title: Magnetic resonance imaging in comparison to clinical palpation in assessing the response of breast cancer to epirubicin primary chemotherapy.
abstract: OBJECTIVE
  To investigate whether magnetic resonance imaging (MRI) is superior to clinical palpation in the assessment of response of breast cancer to primary chemotherapy (PC).
  
  
  METHODS
  Seventy-three patients with T2-4, N0, M0 breast cancer were treated with 3-4 cycles of single agent epirubicin before definitive surgery. MRI was performed at baseline condition and at the end of chemotherapy.
  
  
  RESULTS
  According to the WHO criteria, 20 (27.4%) patients attained a complete response (CR) by clinical palpation and 41 (56.2%) a partial response. The corresponding response rate by MRI was 11 (15.1%) and 34 (46.6%), respectively. Residual tumor assessed by MRI better correlated with pathologic measurements (Spearman r : 0.72) than residual tumor assessed by clinical palpation (Spearman r : 0.58). Post-chemotherapy histology evaluation revealed pathologic CR in three cases, only one of them was considered as complete responder by MRI. Residual disease consisted in in situ carcinoma in four cases, one of them was complete responder at MRI, the remaining three showed residual abnormal contrast enhancement indistinguishable from that of invasive tumors.
  
  
  CONCLUSIONS
  As compared to pathology specimens, MRI is able to represent the extent of cancer more accurately than clinical palpation. It constitutes a promising technique in assessing the BC response to PC. The current limit of MRI is the scarce specificity in predicting the nature of residual disease.
authors.affiliation: Radiologia, Breast Unit and Anatomia Patologica, Azienda Ospedaliera Istituti Ospitalieri, Cremona, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Bodini
authors.forename: Alfredo
authors.initials: A
authors.lastname: Berruti
authors.forename: Alberto
authors.initials: A
authors.lastname: Bottini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Allevi
authors.forename: Carla
authors.initials: C
authors.lastname: Fiorentino
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Brizzi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bersiga
authors.forename: Daniele
authors.initials: D
authors.lastname: Generali
authors.forename: Davide
authors.initials: D
authors.lastname: Volpi
authors.forename: Ugo
authors.initials: U
authors.lastname: Marini
authors.forename: Sergio
authors.initials: S
authors.lastname: Aguggini
authors.forename: Marco
authors.initials: M
authors.lastname: Tampellini
authors.forename: Palmiro
authors.initials: P
authors.lastname: Alquati
authors.forename: Lucio
authors.initials: L
authors.lastname: Olivetti
authors.forename: Luigi
authors.initials: L
authors.lastname: Dogliotti
mesh_terms: D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000494:pharmacology; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D016903:Drug Monitoring; D015251:Epirubicin / Q000494:pharmacology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000473:pathology; D010173:Palpation; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric
chemical_list: D000903:Antibiotics, Antineoplastic; D015251:Epirubicin