AND METHODS. The American College of Radiology Imaging Network 6657 Trial prospectively enrolled women with = 3 cm invasive breast cancer receiving NACT. Preoperative measurements of residual disease included longest diameter by mammography, MRI, and clinical examination and functional volume on MRI. The accuracy of preoperative measurements for detecting pathologic CR and the association with final pathology size were assessed for all lesions, separately for single masses and nonmass enhancements (NMEs), multiple masses, and lesions without ductal carcinoma in situ (DCIS). RESULTS. In the 138 women with all four preoperative measures, longest diameter by MRI showed the highest accuracy for detecting pathologic CR for all lesions and NME (AUC = 0.76 and 0.84, respectively). There was little difference across preoperative measurements in the accuracy of detecting pathologic CR for single masses (AUC = 0.69–0.72). Longest diameter by MRI and longest diameter by clinical examination showed moderate ability for detecting pathologic CR for multiple masses (AUC = 0.78 and 0.74), and longest diameter by MRI and longest diameter by mammography showed moderate ability for detecting pathologic CR for tumors without DCIS (AUC = 0.74 and 0.71). In subjects with residual disease, longest diameter by MRI exhibited the strongest association with pathology size for all lesions and single masses (r = 0.33 and 0.47). Associations between preoperative measures and pathology results were not significantly influenced by tumor subtype or mammographic density. CONCLUSION. Our results indicate that measurement of longest diameter by MRI is more accurate than by mammography and clinical examination for preoperative assessment of tumor residua after NACT and may improve surgical planning.
KW - Clinical examination
KW - Locally advanced breast cancer
KW - MRI
KW - Mammography
KW - Neoadjuvant chemotherapy
KW - Pathologic complete response
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U2 - 10.2214/AJR.17.18323
DO - 10.2214/AJR.17.18323
M3 - Article
C2 - 29708782
AN - SCOPUS:85047763521
SN - 0361-803X
VL - 210
SP - 1376
EP - 1385
JO - American Journal of Roentgenology
JF - American Journal of Roentgenology
IS - 6
ER -