title: Magnetic resonance imaging evaluation of residual tumors in breast cancer after neoadjuvant chemotherapy: surgical implications.
abstract: BACKGROUND
  Magnetic resonance imaging (MRI) can be used to guide breast cancer surgery with breast conservation for large tumors with a substantially reduced size after neoadjuvant chemotherapy (NAC).
  
  
  OBJECTIVE
  To evaluate the value of dynamic contrast-enhanced MRI (DCE-MRI) for measuring residual tumor size and enhancement patterns following preoperative NAC.
  
  
  METHODS
  Eighty-nine patients with breast cancer underwent breast DCE-MRI; 38 patients (39 lesions) were treated with NAC and examined for residual disease following therapy. Two patients were excluded because surgery had been performed >2 weeks after the final MR examination. Thus, we correlated the DCE-MRI results of 36 patients (37 lesions) with postoperative histopathological findings. Residual disease was confirmed by more enhancement compared to normal glandular tissue at the initial tumor site. Residual tumor size on DCE-MRI was compared with postoperative pathology findings. Tumor enhancement patterns on DCE-MRI were analyzed and correlated with pathological classification.
  
  
  RESULTS
  MRI revealed 34 cases of residual tumors, with two false positives and one false negative. Pathological and MR measurements were correlated (r = 0.793). The correlation of mass enhancement size (r = 0.87, n = 14) with pathology and DCE-MRI was higher than for non-mass-like enhancement (NME) (r = 0.735, n = 23). The distribution of pathologic classification was significantly different between different MRI enhancement patterns (P = 0.006). Mass enhancement had higher cellularity than NME.
  
  
  CONCLUSIONS
  MRI is useful for evaluating residual carcinoma following NAC. Mass enhancement with higher cellularity after NAC can be evaluated more accurately, which is suitable for evaluating lumpectomy. However, other approaches are required for NME, which has lower cellularity.
authors.affiliation: Department of Radiology, Affiliated Hospital of the Academy of Military Medical Sciences, Beijing, PR China.
authors.forename: Juan
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Department of Radiology, Affiliated Hospital of the Academy of Military Medical Sciences, Beijing, PR China zjuan122@qq.com.
authors.forename: Gongjie
authors.initials: G
authors.lastname: Li
authors.affiliation: Department of Radiology, Affiliated Hospital of the Academy of Military Medical Sciences, Beijing, PR China.
authors.forename: Fugeng
authors.initials: F
authors.lastname: Sheng
authors.affiliation: Department of Radiology, Affiliated Hospital of the Academy of Military Medical Sciences, Beijing, PR China.
authors.forename: Penggang
authors.initials: P
authors.lastname: Qiao
authors.affiliation: Department of Radiology, Affiliated Hospital of the Academy of Military Medical Sciences, Beijing, PR China.
authors.forename: Hongtao
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Affiliated Hospital of the Academy of Military Medical Sciences, Beijing, PR China.
authors.forename: Xudong
authors.initials: X
authors.lastname: Xing
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D018365:Neoplasm, Residual / Q000473:pathology* / Q000601:surgery; D015203:Reproducibility of Results
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: Breast neoplasm; imaging enhancement; magnetic resonance imaging (MRI); neoadjuvant chemotherapy protocols; pathology