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Prediction of pathologic complete response on MRI in patients with breast cancer receiving neoadjuvant chemotherapy according to molecular subtypes

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Abstract

Objectives

This study aimed to investigate the predictability of breast MRI for pathologic complete response (pCR) by molecular subtype in patients with breast cancer receiving neoadjuvant chemotherapy (NAC) and investigate the MRI findings that can mimic residual malignancy.

Methods

A total of 506 patients with breast cancer who underwent MRI after NAC and underwent surgery between January and December 2018 were included. Two breast radiologists dichotomized the post-NAC MRI findings as radiologic complete response (rCR) and no-rCR. The diagnostic performance of MRI predicting pCR was evaluated. pCR was determined based on the final pathology reports. Tumors were divided according to hormone receptor (HR) and human epidermal growth factor receptor (HER) 2. Residual lesions on post-NAC MRI were divided into overt and subtle which classified as nodularity or delayed enhancement. Pearson’s χ2 and Wilcoxon rank-sum tests were used for MRI findings causing false-negative pCR.

Results

The overall pCR rate was 30.04%. The overall accuracy for predicting pCR using MRI was 76.68%. The accuracy was significantly different by subtypes (p < 0.001), as follows in descending order: HR − /HER2 − (85.63%), HR + /HER2 − (82.84%), HR + /HER2 + (69.37%), and HR − /HER2 + (62.38%). MRI in the HR − /HER2 + type showed the highest false-negative rate (18.81%) for predicting pCR. The subtle residual enhancement observed only in the delayed phase was associated with false-negative findings (76.2%, p = 0.016).

Conclusions

The diagnostic accuracy of MRI for predicting pCR differed by molecular subtypes. When the residual enhancement on MRI after NAC is subtle and seen only in the delayed phase, overinterpretation of residual tumors should be performed with caution.

Key Points

• In patients with breast cancer after completion of neoadjuvant chemotherapy, the diagnostic accuracy of MRI for predicting pathologic complete response (pCR) differed according to molecular subtype.

• When residual enhancement on MRI is subtle and seen only in the delayed phase, this finding could be associated with false-negative pCR results.

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Abbreviations

AC-T:

Adriamycin, cyclophosphamide plus docetaxel, or paclitaxel

DCE:

Dynamic contrast-enhanced

DCIS:

Ductal carcinoma in situ

ER:

Estrogen receptor

HER2:

Human epidermal growth factor receptor 2

HR:

Hormone receptor

ICC:

Interclass correlation coefficient

ĸ :

Cohen’s unweighted kappa

MRI:

Magnetic resonance imaging

NAC:

Neoadjuvant chemotherapy

NME:

Non-mass enhancement

NPV:

Negative predictive value

pCR:

Pathologic complete response

PPV:

Positive predictive value

PR:

Progesterone receptor

rCR:

Radiologic complete response

SER:

Signal enhancement ratio

TCHP:

Docetaxel, carboplatin, trastuzumab, and pertuzumab

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Authors and Affiliations

  1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea

    Jieun Kim, Boo-Kyung Han, Eun Young Ko, Eun Sook Ko, Ji Soo Choi & Ko Woon Park

  2. Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea

    Jieun Kim

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Correspondence to Boo-Kyung Han.

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Kim, J., Han, BK., Ko, E.Y. et al. Prediction of pathologic complete response on MRI in patients with breast cancer receiving neoadjuvant chemotherapy according to molecular subtypes. Eur Radiol 32, 4056–4066 (2022). https://doi.org/10.1007/s00330-021-08461-0

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