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Contrast-enhanced MRI after neoadjuvant chemotherapy of breast cancer: lesion-to-background parenchymal signal enhancement ratio for discriminating pathological complete response from minimal residual tumour

  • Breast
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Abstract

Objectives

To retrospectively investigate whether the lesion-to-background parenchymal signal enhancement ratio (SER) on breast MRI can distinguish pathological complete response (pCR) from minimal residual cancer following neoadjuvant chemotherapy (NAT), and compare its performance with the conventional criterion.

Methods

216 breast cancer patients who had undergone NAT and MRI and achieved pCR or minimal residual cancer on surgical histopathology were included. Clinical-pathological features, SER and lesion size on MR images were analysed. Multivariate logistic regression, ROC curve and McNemar’s test were performed.

Results

SER on early-phase MR images was independently associated with pCR (odds ratio [OR], 0.286 [95% CI: 0.113–0.725], p = .008 for Reader 1; OR, 0.306 [95% CI: 0.111–0.841], p = .022 for Reader 2). Compared with the conventional criterion, SER ≤1.6 increased AUC (0.585–0.599 vs. 0.709–0.771, p=.001-.033) and specificity (21.9–27.4% vs. 80.8–86.3%, p <.001) in identifying pCR. SER ≤1.6 and/or size ≤0.2 cm criterion showed the highest specificity of 90.4%.

Conclusion

SER on early-phase MR images was independently associated with pCR, and showed improved AUC and specificity compared to the conventional criterion. The combined criterion of SER and size could be used to select candidates to avoid surgery in a future study.

Key points

• Compared with conventional criterion, SER ≤ 1.6 criterion increased AUC and specificity.

• Simple measurement of signal intensity could differentiate pCR from minimal residual cancer.

• SER ≤1.6 and/or size≤0.2cm criterion showed the highest specificity of 90.4 %.

• The combined criterion could be used for a study to avoid surgery.

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Abbreviations

DCIS:

Ductal carcinoma in situ

HER2:

Human epidermal growth factor receptor type 2

HR:

Hormone receptor

ICC:

Intraclass correlation coefficient

NAT:

Neoadjuvant chemotherapy

pCR:

Pathological complete response

SER:

Signal enhancement ratio

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Funding

This research has received funding from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (NRF-2016R1D1A1B03933913).

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea

    Soo-Yeon Kim, Nariya Cho, Sung Ui Shin, Bo Ra Kwon, Soo Yeon Kim, Su Hyun Lee, Jung Min Chang & Woo Kyung Moon

  2. Department of Radiology, Seoul National College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea

    Soo-Yeon Kim, Nariya Cho, Sung Ui Shin, Bo Ra Kwon, Soo Yeon Kim, Su Hyun Lee, Jung Min Chang & Woo Kyung Moon

  3. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea

    Soo-Yeon Kim, Nariya Cho, Sung Ui Shin, Bo Ra Kwon, Soo Yeon Kim, Su Hyun Lee, Jung Min Chang & Woo Kyung Moon

  4. Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea

    Han-Byoel Lee & Wonshik Han

  5. Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea

    In Ae Park

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  1. Soo-Yeon Kim
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Correspondence to Nariya Cho.

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The scientific guarantor of this publication is Nariya Cho.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Kim, SY., Cho, N., Shin, S.U. et al. Contrast-enhanced MRI after neoadjuvant chemotherapy of breast cancer: lesion-to-background parenchymal signal enhancement ratio for discriminating pathological complete response from minimal residual tumour. Eur Radiol 28, 2986–2995 (2018). https://doi.org/10.1007/s00330-017-5251-8

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  • DOI: https://doi.org/10.1007/s00330-017-5251-8

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