title: MR spectroscopy of breast cancer for assessing early treatment response: Results from the ACRIN 6657 MRS trial.
abstract: To estimate the accuracy of predicting response to neoadjuvant chemotherapy (NACT) in patients with locally advanced breast cancer using MR spectroscopy (MRS) measurements made very early in treatment.
  
  
  
  This prospective Health Insurance Portability and Accountability Act (HIPAA)-compliant protocol was approved by the American College of Radiology and local-site institutional review boards. One hundred nineteen women with invasive breast cancer of ≥3 cm undergoing NACT were enrolled between September 2007 and April 2010. MRS measurements of the concentration of choline-containing compounds ([tCho]) were performed before the first chemotherapy regimen (time point 1, TP1) and 20-96 h after the first cycle of treatment (TP2). The change in [tCho] was assessed for its ability to predict pathologic complete response (pCR) and radiologic response using the area under the receiver operating characteristic curve (AUC) and logistic regression models.
  
  
  
  Of the 119 subjects enrolled, only 29 cases (24%) with eight pCRs provided usable data for the primary analysis. Technical challenges in acquiring quantitative MRS data in a multi-site trial setting limited the capture of usable data. In this limited data set, the decrease in tCho from TP1 to TP2 had poor ability to predict either pCR (AUC = 0.53, 95% confidence interval [CI]: 0.27-0.79) or radiologic response (AUC = 0.51, 95% CI: 0.27-0.75).
  
  
  
  The technical difficulty of acquiring quantitative MRS data in a multi-site clinical trial setting led to a low yield of analyzable data, which was insufficient to accurately measure the ability of early MRS measurements to predict response to NACT.
  
  
  
  1 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:290-302.
authors.affiliation: Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bolan
authors.affiliation: National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA.|American College of Radiology Imaging Network (ACRIN), Philadelphia, Pennsylvania, USA.
authors.forename: Eunhee
authors.initials: E
authors.lastname: Kim
authors.affiliation: American College of Radiology Imaging Network (ACRIN), Philadelphia, Pennsylvania, USA.|Center for Statistical Sciences, Brown University, Providence, Rhode Island, USA.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Herman
authors.affiliation: Department of Radiology, University of Chicago, Chicago, Illinois, USA.
authors.forename: Gillian M
authors.initials: GM
authors.lastname: Newstead
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Rosen
authors.affiliation: American College of Radiology Imaging Network (ACRIN), Philadelphia, Pennsylvania, USA.|Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Schnall
authors.affiliation: Department of Radiology, Medical College of South Carolina, Charleston, South Carolina, USA.
authors.forename: Etta D
authors.initials: ED
authors.lastname: Pisano
authors.affiliation: Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Paul T
authors.initials: PT
authors.lastname: Weatherall
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Morris
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Constance D
authors.initials: CD
authors.lastname: Lehman
authors.affiliation: Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Garwood
authors.affiliation: Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Nelson
authors.affiliation: Masonic Cancer Center and Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Yee
authors.affiliation: Washington Radiology Associates, P.C., Fairfax, Virginia, USA.
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Polin
authors.affiliation: Department of Surgery, University of California, San Francisco, California, USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Esserman
authors.affiliation: American College of Radiology Imaging Network (ACRIN), Philadelphia, Pennsylvania, USA.|Center for Statistical Sciences, Brown University, Providence, Rhode Island, USA.
authors.forename: Constantine A
authors.initials: CA
authors.lastname: Gatsonis
authors.affiliation: Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Metzger
authors.affiliation: Department of Radiology, University of California, San Francisco, California, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Newitt
authors.affiliation: Department of Radiology, University of Washington, Seattle, Washington, USA.
authors.forename: Savannah C
authors.initials: SC
authors.lastname: Partridge
authors.affiliation: Department of Radiology, University of California, San Francisco, California, USA.
authors.forename: Nola M
authors.initials: NM
authors.lastname: Hylton
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D014408:Biomarkers, Tumor / Q000032:analysis*; D001943:Breast Neoplasms / Q000737:chemistry* / Q000175:diagnosis / Q000628:therapy*; D002794:Choline / Q000032:analysis*; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D057054:Molecular Imaging / Q000379:methods; D015203:Reproducibility of Results; D055502:Secondary Prevention / Q000379:methods*; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D002794:Choline
keywords: breast cancer; choline; magnetic resonance spectroscopy; treatment response