[Preoperative evaluation of pathologic response in patients with breast cancer by dynamic contrast-enhanced magnetic resonance imaging].
OBJECTIVE
To investigate the clinical value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in assessing pathologic responses in breast cancer treated with neoadjuvant chemotherapy.


METHODS
Forty-five patients with pathologically confirmed breast carcinoma who finished last course of neoadjuvant chemotherapy underwent preoperative breast MRI. All the specimen slices were blindly reviewed by one pathologist. Pathologic response was assessed according Miller & Payne five-point classification, of which grade 5 defined as pathological complete response (pCR) , and grade 5 or 4 defined as major histological response (MHR). DCE-MRI images were blindly reviewed by two radiologists retrospectively on workstation with Functool software. Any non-vessel enhancement in previous tumor bed in any phase of postcontrast acquisition was defined as residual disease. The diagnostic results of two radiologists were correlated to pathological gold standard. Inter-observer consistency was analyzed by Kappa statistics.


RESULTS
DCE-MRI for pathological invasive (pINV) residual disease detection in two radiologists had sensitivities of 94.7% and 97.4%, specificities of 42.8% and 57.1%, and accuracy of 86.6% and 91.1%, respectively, while MHR evaluation had sensitivities of 95.5% and 81.8%, specificities of 73.9% and 82.6%, and accuracies of 84.4% and 82.2%, respectively. K values in determine pINV and MHR were 0.728 and 0.778, respectively, showing good inter-observer consistency.


CONCLUSIONS
DCE-MRI is sensitive in detecting residual breast cancer after neoadjuvant chemotherapy, and can be used to predict the postoperative pathologic response.
Zhang
Xiao-Peng
XP
Department of Radiology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing 100036, China. zxp@bjcancer.org
Li
Jie
J
Sun
Ying-Shi
YS
Cao
Kun
K
Tang
Lei
L
D001943:Breast Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D003287:Contrast Media; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D020360:Neoadjuvant Therapy; D018365:Neoplasm, Residual; D012680:Sensitivity and Specificity
D003287:Contrast Media