title: Predicting pathological response to neoadjuvant chemotherapy in breast cancer with quantitative 1H MR spectroscopy using the external standard method.
abstract: OBJECTIVE
  To assess the efficacy of quantitative (1)H MR spectroscopy (MRS) using the external standard method to predict the pathological response to neoadjuvant chemotherapy with an anthracycline-based regimen in breast cancer patients.
  
  
  METHODS
  Sixteen patients with breast cancer were included. Tumor response to chemotherapy was evaluated after the second cycle using MRI and MRS. Final histopathology following surgery after four cycles of chemotherapy served as reference.
  
  
  RESULTS
  The average normalized choline (Cho) signal was 1.2 (range, 0.40 to 2.8). There were no significant differences in the baseline tumor size and normalized Cho signals between the pathological responders (n = 8) and nonresponders (n = 8). The reduction rates of the normalized Cho signal were statistically significantly different between the pathological responders and nonresponders (P = 0.004), whereas the reduction rates of the lesion size were not significantly different between the two groups. When 40-50% of the reduction rates of the normalized Cho was chosen as the cutoff value, the positive and negative predictive values of MRS were 89% (8/9) and 100% (7/7), respectively.
  
  
  CONCLUSIONS
  The changes in Cho after the second cycle of chemotherapy as determined by quantitative MRS may be more sensitive than changes in the tumor size to predict the pathological response.
authors.affiliation: Breast Center, Kameda Medical Center, Kamogawa, Chiba, Japan. e-tozaki@keh.biglobe.ne.jp
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Tozaki
authors.forename: Masaaki
authors.initials: M
authors.lastname: Sakamoto
authors.forename: Yu
authors.initials: Y
authors.lastname: Oyama
authors.forename: Katsuya
authors.initials: K
authors.lastname: Maruyama
authors.forename: Eisuke
authors.initials: E
authors.lastname: Fukuma
mesh_terms: D000328:Adult; D000465:Algorithms; D018943:Anthracyclines / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000628:therapy; D002794:Choline / Q000737:chemistry; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D011237:Predictive Value of Tests; D016896:Treatment Outcome
chemical_list: D018943:Anthracyclines; D002794:Choline