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Radiologic complete response (rCR) in contrast-enhanced magnetic resonance imaging (CE-MRI) after neoadjuvant chemotherapy for early breast cancer predicts recurrence-free survival but not pathologic complete response (pCR).
Gampenrieder, Simon Peter; Peer, Andreas; Weismann, Christian; Meissnitzer, Matthias; Rinnerthaler, Gabriel; Webhofer, Johanna; Westphal, Theresa; Riedmann, Marina; Meissnitzer, Thomas; Egger, Heike; Klaassen Federspiel, Frederike; Reitsamer, Roland; Hauser-Kronberger, Cornelia; Stering, Katharina; Hergan, Klaus; Mlineritsch, Brigitte; Greil, Richard.
Afiliación
  • Gampenrieder SP; Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center; Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Salzburg, Austria.
  • Peer A; Cancer Cluster Salzburg, Salzburg, Austria.
  • Weismann C; Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center; Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Salzburg, Austria.
  • Meissnitzer M; Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria.
  • Rinnerthaler G; Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria.
  • Webhofer J; Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center; Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Salzburg, Austria.
  • Westphal T; Cancer Cluster Salzburg, Salzburg, Austria.
  • Riedmann M; Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center; Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Salzburg, Austria.
  • Meissnitzer T; Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center; Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Salzburg, Austria.
  • Egger H; Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria.
  • Klaassen Federspiel F; Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria.
  • Reitsamer R; Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria.
  • Hauser-Kronberger C; Department of Special Gynecology and Breast Center, Paracelsus Medical University Salzburg, Salzburg, Austria.
  • Stering K; Department of Special Gynecology and Breast Center, Paracelsus Medical University Salzburg, Salzburg, Austria.
  • Hergan K; Department of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria.
  • Mlineritsch B; Department of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria.
  • Greil R; Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria.
Breast Cancer Res ; 21(1): 19, 2019 01 31.
Article en En | MEDLINE | ID: mdl-30704493
BACKGROUND: Patients with early breast cancer (EBC) achieving pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT) have a favorable prognosis. Breast surgery might be avoided in patients in whom the presence of residual tumor can be ruled out with high confidence. Here, we investigated the diagnostic accuracy of contrast-enhanced MRI (CE-MRI) in predicting pCR and long-term outcome after NACT. METHODS: Patients with EBC, including patients with locally advanced disease, who had undergone CE-MRI after NACT, were retrospectively analyzed (n = 246). Three radiologists, blinded to clinicopathologic data, reevaluated all MRI scans regarding to the absence (radiologic complete remission; rCR) or presence (no-rCR) of residual contrast enhancement. Clinical and pathologic responses were compared categorically using Cohen's kappa statistic. The Kaplan-Meier method was used to estimate recurrence-free survival (RFS) and overall survival (OS). RESULTS: Overall rCR and pCR (no invasive tumor in the breast and axilla (ypT0/is N0)) rates were 45% (111/246) and 29% (71/246), respectively. Only 48% (53/111; 95% CI 38-57%) of rCR corresponded to a pCR (= positive predictive value - PPV). Conversely, in 87% (117/135; 95% CI 79-92%) of patients, residual tumor observed on MRI was pathologically confirmed (= negative predictive value - NPV). Sensitivity to detect a pCR was 75% (53/71; 95% CI 63-84%), while specificity to detect residual tumor and accuracy were 67% (117/175; 95% CI 59-74%) and 69% (170/246; 95% CI 63-75%), respectively. The PPV was significantly lower in hormone-receptor (HR)-positive compared to HR-negative tumors (17/52 = 33% vs. 36/59 = 61%; P = 0.004). The concordance between rCR and pCR was low (Cohen's kappa - 0.1), however in multivariate analysis both assessments were significantly associated with RFS (rCR P = 0.037; pCR P = 0.033) and OS (rCR P = 0.033; pCR P = 0.043). CONCLUSION: Preoperative CE-MRI did not accurately predict pCR after NACT for EBC, especially not in HR-positive tumors. However, rCR was strongly associated with favorable RFS and OS.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias de la Mama / Imagen por Resonancia Magnética / Protocolos de Quimioterapia Combinada Antineoplásica / Recurrencia Local de Neoplasia Tipo de estudio: Evaluation_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Middle aged Idioma: En Revista: Breast Cancer Res Asunto de la revista: NEOPLASIAS Año: 2019 Tipo del documento: Article País de afiliación: Austria Pais de publicación: Reino Unido

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias de la Mama / Imagen por Resonancia Magnética / Protocolos de Quimioterapia Combinada Antineoplásica / Recurrencia Local de Neoplasia Tipo de estudio: Evaluation_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Middle aged Idioma: En Revista: Breast Cancer Res Asunto de la revista: NEOPLASIAS Año: 2019 Tipo del documento: Article País de afiliación: Austria Pais de publicación: Reino Unido