Locally advanced breast carcinoma: accuracy of mammography versus clinical examination in the prediction of residual disease after chemotherapy.
OBJECTIVE
To determine the mammographic features of locally advanced breast carcinoma treated with neoadjuvant chemotherapy and to evaluate the accuracy of mammography in the prediction of residual carcinoma.


METHODS
Of 90 women treated with hormonally synchronized cytotoxic therapy before mastectomy or lumpectomy for advanced breast carcinoma, 56 were selected because they had undergone mammography before and after neo-adjuvant therapy. Mammographic and clinical opinion on the presence of residual disease was compared with histologic results.


RESULTS
Fifty-four (96%) of 56 women had a complete (n = 34 [61%]) or partial (n = 20 [36%]) clinical response. Thirteen (23%) of 56 women had no residual tumor. Sensitivity of mammography in the prediction of residual carcinoma was greater than that of clinical examination (79% vs 49%), but specificity was lower (77% vs 92%). In 24 women with inflammatory carcinoma, sensitivity of mammography was 78% while that of clinical examination was 39%; specificity was equal (83%).


CONCLUSIONS
Mammography was more sensitive than clinical examination in the prediction of residual carcinoma; it was not accurate enough to obviate surgical biopsy.
Helvie
M A
MA
Department of Radiology, University of Michigan Medical Center, Ann Arbor 48109-0326, USA.
Joynt
L K
LK
Cody
R L
RL
Pierce
L J
LJ
Adler
D D
DD
Merajver
S D
SD
D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D018275:Carcinoma, Lobular / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D004966:Estrogens, Conjugated (USP) / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008327:Mammography; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D018365:Neoplasm, Residual; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013629:Tamoxifen / Q000008:administration & dosage
D000970:Antineoplastic Agents; D004966:Estrogens, Conjugated (USP); D013629:Tamoxifen; D004317:Doxorubicin; D003520:Cyclophosphamide; D005472:Fluorouracil; D008727:Methotrexate