Assessing the accuracy of conventional gadolinium-enhanced breast MRI in measuring the nodal response to neoadjuvant chemotherapy (NAC) in breast cancer.

Management of the axilla in the era of neoadjuvant chemotherapy for breast cancer is evolving. The aim of this study is to determine if conventional gadolinium-enhanced breast MRI can aid in evaluation of the response to neoadjuvant chemotherapy in the axilla. A retrospective review of a prospectively maintained database of patients undergoing neoadjuvant chemotherapy for breast cancer was performed. Pre and post-neoadjuvant chemotherapy MRI reports for node-positive patients were examined in conjunction with demographic data, treatment type, and final histopathology reports. One-hundred and fourteen patients with breast cancer undergoing neoadjuvant chemotherapy were included in the study. The sensitivity of magnetic resonance imaging in detecting nodal response post-neoadjuvant chemotherapy was 33.93% and the specificity was 82.76%. Magnetic resonance imaging had a positive predictive value of 65.52% and a negative predictive value of 56.47%. MRI was found to be most specific in the detection of triple-negative cancer response. Specificity was 100% in this group and sensitivity was 75%. Magnetic resonance imaging has a relatively high specificity in detecting nodal response post-neoadjuvant chemotherapy but has a low sensitivity. Alone it cannot be relied upon to identify active axillary malignancy post-neoadjuvant chemotherapy. However, given its increased specificity among certain subgroups, it may have a role in super-selecting patients suitable for sentinel lymph node biopsy post-neoadjuvant chemotherapy.

Effect of prostate manipulation on the serum levels of complexed prostate-specific antigen and total prostate-specific antigen.

BACKGROUND: Recently there has been considerable interest in complexed prostate-specific antigen (cPSA) as an alternative to total PSA (tPSA). Data regarding the variations of cPSA are limited. We performed a prospective study using different forms of prostate manipulation to demonstrate and compare variations between cPSA and tPSA. METHODS: The study included 113 men, 34 of whom had a digital rectal examination, 28 had a flexible cystoscopy, 17 had a rigid cystoscopy, 21 had a prostate biopsy, and 13 underwent a transurethral resection of the prostate (TURP). Blood samples were taken before and after manipulation for measurement of tPSA and cPSA. RESULTS: There was a statistically significant difference in the cPSA and tPSA before and after manipulation, with the exception of cystoscopy. On review of the data, it was clear that not all changes were clinically significant. The mean differences were greater for tPSA than for cPSA for all procedures. This was most apparent following prostate biopsy and TURP. Regression analysis also showed that cPSA and tPSA were affected differently by prostate manipulation. CONCLUSION: Our results demonstrate that cPSA is less prone to variations when compared to tPSA.