title: Prospective comparison of mammography, sonography, and MRI in patients undergoing neoadjuvant chemotherapy for palpable breast cancer.
abstract: OBJECTIVE
  The objective of our study was to determine the relative accuracy of mammography, sonography, and MRI in predicting residual tumor after neoadjuvant chemotherapy for breast cancer as compared with the gold standards of physical examination and pathology.
  
  
  METHODS
  Forty-one women with stage IIB-III palpable breast cancer were prospectively enrolled in a study investigating the effects of sequential single-agent chemotherapy (doxorubicin followed by paclitaxel or vice versa) on tumor imaging. The study cohort consisted of the first 31 patients (age range, 31-65 years; mean, 45 years) who completed the protocol. All underwent physical examination, mammography, sonography, and MRI before and after receiving each neoadjuvant chemotherapeutic drug. Imaging studies were reviewed by two radiologists using conventional lexicons for lesion analysis, and the findings were compared with clinical response and pathology results.
  
  
  RESULTS
  Complete, partial, and stable clinical response as defined by clinical examination was seen in 15, 14, and two of the 31 patients, respectively. Agreement rates about the degree of response were 32%, 48%, and 55%, respectively, for mammography, sonography, and MRI compared with clinical evaluation and did not differ statistically. Agreement about the rate of response as measured by clinical examination, mammography, sonography, and MRI compared with the gold standard (pathology) was 19%, 26%, 35%, and 71%, respectively. Of the four, MRI agreed with the gold standard significantly more often (p < 0.002 for all three paired comparisons with MRI). When there was disagreement with the gold standard, none of the four exhibited a significant tendency to either under- or overestimate.
  
  
  CONCLUSIONS
  MRI appears to provide the best correlation with pathology-better than physical examination, mammography, and sonography-in patients undergoing neoadjuvant chemotherapy. However, MRI may overestimate (6%) or underestimate (23%) residual disease in approximately 29% of the patients (95% confidence interval, 14-48%).
authors.affiliation: Department of Radiology, Massachusetts General Hospital, 15 Parkman St., ACC-219, Boston, MA 02114, USA. eyeh@partners.org
authors.forename: Eren
authors.initials: E
authors.lastname: Yeh
authors.forename: Priscilla
authors.initials: P
authors.lastname: Slanetz
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Kopans
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rafferty
authors.forename: Dianne
authors.initials: D
authors.lastname: Georgian-Smith
authors.forename: Linda
authors.initials: L
authors.lastname: Moy
authors.forename: Elkan
authors.initials: E
authors.lastname: Halpern
authors.forename: Richard
authors.initials: R
authors.lastname: Moore
authors.forename: Irene
authors.initials: I
authors.lastname: Kuter
authors.forename: Alphonse
authors.initials: A
authors.lastname: Taghian
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008327:Mammography / Q000706:statistics & numerical data; D008875:Middle Aged; D010173:Palpation; D011446:Prospective Studies; D015203:Reproducibility of Results; D014463:Ultrasonography