title: Predicting response to neoadjuvant chemotherapy in primary breast cancer using volumetric helical perfusion computed tomography: a preliminary study.
abstract: OBJECTIVE
  To investigate whether CT-derived vascular parameters in primary breast cancer predict complete pathological response (pCR) to neoadjuvant chemotherapy (NAC).
  
  
  METHODS
  Twenty prospective patients with primary breast cancer due for NAC underwent volumetric helical perfusion CT to derive whole tumour regional blood flow (BF), blood volume (BV) and flow extraction product (FE) by deconvolution analysis. A pCR was achieved if no residual invasive cancer was detectable on pathological examination. Relationships between baseline BF, BV, FE, tumour size and volume, and pCR were examined using the Mann-Whitney U test. Receiver operating characteristic (ROC) curve analysis was performed to assess the parameter best able to predict response. Intra- and inter-observer variability was assessed using Bland-Altman statistics.
  
  
  RESULTS
  Seventeen out of 20 patients completed NAC with four achieving a pCR. Baseline BF and FE were higher in patients who achieved a pCR compared with those who did not (P = 0.032); tumour size and volume were not significantly different (P > 0.05). ROC analysis revealed that BF and FE were able to identify responders effectively (AUC = 0.87; P = 0.03). There was good intra- and inter-observer agreement.
  
  
  CONCLUSIONS
  Primary breast cancers which exhibited higher levels of perfusion before treatment were more likely to achieve a pCR to NAC.
authors.affiliation: Academic Oncology Unit, Mount Vernon Cancer Centre, Northwood, Middlesex, HA6 2RN, UK.
authors.forename: Sonia P
authors.initials: SP
authors.lastname: Li
authors.forename: Andreas
authors.initials: A
authors.lastname: Makris
authors.forename: Andrew
authors.initials: A
authors.lastname: Gogbashian
authors.forename: Ian C
authors.initials: IC
authors.lastname: Simcock
authors.forename: J James
authors.initials: JJ
authors.lastname: Stirling
authors.forename: Vicky
authors.initials: V
authors.lastname: Goh
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008327:Mammography / Q000379:methods*; D020360:Neoadjuvant Therapy / Q000379:methods; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000209:etiology; D055420:Perfusion Imaging / Q000379:methods*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000379:methods*; D016896:Treatment Outcome