title: Accuracy of physical examination, ultrasonography, and mammography in predicting residual pathologic tumor size in patients treated with neoadjuvant chemotherapy.
abstract: OBJECTIVE
  To assess the accuracy of physical examination, ultrasonography, and mammography in predicting residual size of breast tumors following neoadjuvant chemotherapy.
  
  
  BACKGROUND
  Neoadjuvant chemotherapy is an accepted part of the management of stage II and III breast cancer. Accurate prediction of residual pathologic tumor size after neoadjuvant chemotherapy is critical in guiding surgical therapy. Although physical examination, ultrasonography, and mammography have all been used to predict residual tumor size, there have been conflicting reports about the accuracy of these methods in the neoadjuvant setting.
  
  
  METHODS
  We reviewed the records of 189 patients who participated in 1 of 2 protocols using doxorubicin-containing neoadjuvant chemotherapy, and who had assessment by physical examination, ultrasonography, and/or mammography no more than 60 days before their surgical resection. Size correlations were performed using Spearman rho analysis. Clinical and pathologic measurements were also compared categorically using the weighted kappa statistic.
  
  
  RESULTS
  Size estimates by physical examination, ultrasonography, and mammography were only moderately correlated with residual pathologic tumor size after neoadjuvant chemotherapy (correlation coefficients: 0.42, 0.42, and 0.41, respectively), with an accuracy of +/-1 cm in 66% of patients by physical examination, 75% by ultrasonography, and 70% by mammography. Kappa values (0.24-0.35) indicated poor agreement between clinical and pathologic measurements.
  
  
  CONCLUSIONS
  Physical examination, ultrasonography, and mammography were only moderately useful for predicting residual pathologic tumor size after neoadjuvant chemotherapy.
authors.affiliation: Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4095, USA.
authors.forename: Anees B
authors.initials: AB
authors.lastname: Chagpar
authors.forename: Lavinia P
authors.initials: LP
authors.lastname: Middleton
authors.forename: Aysegul A
authors.initials: AA
authors.lastname: Sahin
authors.forename: Peter
authors.initials: P
authors.lastname: Dempsey
authors.forename: Aman U
authors.initials: AU
authors.lastname: Buzdar
authors.forename: Attiqa N
authors.initials: AN
authors.lastname: Mirza
authors.forename: Fredrick C
authors.initials: FC
authors.lastname: Ames
authors.forename: Gildy V
authors.initials: GV
authors.lastname: Babiera
authors.forename: Barry W
authors.initials: BW
authors.lastname: Feig
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.forename: Henry M
authors.initials: HM
authors.lastname: Kuerer
authors.forename: Funda
authors.initials: F
authors.lastname: Meric-Bernstam
authors.forename: Merrick I
authors.initials: MI
authors.lastname: Ross
authors.forename: S Eva
authors.initials: SE
authors.lastname: Singletary
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging / Q000379:methods; D018365:Neoplasm, Residual / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology*; D017239:Paclitaxel / Q000008:administration & dosage; D010808:Physical Examination; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016217:Ultrasonography, Mammary
chemical_list: D004317:Doxorubicin; D003520:Cyclophosphamide; D017239:Paclitaxel; D005472:Fluorouracil