Breast cancer: influence of tumour volume estimation method at MRI on prediction of pathological response to neoadjuvant chemotherapy

Shelley A. Henderson (Lead / Corresponding author), Naleen Muhammad Gowdh, Colin A. Purdie, Lee B. Jordan, Andrew Evans, Tracy Brunton, Alastair M. Thompson, Sarah Vinnicombe

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
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Abstract

Objective: Does method of tumour volume measurement on MRI influence prediction of treatment outcome in patients with primary breast cancer undergoing neoadjuvant chemotherapy (NAC)?

Method: The study comprised 136 women with biopsy-proven breast cancer scheduled for MRI monitoring during NAC treatment. Dynamic contrast-enhanced images were acquired at baseline (pre-NAC) and interim (post 3 NAC cycles) timepoints. Functional tumour volumes (FTV), automatically derived using vendor software and enhancing tumour volumes (ETV), user-derived using a semi-automated thresholding technique, were calculated at each timepoint and percentage changes calculated. Response, assessed using residual cancer burden (RCB) score on surgically resected specimens, was compared statistically with volumetric changes and ROC analysis performed.

Results: Mean volumetric differences for each RCB response category were (FTV/ETV): pCR 95.5/96.8%, RCB-I 69.8/66.7%, RCB-II 64.0/65.5%, RCB-III 25.4/24.0%. Differences were significant between pCR and RCB-II/RCB-III categories (p < 0.040; unpaired t-test) using FTV measures and between pCR and RCB-I/RCB-II/RCB-III categories (p < 0.006; unpaired t-test) when ETV was used. ROC analysis for pCR identification post-NAC yielded area under the curve for FTV/ETV of 0.834/0.920 respectively. Sensitivity and specificity for FTV was 80.0 and 76.8% for FTV and 81.0 and 91.8% for ETV.

Conclusion: ETV changes can identify patients likely to achieve a complete response to NAC. Potentially, this could impact patient management regarding the possible avoidance of post-NAC surgery. Advances in Knowledge: Interim changes in ETV are more useful than FTV in predicting final pathological response to NAC. ETV differentiates patients who will achieve a complete response from those who will have residual disease.

Original languageEnglish
Article number20180123
Pages (from-to)1-9
Number of pages9
JournalBritish Journal of Radiology
Volume91
Issue number1087
Early online date11 Apr 2018
DOIs
Publication statusPublished - 2 May 2018

Keywords

  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols
  • Breast Neoplasms/diagnostic imaging
  • Contrast Media
  • Cyclophosphamide/administration & dosage
  • Epirubicin/administration & dosage
  • Female
  • Fluorouracil/administration & dosage
  • Humans
  • Image Interpretation, Computer-Assisted/methods
  • Magnetic Resonance Imaging/methods
  • Meglumine
  • Middle Aged
  • Neoadjuvant Therapy
  • Organometallic Compounds
  • Predictive Value of Tests
  • Reproducibility of Results
  • Retrospective Studies
  • Taxoids/administration & dosage
  • Trastuzumab/administration & dosage
  • Treatment Outcome
  • Tumor Burden

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