title: Can Routine Imaging After Neoadjuvant Chemotherapy in Breast Cancer Predict Pathologic Complete Response?
abstract: BACKGROUND
  This study evaluated breast imaging procedures for predicting pathologic complete response (pCR = ypT0) after neoadjuvant chemotherapy (NACT) for breast cancer to challenge surgery as a diagnostic procedure after NACT.
  
  
  METHODS
  This retrospective, exploratory, monocenter study included 150 invasive breast cancers treated by NACT. The patients received magnetic resonance imaging (MRI), mammography (MGR), and ultrasound (US). The results were classified in three response subgroups according to response evaluation criteria in solid tumors. To incorporate specific features of MRI and MGR, an additional category [clinical near complete response (near-cCR)] was defined. Residual cancer in imaging and pathology was defined as a positive result. Negative predictive values (NPVs), false-negative rates (FNRs), and false-positive rates (FPRs) of all imaging procedures were analyzed for the whole cohort and for triple-negative (TN), HER2-positive (HER2+), and HER2-negative/hormone-receptor-positive (HER2-/HR+) cancers, respectively.
  
  
  RESULTS
  In 46 cases (31%), pCR (ypT0) was achieved. Clinical complete response (cCR) and near-cCR showed nearly the same NPVs and FNRs. The NPV was highest with 61% for near-cCR in MRI and lowest with 44% for near-cCR in MGR for the whole cohort. The FNRs ranged from 4 to 25% according to different imaging methods. The MRI performance seemed to be superior, especially in TN cancers (NPV 94%; FNR 5%). The lowest FPR was 10 % in MRI, and the highest FPR was 44% in US.
  
  
  CONCLUSIONS
  Neither MRI nor MGR or US can diagnose a pCR (ypT0) with sufficient accuracy to replace pathologic diagnosis of the surgical excision specimen.
authors.affiliation: Department of Gynecology, University Breast Unit, Heidelberg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Schaefgen
authors.affiliation: Department of Gynecology, University Breast Unit, Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Mati
authors.affiliation: Institute of Pathology, University of Heidelberg, Heidelberg, Germany.
authors.forename: H P
authors.initials: HP
authors.lastname: Sinn
authors.affiliation: Department of Gynecology, University Breast Unit, Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Golatta
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Breast Unit, Heidelberg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Stieber
authors.affiliation: Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Rauch
authors.affiliation: Department of Gynecology, University Breast Unit, Heidelberg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Hennigs
authors.affiliation: Department of Gynecology, University Breast Unit, Heidelberg, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Richter
authors.affiliation: Department of Gynecology, University Breast Unit, Heidelberg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Domschke
authors.affiliation: Department of Gynecology, University Breast Unit, Heidelberg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Schuetz
authors.affiliation: Department of Gynecology, University Breast Unit, Heidelberg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Sohn
authors.affiliation: Department of Gynecology, University Breast Unit, Heidelberg, Germany.|National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Schneeweiss
authors.affiliation: Department of Gynecology, University Breast Unit, Heidelberg, Germany. joerg.heil@med.uni-heidelberg.de.
authors.forename: Joerg
authors.initials: J
authors.lastname: Heil
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000378:metabolism; D017024:Chemotherapy, Adjuvant; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D008875:Middle Aged; D064847:Multimodal Imaging; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012189:Retrospective Studies; D064726:Triple Negative Breast Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000378:metabolism
chemical_list: D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human