Dynamic contrast-enhanced MRI for prediction of breast cancer response to neoadjuvant chemotherapy: initial results
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Dynamic contrast-enhanced MRI for prediction of breast cancer response to neoadjuvant chemotherapy: initial results. / Loo, Claudette E; Teertstra, H Jelle; Rodenhuis, Sjoerd; van de Vijver, Marc J; Hannemann, Juliane; Muller, Saar H; Peeters, Marie-Jeanne Vrancken; Gilhuijs, Kenneth G A.
In: AM J ROENTGENOL, Vol. 191, No. 5, 11.2008, p. 1331-8.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Dynamic contrast-enhanced MRI for prediction of breast cancer response to neoadjuvant chemotherapy: initial results
AU - Loo, Claudette E
AU - Teertstra, H Jelle
AU - Rodenhuis, Sjoerd
AU - van de Vijver, Marc J
AU - Hannemann, Juliane
AU - Muller, Saar H
AU - Peeters, Marie-Jeanne Vrancken
AU - Gilhuijs, Kenneth G A
PY - 2008/11
Y1 - 2008/11
N2 - OBJECTIVE: The aim of this study was to establish changes in contrast-enhanced MRI of breast cancer during neoadjuvant chemotherapy that are indicative of pathology outcome.MATERIALS AND METHODS: In 54 patients with breast cancer, dynamic contrast-enhanced MRI was performed before chemotherapy and after two chemotherapy cycles. Imaging was correlated with final histopathology. Multivariate analysis with cross-validation was performed on MRI features describing kinetics and morphology of contrast uptake in the early and late phases of enhancement. Receiver operating characteristic (ROC) analysis was used to develop a guideline that switches patients at high risk for incomplete remission to a different chemotherapy regimen while maintaining first-line therapy in 95% of patients who are not at risk (i.e., high specificity).RESULTS: Change in largest diameter of late enhancement during chemotherapy was the single most predictive MRI characteristic for tumor response in multivariate analysis (A(z) [area under the ROC curve] = 0.73, p < 0.00001). Insufficient (< 25%) decrease in largest diameter of late enhancement during chemotherapy was most indicative of residual tumor at final pathology. Using this criterion, the fraction of unfavorable responders indicated by MRI was 41% (22/54). Approximately half (44%, 14/32) of the patients who showed favorable response at MRI achieved complete remission at pathology. Conversely, 95% (21/22) of patients who showed unfavorable response at MRI had residual tumor at pathology.CONCLUSION: Reduction of less than 25% in largest diameter of late enhancement during neoadjuvant chemotherapy shows the potential to predict residual tumor after therapy with high specificity.
AB - OBJECTIVE: The aim of this study was to establish changes in contrast-enhanced MRI of breast cancer during neoadjuvant chemotherapy that are indicative of pathology outcome.MATERIALS AND METHODS: In 54 patients with breast cancer, dynamic contrast-enhanced MRI was performed before chemotherapy and after two chemotherapy cycles. Imaging was correlated with final histopathology. Multivariate analysis with cross-validation was performed on MRI features describing kinetics and morphology of contrast uptake in the early and late phases of enhancement. Receiver operating characteristic (ROC) analysis was used to develop a guideline that switches patients at high risk for incomplete remission to a different chemotherapy regimen while maintaining first-line therapy in 95% of patients who are not at risk (i.e., high specificity).RESULTS: Change in largest diameter of late enhancement during chemotherapy was the single most predictive MRI characteristic for tumor response in multivariate analysis (A(z) [area under the ROC curve] = 0.73, p < 0.00001). Insufficient (< 25%) decrease in largest diameter of late enhancement during chemotherapy was most indicative of residual tumor at final pathology. Using this criterion, the fraction of unfavorable responders indicated by MRI was 41% (22/54). Approximately half (44%, 14/32) of the patients who showed favorable response at MRI achieved complete remission at pathology. Conversely, 95% (21/22) of patients who showed unfavorable response at MRI had residual tumor at pathology.CONCLUSION: Reduction of less than 25% in largest diameter of late enhancement during neoadjuvant chemotherapy shows the potential to predict residual tumor after therapy with high specificity.
KW - Adult
KW - Aged
KW - Antineoplastic Agents/administration & dosage
KW - Breast Neoplasms/diagnosis
KW - Chemotherapy, Adjuvant/methods
KW - Contrast Media
KW - Female
KW - Gadolinium
KW - Heterocyclic Compounds
KW - Humans
KW - Magnetic Resonance Imaging/methods
KW - Middle Aged
KW - Neoadjuvant Therapy/methods
KW - Organometallic Compounds
KW - Pilot Projects
KW - Prognosis
KW - Reproducibility of Results
KW - Sensitivity and Specificity
KW - Treatment Outcome
U2 - 10.2214/AJR.07.3567
DO - 10.2214/AJR.07.3567
M3 - SCORING: Journal article
C2 - 18941065
VL - 191
SP - 1331
EP - 1338
JO - AM J ROENTGENOL
JF - AM J ROENTGENOL
SN - 0361-803X
IS - 5
ER -
