Abstract
Abstract Purpose To assess radiological tumor response to neoadjuvant chemotherapy (NAC) with Diffusion weighted imaging (DWI) at 3Tesla. Materials and methods 30 patients (mean age 51.4 years) with a histopatholgical verified breast cancer (BIRADS 6) who underwent NAC were included in this prospective IRB approved study. Additionally to routine staging with dynamic contrast enhanced magnetic resonance imaging (CE-MRI) protocol a diffusion weighted sequence with the following parameters was included in the imaging protocol: single-shot, echo-planar imaging sequence with eddy current compensation, a three direction trace diffusion scheme, inversion recovery fat suppression and two b-values of 50 and 850 s/mm2 (TR/TE/TI 13700/83/220ms; FOV 340x117 mm; 40 axial slices; SI 3.5 mm (no gap); matrix 192x64 two averages; spatial resolution, 1.8x1.8x3.5 mm; bandwidth 1446 Hz/pixel; 3:19 min. Patients were examined before the beginning and after 5 or 6 cycles of NAC. In DWI manually drawn ROIs of suspicious areas were assessed for restricted diffusion and apparent diffusion coefficient (ADC) values were calculated. An ADC threshold 1.25x10-3mm2/s was defined as a marker of malignancy. Data were dichotomized and complete response (cr) and partial response (pr) were considered as response and stable disease (sd) and progressive disease (pd) were considered as non-response to NAC. The histopathological assessment of tumor response was used as the standard of reference. Results There were 23 invasive ductal cancers (IDC) and 6 invasive lobular cancers (ILC). Average tumor size was 43.4mm. In the baseline scan one IDC (3%) had an ADC value above the cut-off for malignancy and was excluded. There were 4 (14%) non-responders and 25 (86%) responders. Responders demonstrated an average increase in ADC values of 0.58x10-3mm2/s whereas non-responders failed to show a significant increase in ADC values (average increase 0.09x10-3mm2/s). The classification of DWI as responders and non-responders correlated with histopathological diagnoses of treatment response. Conclusion ADC as an adjunct to conventional CE-MRI is an additional valuable imaging biomarker for the assessment of treatment response to NAC in breast cancer patients. Disclosure All authors have declared no conflicts of interest.
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