Monitoring response to primary chemotherapy in breast cancer using dynamic contrast-enhanced magnetic resonance imaging

Laura Martincich, Filippo Montemurro, Giovanni De Rosa, Vincenzo Marra, Riccardo Ponzone, Stefano Cirillo, Marco Gatti, Nicoletta Biglia, Ivana Sarotto, Piero Sismondi, Daniele Regge, Massimo Aglietta

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) allows analysis of both tumor volume and contrast enhancement pattern using a single tool. We sought to investigate whether DCE-MRI could be used to predict histological response in patients undergoing primary chemotherapy (PCT) for breast cancer. Patients and methods. Thirty patients with breast cancer, clinical diameter >3cm or stage III A/B, received anthracycline and taxane based PCT. DCE-MRI was performed at the baseline, after two cycles and after four cycles of PCT, before surgery. Histological response was assessed using a five-point scheme. Grade 4 (small cluster of dispersed residual cancer cells) and grade 5 (no residual viable cancer cell) were defined as a major histopathological response (MHR). Results. Univariate analysis showed that a >65% reduction in the tumor volume and a reduction in the early enhancement ratio (ECU) after two cycles of PCT were associated with a MHR. Multivariate analysis revealed that tumor volume reduction after two cycles of PCT was independently associated with a MHR (odds ratio [OR] 39.968, 95% confidence interval [CI] 3.438-464.962, p <0.01). ECU reduction was still associated with a MHR (OR 2.50, 95% CI 0.263-23.775), but it did not retain statistical significance (p = 0.42). Combining tumor volume and ECU reduction after two cycles of PCT yielded a 93% diagnostic accuracy in identifying tumors achieving a pathological complete response (pCR) (histopathological grade 5). Conclusions. DCE-MRI allows prediction of the effect of neoadjuvant chemotherapy in breast cancer. Although in our study tumor volume reduction after two cycles had the strongest predictive value, DCE-MRI has the potential to provide functional parameters that could be integrated to optimize neoadjuvant chemotherapy strategies.

Original languageEnglish
Pages (from-to)67-76
Number of pages10
JournalBreast Cancer Research and Treatment
Volume83
Issue number1
DOIs
Publication statusPublished - Jan 2004

Keywords

  • Antineoplastic agents combined
  • Breast neoplasms
  • Histopathological response
  • Image processing
  • Magnetic resonance imaging
  • Neoadjuvant chemotherapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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