Abstract
PurposeThis study aimed to assess the diagnostic performance and the added value to radiologists of different levels of a computer-aided diagnosis (CAD) system for the detection of pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) in patients with breast cancer. Besides, to investigate whether tumor molecular typing is associated with the efficiency of diagnosis of the CAD systems.Methods470 patients were identified with breast cancers who underwent NAC and post MR imaging between January 2016 and March 2019. The diagnostic performance of radiologists of different levels and the CAD system were compared. The added value of the CAD system was assessed and subgroup analyses were performed according to the tumor molecular typing.ResultsAmong 470 patients, 123 (26%) underwent pCR. The CAD system showed a comparable specificity as the senior radiologist (83.29% vs. 84.15%, p=0.488) and comparable area under the curve (AUC) (0.839 vs. 0.835, p =0.452). The performance of all radiologists significantly improved when aided by the CAD system (P<0.05), And there were no statistical differences in terms of sensitivity, specificity and accuracy between the two groups with CAD assistance(p>0.05).The AUC values for identifying pCR in TN patients were significant (0.883, 95%CI: 0.801-0.964, p < 0.001).ConclusionThe CAD system assessed in this study improves the performance of all radiologists, regardless of experience. The molecular typing of breast cancer is potential influencer of CAD diagnostic performance.
Highlights
With the wide application of neoadjuvant chemotherapy in the treatment of breast cancer patients, it has become an essential part of the treatment of breast cancer, especially stage II and III breast cancer [1, 2]
All patients in whom invasive breast cancer were diagnosed between January 2016 and March 2019, treated with neoadjuvant chemotherapy, and who underwent breast MR imaging before neoadjuvant chemotherapy were eligible
The chemotherapy regimens were drawn up according to the neoadjuvant therapy regimens of NCCN guidelines breast cancer version 1.2016 including: AC-T(doxorubicin 60mg/m2 plus cyclophosphamide 600mg/m2 IV day 1 every 21 days for 4 cycles followed by docetaxel 100mg/m2 IV day 1 every 21 days for 4 cycles);:TAC(docetaxel 75mg/m2 plus doxorubicin 50mg/m2 plus cyclophosphamide 500mg/m2 every 21 days for 6 cycles)
Summary
With the wide application of neoadjuvant chemotherapy in the treatment of breast cancer patients, it has become an essential part of the treatment of breast cancer, especially stage II and III breast cancer [1, 2]. Its curative effect directly affects the follow-up treatment and prognosis of patients. Effective NAC can reduce tumor stage, make breast conserving surgery possible, and even achieve preoperative pathological complete remission (pCR) in up to 30% of patients [3, 4]. The efficacy of chemotherapy varies and depends on the subtypes of breast cancers [5]. HER2- positive and triple-negative patients are more likely to achieve pCR, and surgery is expected to be avoided [6]. Accurate recognition of treatment response is crucial to optimize patient management and treatment adjustment
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