Abstract
The accuracy of mammography, sonography and magnetic resonance imaging (MRI) in identifying residual disease after neoadjuvant chemotherapy is evaluated and imaging findings are correlated with pathologic findings. Fifteen patients enrolled in an experimental protocol of preoperative neoadjuvant chemotherapy underwent clinical examination, mammography, sonography and dynamic MRI, performed in this order, before and respectively after 2 and 4 cycles of neoadjuvant chemotherapy. Four radiologists, two for mammography, one for sonography and one for MR, examined the images, blinded to the results of the other examinations. All patients underwent radical or conservative surgery, and imaging findings were compared with pathologic findings. MRI identified 2/15 (13.3.%) clinically complete response (CR), 9/15 (60%) partial response (PR), 3/15 (20%) stable disease (SD) and 1/15 (6.7%) progressive disease. Mammography identified 1/15 (6.7%) clinically CR, 8/15 (53.3%) PR and 4/15 (27%) SD, and was not able to evaluate the disease in 2/15 (13%) cases. Sonography presented the same results as MRI. Therefore, MRI and sonography compared to mammography correctly identified residual disease in 100 vs. 86%. MRI resulted in two false-negative results because of the presence of microfoci of in situ ductal carcinoma (DCIS) and invasive lobular carcinoma (LCI). MRI was superior to mammography in cases of multifocal or multicentric disease (83 vs. 33%). Sonography performed after MRI improves the accuracy in evaluation of uncertain foci of multifocal disease seen on MR images with an increase of diagnostic accuracy from 73 to 84.5%. MRI assesses response to neoadjuvant chemotherapy better than traditional methods of physical examination and mammography.
Similar content being viewed by others
References
Fisher B, Brown A, Mamounas E et al (1997) Effects of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol 15:2483–2493
Abraham DC, Jones RC, Jones SE et al (1996) Evaluation of neoadjuvant chemotherapeutic response of locally advanced breast cancer by Magnetic Resonance Imaging. Cancer 78:91–100
Dash N, Chafin SH, Johnson RR et al (1999) Usefulness of tissue marker clips in patients undergoing neoadjuvant chemotherapy for breast cancer. AJR 173:911–917
Vinnicombe SJ, Mac Vicar AD, Guy RL et al (1996) Primary breast cancer: mammographic changes after neoadjuvant chemotherapy, with pathologic correlation. Radiology 198:333–340
Fisher B, Bryant J, Wolkmar N et al (1998) Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol 16:2672–2685
Fisher B, Mamounas EP (1995) Preoperative chemotherapy: a model for studying the biology and therapy of primary breast cancer. J Clin Oncol 13:537–540
Trecate G, Ceglia E, Stabile F et al (1998) Tumori della mammella localmente avanzati. Ruolo della Risonanza Magnetica nella valutazione della risposta alla terapia prechirurgica e del residuo neoplastico prima dell’intervento. Radiol Med 95:449–455
Liem BJ, Holland JM, Kang MY et al (2002) Karnofsky Performance Status Assessment: resident versus attending. J Cancer Educ Fall 17:138–141
American College of Radiology (1998) Breast imaging reporting and data system (BI-RADS), 3rd edn. American College of Radiology, Reston, VA
Fischer U, Kopka L, Grabbe E (1999) Breast carcinoma: effect of preoperative contrast-enhanced MR imaging on the therapeutic approach. Radiology 213:881–888
Therasse P, Arbuck SG, Eisenhauer EA et al (2000) New Guidelines to evaluate the response to treatment in solid tumors. JNCI 92:205–216
Hermanek P, Hutter RVP, Sobin LH et al (1985) International Union against Cancer (UICC) (eds) TNM Atlas. Springer, Berlin Heidelberg New York, Germany
Heywang S, Wolf A, Pruss E et al (1989) MR imaging of the breast with Gd-DTPA: use and limitations. Radiology 171:95–103
Kaiser W, Zeitler E (1989) MR imaging of the breast: fast imaging sequences with and without Gd-DTPA. Radiology 170:681–686
Rieber A, Merkle E, Bohm W et al (1997) MRI of histologically confirmed mammary carcinoma: clinical relevance of diagnostic procedures for detection of multifocal or controlateral secondary carcinoma. J Comput Assist Tomogr 21:773–779
Oellinger H, Heins S, Sander B et al (1993) Gd-DTPA enhanced MRI of breast: the most sensitive method for detecting multicentric carcinomas in female breast? Eur Radiol 3:223–226
Harms SE, Flamig DP, Hesley KL et al (1993) MR imaging of the breast with rotating delivery of excitation off resonance: clinical experience with pathologic correlation. Radiology 187:493–501
Boetes C, Mus RDM, Holland R et al (1995) Breast tumors: comparative accuracy of MR imaging relative to mammography and US for demonstrating extent. Radiology 197:743–747
Mumtaz H, Hall-Craggs MA, Davidson T et al (1997) Staging of symptomatic primary breast cancer with MR imaging. AJR 169:417–424
Hung WK, Lau Y, Chan CM et al (2000) Experience of neoadjuvant chemotherapy for breast cancer at a public hospital: retrospective study. HKMJ 6:265–268
Hortobagyi GN (1994) Multidisciplinary management of advanced primary and metastatic breast cancer. Cancer 74:416–423
Pierce LJ, Lippman M, Ben-Baruch N et al (1992) The effect of systemic therapy on local-regional control in locally advanced breast cancer. Int J Radiat Oncol Biol Phys 23:949–960
Powels TJ, Hickish TF, Makris A et al (1995) Randomized trial of chemoendocrine therapy started before or after surgery for treatment of primary breast cancer. J Clin Oncol 13:547–552
Gilles R, Guinebretiere J-M, Toussaint C et al (1994) Locally advanced breast cancer: contrast-enhanced subtraction MR imaging of response to preoperative chemotherapy. Radiology 191:633–638
Helvie MA, Joynt LK, Cody RL et al (1996) Locally advanced breast carcinoma: accuracy of mammography versus clinical examination in the prediction of residual disease after chemotherapy. Radiology 198:327–332
Moskovic EC, Mansi JL, King DM et al (1993) Mammography in the assessment of response to medical treatment of large primary breast cancer. Clin Radiol 47:339–344
Rieber A, Brambs HJ, Gabelmann A et al (2002) Breast MRI for monitoring response of primary breast cancer to neo-adjuvant chemotherapy. Eur Radiol 12:1711–1719
Esserman L, Hylton N, Yassa L et al (1999) Utility of magnetic resonance imaging in the management of breast cancer: evidence for improved preoperative staging. J Clin Oncol 17:110–119
Rieber A, Zeitler H, Rosenthal H et al (1997) MRI of breast cancer: influence of chemotherapy on sensitivity. BJR 70:452–458
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Londero, V., Bazzocchi, M., Del Frate, C. et al. Locally advanced breast cancer: comparison of mammography, sonography and MR imaging in evaluation of residual disease in women receiving neoadjuvant chemotherapy. Eur Radiol 14, 1371–1379 (2004). https://doi.org/10.1007/s00330-004-2246-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-004-2246-z