Rationale and Objectives
To compare the accuracy of preoperative contrast-enhanced cone beam breast CT (CE-CBBCT)
and MRI in assessment of residual tumor after neoadjuvant chemotherapy (NAC).
Materials and methods
Residual tumor assessments in 91 female patients were performed on preoperative CE-CBBCT
and MRI images after NAC. The agreements of tumor size between imaging and pathology
were tested by Intraclass Correlation Coefficient (ICC). Subgroup analyses were set
according to ductal carcinoma in situ (DCIS), calcifications and molecular subtypes.
Correlated-samples Wilcoxon Signed-rank test was used to analyze the difference between
imaging and pathology in total and subgroups. AUC, sensitivity, specificity, PPV,
and NPV were calculated to compare the performance of CE-CBBCT and MRI in predicting
pathological complete response (pCR).
Results
Comparing with pathology, the agreement on CE-CBBCT was good (ICC = 0.64, 95% CI,
0.35-0.78), whereas on MRI was moderate (ICC = 0.59, 95% CI, 0.36-0.77), and overestimation
on CE-CBBCT was less than that on MRI (median (interquartile range, IQR): 0.24 [0.00,
1.31] cm vs. 0.67 [0.00, 1.81] cm; p = 0.000). In subgroup analysis, CE-CBBCT showed superior accuracy than MRI when residual
DCIS (p = 0.000) and calcifications (p = 0.000) contained, as well as luminal A (p = 0.043) and luminal B (p = 0.009) breast cancer. CE-CBBCT and MRI performed comparable in predicting pCR,
AUCs were 0.749 and 0.733 respectively (p > 0.05).
Conclusion
CE-CBBCT showed superior accuracy in assessment of residual tumor compared with MRI,
especially when residual DCIS or calcifications contained and luminal subtype. The
performance of preoperative CE-CBBCT in predicting pCR was comparable to MRI. CE-CBBCT
could be an alternative method used for preoperative assessment after NAC.
Keywords
Abbreviations:
NAC (neoadjuvant chemotherapy), BCS (breast conserving surgery), DCIS (ductal carcinoma in situ), CBBCT (cone beam breast CT), CE-CBBCT (contrast-enhanced cone beam breast CT), MG (mammography), pCR (pathological complete response), 3D-MIP (three-dimensional maximum intensity projection), NME (non mass enhancement), rCR (radiological complete response), IHC (immunohistochemical), ER (estrogen receptor), PR (progesterone receptor), HER2 (human epidermal growth factor receptor 2), ICC (intraclass correlation coefficient), IQR (interquartile range), AUC (area under the curve), PPV (positive predictive value), NPV (negative predictive value)To read this article in full you will need to make a payment
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Reference
- Breast cancer, version 3.2022, nccn clinical practice guidelines in oncology.J Natl Compr Canc Netw. 2022; 20: 691-722
- Changing frameworks in treatment sequencing of triple-negative and HER2-positive, early-stage breast cancers.Lancet Oncol. 2019; 20: e390-e396
- Breast-conserving surgery following neoadjuvant therapy-a systematic review on surgical outcomes.Breast Cancer Res Treat. 2018; 168: 1-12
- Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials.Lancet Oncol. 2018; 19: 27-39
- Role of MRI to assess response to neoadjuvant therapy for breast cancer.J Magn Reson Imaging. 2020; 52: 1587-1606
- Role of magnetic resonance imaging in detection of pathologic complete remission in breast cancer patients treated with neoadjuvant chemotherapy: a meta-analysis.Clin Breast Cancer. 2017; 17: 245-255
- Microcalcifications in 1657 patients with pure ductal carcinoma in situ of the breast: correlation with clinical, histopathologic, biologic features, and local recurrence.Ann Surg Oncol. 2016; 23: 482-489
- Ductal carcinoma in situ of the breast: an update with emphasis on radiological and morphological features as predictive prognostic factors.Cancers (Basel). 2020; 12: 609
- Cone beam breast CT with multiplanar and three dimensional visualization in differentiating breast masses compared with mammography.Eur J Radiol. 2015; 84: 48-53
- Dedicated breast CT: state of the art-Part II. Clinical application and future outlook.Eur Radiol. 2022; 32: 2286-2300
- Contrast-enhanced cone-beam breast-CT (CBBCT): clinical performance compared to mammography and MRI.Eur Radiol. 2018; 28: 3731-3741
- Diagnostic accuracy of cone-beam breast computed tomography: a systematic review and diagnostic meta-analysis.Eur Radiol. 2019; 29: 1194-1202
- The accuracy of tumor size evaluation on invasive breast cancer based on cone beam breast CT.Chin J Radiol. 2019; 53: 286-291
- Breast lesion size assessment in mastectomy specimens: Correlation of cone-beam breast-CT, digital breast tomosynthesis and full-field digital mammography with histopathology.Medicine (Baltimore). 2019; 98: e17082
- Comparative analysis of contrast-enhanced cone beam breast CT, MRI and digital mammography measure size of breast non-mass lesions.Adv Clin Exp Med Clin (Barc). 2020; 10: 2387-2392
- Contrast-enhanced cone beam breast CT features of breast cancers: correlation with immunohistochemical receptors and molecular subtypes.Eur Radiol. 2021; 31: 2580-2589
- Cone-beam breast CT features associated with HER2/neu overexpression in patients with primary breast cancer.Eur Radiol. 2020; 30: 2731-2739
- Assessment of cone-beam breast computed tomography for predicting pathologic response to neoadjuvant chemotherapy in breast cancer: a prospective study.J Oncol. 2022; 20229321763
- Contrast-enhanced cone-beam breast-CT: Analysis of optimal acquisition time for discrimination of breast lesion malignancy.Eur J Radiol. 2018; 99: 9-16
- Comparison of background parenchymal enhancement (BPE) on contrast-enhanced cone-beam breast CT (CE-CBBCT) and breast MRI.Eur Radiol. 2022; 32: 5773-5782
- Tailoring therapies-improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015.Ann Oncol. 2015; 26: 1533-1546
- Intraclass correlations: uses in assessing rater reliability.Psychol Bull. 1979; 86: 420-428
- Dynamic contrast-enhanced breast mri for evaluating residual tumor size after neoadjuvant chemotherapy.Radiology. 2018; 289: 327-334
- Breast cancer molecular phenotype and the use of her2-targeted agents influence the accuracy of breast mri after neoadjuvant chemotherapy.Ann Surg. 2013; 257: 133-137
- Accuracy of MRI for estimating residual tumor size after neoadjuvant chemotherapy in locally advanced breast cancer: relation to response patterns on MRI.Acta Oncol. 2007; 46: 996-1003
- Dedicated breast ct: feasibility for monitoring neoadjuvant chemotherapy treatment.J Clin Imaging Sci. 2014; 4: 64
- Optimal acquisition time to discriminate between breast cancer subtypes with contrast-enhanced cone-beam CT.Diagn Interv Imaging. 2020; 101: 391-399
- Pre-treatment MRI tumor features and post-treatment mammographic findings: may they contribute to refining the prediction of pathologic complete response in post-neoadjuvant breast cancer patients with radiologic complete response on MRI?.Eur Radiol. 2022; 32: 1663-1675
- Do Calcifications Seen on Mammography After Neoadjuvant Chemotherapy for Breast Cancer Always Need to Be Excised?.Ann Surg Oncol. 2017; 24: 1492-1498
- Residual mammographic microcalcifications and enhancing lesions on mri after neoadjuvant systemic chemotherapy for locally advanced breast cancer: correlation with histopathologic residual tumor size.Ann Surg Oncol. 2016; 23: 1135-1142
- Residual microcalcifications after neoadjuvant chemotherapy for locally advanced breast cancer: comparison of the accuracies of mammography and MRI in predicting pathological residual tumor.World J Surg Oncol. 2017; 15: 198
- Magnetic resonance imaging response monitoring of breast cancer during neoadjuvant chemotherapy: relevance of breast cancer subtype.J Clin Oncol. 2011; 29: 660-666
- MRI predicts pathologic complete response in HER2-positive breast cancer after neoadjuvant chemotherapy.Breast Cancer Res Treat. 2017; 164: 99-106
- Factors affecting pathologic complete response following neoadjuvant chemotherapy in breast cancer: development and validation of a predictive nomogram.Radiology. 2021; 299: 290-300
- Accuracy of magnetic resonance imaging for predicting pathological complete response of breast cancer after neoadjuvant chemotherapy: association with breast cancer subtype.Springerplus. 2016; 5: 152
- Magnetic resonance imaging evaluation of residual tumors in breast cancer after neoadjuvant chemotherapy: surgical implications.Acta Radiol. 2016; 57: 529-537
Article info
Publication history
Published online: January 06, 2023
Accepted:
December 16,
2022
Received in revised form:
December 11,
2022
Received:
October 26,
2022
Publication stage
In Press Corrected ProofFootnotes
Declaration of interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Identification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
