title: Computer-aided evaluation of breast MRI for the residual tumor extent and response monitoring in breast cancer patients receiving neoadjuvant chemotherapy.
abstract: OBJECTIVE
  To evaluate the accuracy of a computer-aided evaluation program (CAE) of breast MRI for the assessment of residual tumor extent and response monitoring in breast cancer patients receiving neoadjuvant chemotherapy.
  
  
  METHODS
  Fifty-seven patients with breast cancers who underwent neoadjuvant chemotherapy before surgery and dynamic contrast enhanced MRI before and after chemotherapy were included as part of this study. For the assessment of residual tumor extent after completion of chemotherapy, the mean tumor diameters measured by radiologists and CAE were compared to those on histopathology using a paired student t-test. Moreover, the agreement between unidimensional (1D) measurement by radiologist and histopathological size or 1D measurement by CAE and histopathological size was assessed using the Bland-Altman method. For chemotherapy monitoring, we evaluated tumor response through the change in the 1D diameter by a radiologist and CAE and three-dimensional (3D) volumetric change by CAE based on Response Evaluation Criteria in Solid Tumors (RECIST). Agreement between the 1D response by the radiologist versus the 1D response by CAE as well as by the 3D response by CAE were evaluated using weighted kappa (k) statistics.
  
  
  RESULTS
  For the assessment of residual tumor extent after chemotherapy, the mean tumor diameter measured by radiologists (2.0 ± 1.7 cm) was significantly smaller than the mean histological diameter (2.6 ± 2.3 cm) (p = 0.01), whereas, no significant difference was found between the CAE measurements (mean = 2.2 ± 2.0 cm) and histological diameter (p = 0.19). The mean difference between the 1D measurement by the radiologist and histopathology was 0.6 cm (95% confidence interval: -3.0, 4.3), whereas the difference between CAE and histopathology was 0.4 cm (95% confidence interval: -3.9, 4.7). For the monitoring of response to chemotherapy, the 1D measurement by the radiologist and CAE showed a fair agreement (k = 0.358), while the 1D measurement by the radiologist and 3D measurement by CAE showed poor agreement (k = 0.106).
  
  
  CONCLUSIONS
  CAE for breast MRI is sufficiently accurate for the assessment of residual tumor extent in breast cancer patients receiving neoadjuvant chemotherapy. However, for the assessment of response to chemotherapy, the assessment by the radiologist and CAE showed a fair to poor agreement.
authors.affiliation: Department of Radiology and Clinical Research Institute, Seoul National University Hospital and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744, Korea.
authors.forename: Chae Yeon
authors.initials: CY
authors.lastname: Lyou
authors.forename: Nariya
authors.initials: N
authors.lastname: Cho
authors.forename: Sun Mi
authors.initials: SM
authors.lastname: Kim
authors.forename: Mijung
authors.initials: M
authors.lastname: Jang
authors.forename: Jeong-Seon
authors.initials: JS
authors.lastname: Park
authors.forename: Seung Yon
authors.initials: SY
authors.lastname: Baek
authors.forename: Woo Kyung
authors.initials: WK
authors.lastname: Moon
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D003936:Diagnosis, Computer-Assisted; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018365:Neoplasm, Residual; D055815:Young Adult