J Korean Soc Radiol.  2021 May;82(3):654-669. 10.3348/jksr.2020.0120.

Evaluation of PostNeoadjuvant Chemotherapy Pathologic Complete Response and Residual Tumor Size of Breast Cancer: Analysis on Accuracy of MRI and Affecting Factors

Affiliations
  • 1Department of Radiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
  • 2Department of Surgery, Division of Breast & Thyroid Surgical Oncology, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 3Department of Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea

Abstract

Purpose
To evaluate the accuracy of MRI in predicting the pathological complete response (pCR) and the residual tumor size of breast cancer after neoadjucant chemotherapy (NAC), and to determine the factors affecting the accuarcy.
Materials and Methods
Eighty-eight breast cancer patients who underwent surgery after NAC at our center between 2010 and 2017 were included in this study. pCR was defined as the absence of invasive cancer on pathological evaluation. The maximum diameter of the residual tumor on post-NAC MRI was compared with the tumor size of the surgical specimen measured pathologically. Statistical analysis was performed to elucidate the factors affecting pCR and the residual tumor size-discrepancy between the MRI and the pathological measurements.
Results
The pCR rate was 10%. The diagnostic accuracy of MRI and the area under the curve for predicting pCR were 90.91% and 0.8017, respectively. The residual tumor sizes obtained using MRI and pathological measurements showed a strong correlation (r = 0.9, p < 0.001), especially in patients with a single mass lesion (p = 0.047). The size discrepancy between MRI and the pathological measurements was significantly greater in patients with the luminal type (p = 0.023) and multifocal tumors/non-mass enhancement on pre-NAC MRI (p = 0.047).
Conclusion
MRI is an accurate tool for evaluating pCR and residual tumor size in breast cancer patients who receive NAC. Tumor subtype and initial MRI features affect the accuracy of MRI.

Keyword

Breast Neoplasm; Neoadjuvant Therapy; Magnetic Resonance Imaging
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