title: Magnetic resonance imaging tumor regression shrinkage patterns after neoadjuvant chemotherapy in patients with locally advanced breast cancer: Correlation with tumor biological subtypes and pathological response after therapy.
abstract: The objective of this study is to analyze magnetic resonance imaging shrinkage pattern of tumor regression after neoadjuvant chemotherapy and to evaluate its relationship with biological subtypes and pathological response. We reviewed the magnetic resonance imaging studies of 51 patients with single mass-enhancing lesions (performed at time 0 and at the II and last cycles of neoadjuvant chemotherapy). Tumors were classified as Luminal A, Luminal B, HER2+, and Triple Negative based on biological and immunohistochemical analysis after core needle biopsy. We classified shrinkage pattern, based on tumor regression morphology on magnetic resonance imaging at the II cycle, as concentric, nodular, and mixed. We assigned a numeric score (0: none; 1: low; 2: medium; 3: high) to the enhancement intensity decrease. Pathological response on the surgical specimen was classified as complete (grade 5), partial (grades 4-3), and non-response (grades 1-2) according to Miller and Payne system. Fisher test was used to relate shrinkage pattern with biological subtypes and final pathological response. Seventeen patients achieved complete response, 25 partial response, and 9 non-response. A total of 13 lesions showed nodular pattern, 20 concentric, and 18 mixed. We found an association between concentric pattern and HER2+ (p < 0.001) and mixed pattern and Luminal A lesions (p < 0.001). We observed a statistical significant correlation between concentric pattern and complete response (p < 0.001) and between mixed pattern and non-response (p = 0.005). Enhancement intensity decrease 3 was associated with complete response (p < 0.001). Shrinkage pattern and enhancement intensity decrease may serve as early response indicators after neoadjuvant chemotherapy. Shrinkage pattern correlates with tumor biological subtypes.
authors.affiliation: 1 Department of Radiological Oncological and Anatomopathological Sciences, Sapienza University of Rome and Umberto I Hospital, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Ballesio
authors.affiliation: 1 Department of Radiological Oncological and Anatomopathological Sciences, Sapienza University of Rome and Umberto I Hospital, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Gigli
authors.affiliation: 1 Department of Radiological Oncological and Anatomopathological Sciences, Sapienza University of Rome and Umberto I Hospital, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Di Pastena
authors.affiliation: 2 Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Giraldi
authors.affiliation: 1 Department of Radiological Oncological and Anatomopathological Sciences, Sapienza University of Rome and Umberto I Hospital, Rome, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Manganaro
authors.affiliation: 3 Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Anastasi
authors.affiliation: 1 Department of Radiological Oncological and Anatomopathological Sciences, Sapienza University of Rome and Umberto I Hospital, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
mesh_terms: D001940:Breast / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D001943:Breast Neoplasms / Q000145:classification / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D020360:Neoadjuvant Therapy; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: Tumor biological subtypes; breast magnetic resonance imaging; neoadjuvant chemotherapy; shrinkage pattern; tumor regression