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Differences Between Ipsilateral and Contralateral Early Parenchymal Enhancement Kinetics Predict Response of Breast Cancer to Neoadjuvant Therapy

Published:March 26, 2022DOI:https://doi.org/10.1016/j.acra.2022.02.008

      Rationale and Objectives

      To determine whether kinetics measured with ultrafast dynamic contrast-enhanced magnetic resonance imaging in tumor and normal parenchyma pre- and post-neoadjuvant therapy (NAT) can predict the response of breast cancer to NAT.

      Materials and Methods

      Twenty-four patients with histologically confirmed invasive breast cancer were enrolled. They were scanned with ultrafast dynamic contrast-enhanced magnetic resonance imaging (3-7 seconds/frame) pre- and post-NAT. Four kinetic parameters were calculated in the segmented tumors, and ipsi- and contra-lateral normal parenchyma: (1) tumor (tSE30) or background parenchymal relative enhancement at 30 seconds (BPE30), (2) maximum relative enhancement slope (MaxSlope), (3) bolus arrival time (BAT), and (4) area under relative signal enhancement curve for the initial 30 seconds (AUC30). The tumor kinetics and the differences between ipsi- and contra-lateral parenchymal kinetics were compared for patients achieving pathologic complete response (pCR) vs those who had residual disease after NAT. The chi-squared test and two-sided t-test were used for baseline demographics. The Wilcoxon rank sum test and one-way analysis of variance were used for differential responses to therapy.

      Results

      Patients with similar pre-NAT mean BPE30, median BAT and mean AUC30 in the ipsi- and contralateral normal parenchyma were more likely to achieve pCR following NAT (p < 0.02). Patients classified as having residual cancer burden (RCB) II after NAT showed higher post-NAT tSE30 and tumor AUC30 and higher post-NAT MaxSlope in ipsilateral normal parenchyma compared to those classified as RCB I or pCR (p < 0.05).

      Conclusion

      Bilateral asymmetry in normal parenchyma could predict treatment outcome prior to NAT. Post-NAT tumor kinetics could evaluate the aggressiveness of residual tumor.

      Key Words

      Abbreviations:

      AUC30 (initial area under signal enhancement curve over 30 seconds), BAT (bolus arrival time), BPE (background parenchymal enhancement), BPE30 (initial background parenchymal enhancement at 30 seconds), DCE-MRI (Dynamic contrast-enhanced magnetic resonance imaging), IDC (invasive ductal carcinoma), MaxSlope (maximum relative enhancement slope), NAT (Neoadjuvant therapy), pCR (pathologic complete response), PSE (percent signal enhancement), RCB (residual cancer burden), ROI (Region of interest), tSE30 (initial relative signal enhancement in tumor at 30 seconds)
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