MRI measurements of breast tumor volume predict response to neoadjuvant chemotherapy and recurrence-free survival.
OBJECTIVE
The purpose of this study was to assess the value of MRI measurements of breast tumor size for predicting recurrence-free survival (RFS) in patients undergoing neoadjuvant (preoperative) chemotherapy and to compare the predictive value of MRI with that of established prognostic indicators.


METHODS
The study included 62 patients undergoing neoadjuvant chemotherapy. The longest diameter and volume of each tumor were measured on MRI before and after one and four cycles of treatment. Change in diameter on clinical examination, tumor size at pathology, and the number of positive nodes were determined. Each measure of tumor extent was assessed for the ability to predict RFS.


RESULTS
Univariate Cox analysis showed initial MRI volume was the strongest predictor of RFS (p = 0.002). Final change in MRI volume (p = 0.015) was more predictive than change in diameter on MRI (p = 0.077) or clinical examination (p = 0.27). Initial diameter on MRI (p = 0.003) and clinical examination (p = 0.033), tumor size at pathology (p = 0.016), and number of positive nodes (p = 0.045) were also significantly predictive of RFS. Early change in MRI volume (p = 0.071) and diameter (p = 0.081) after one chemotherapy cycle showed trends of association with RFS. Multivariate analysis showed initial MRI volume (p = 0.005) and final change in MRI volume (p = 0.003) were significant independent predictors.


CONCLUSIONS
MRI tumor volume was more predictive of RFS than tumor diameter, suggesting that volumetric changes measured using MRI may provide a more sensitive assessment of treatment efficacy.
Partridge
Savannah C
SC
Department of Radiology, University of California, San Francisco, San Francisco, CA 94143, USA. scp3@u.washington.edu
Gibbs
Jessica E
JE
Lu
Ying
Y
Esserman
Laura J
LJ
Tripathy
Debasish
D
Wolverton
Dulcy S
DS
Rugo
Hope S
HS
Hwang
E Shelley
ES
Ewing
Cheryl A
CA
Hylton
Nola M
NM
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D001952:Bridged-Ring Compounds / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D016019:Survival Analysis; D043823:Taxoids / Q000008:administration & dosage
D001952:Bridged-Ring Compounds; D043823:Taxoids; C080625:taxane; D004317:Doxorubicin; D003520:Cyclophosphamide