Abstract
PurposeTo assess the accuracy of magnetic resonance imaging (MRI) measurements in locally advanced oestrogen receptor-positive and human epidermal growth factor receptor 2-negative breast tumours before, during and after neoadjuvant endocrine treatment (NET) for evaluation of tumour response in comparison with clinical and pathological assessments.MethodsThis prospective study enrolled postmenopausal patients treated neoadjuvant with letrozole and exemestane given sequentially in an intra-patient cross-over regimen. Fifty-four patients were initially recruited, but only 35 fulfilled the inclusion criteria and confirmed to participate with a median age of 77. Tumours were scanned with MRI prior to treatment, during the eighth week of treatment and prior to surgery. Additionally, changes in longest diameter on clinical examination (CE) and tumour size at pathology were determined. Pre- and post-operative measurements of tumour size were compared in order to evaluate tumour response.ResultsThe correlation between post-treatment MRI size and pathology was moderate and higher with a correlation coefficient (r) 0.64 compared to the correlation between CE and pathology r = 0.25. Post-treatment MRI and clinical results had a negligible bias towards underestimation of lesion size. Tumour size on MRI and CE had 0.82 cm and 0.52 cm lower mean size than tumour size measured by pathology, respectively.ConclusionsThe higher correlation between measurements of residual disease obtained on MRI and those obtained with pathology validates the accuracy of imaging assessment during NET. MRI was found to be more accurate for estimating complete responses than clinical assessments and warrants further investigation in larger cohorts to validate this finding.
Highlights
Current response assessments of locally advanced breast cancer (LABC) in the neoadjuvant setting are not entirely accurate in determining pathological complete response, depending on the modality used, the measurement technique and varied response of different tumour subtypes [1, 2]
The aim of the current study is to compare tumour size estimated by clinical examination (CE) and magnetic resonance imaging (MRI) with the tumour size in surgical specimen, in order to determine which is the most accurate assessment to evaluate tumour response in patients with LABC treated neoadjuvant with aromatase inhibitor (NAAI) therapy
The Bland–Altman plot was used to measure the difference of pre-surgical tumour sizes against the mean value of MRI and clinical assessments
Summary
Current response assessments of locally advanced breast cancer (LABC) in the neoadjuvant setting are not entirely accurate in determining pathological complete response, depending on the modality used, the measurement technique and varied response of different tumour subtypes [1, 2]. Tailoring the most accurate tumour size after neoadjuvant treatment must require a precise assessment, in order to achieve the most appropriate surgical management: mastectomy or breast-conserving surgery (BCS). Conventional assessment includes clinical examination (CE) and imaging modalities (mammography, ultrasound and/or magnetic resonance imaging (MRI)), along with pathological examinations of the sectioned surgical specimen, which take place typically during the first weeks after surgery. For patients with breast symptoms, a CE should be performed before any additional imaging assessments are sought. It should be a part of routine periodic examinations, especially in older women (more than 69 years old) and in women less than 50 years who are less likely to undergo mammographic screening [3]. CE is typically performed prior to each neoadjuvant therapy cycle or every 4–6 weeks during neoadjuvant endocrine therapy (NET)
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