Abstract
Background: Evaluating the tumor response to neoadjuvant chemotherapy is key to planning further therapy of breast cancer. Our study aimed to evaluate the effectiveness of low-energy and subtraction contrast-enhanced spectral mammography (CESM) images in the detection of complete response (CR) for neoadjuvant chemotherapy (NAC) in breast cancer. Methods: A total of 63 female patients were qualified for our retrospective analysis. Low-energy and subtraction CESM images just before the beginning of NAC and as a follow-up examination 2 weeks before the end of chemotherapy were compared with one another and assessed for compliance with the postoperative histopathological examination (HP). The response to preoperative chemotherapy was evaluated based on the RECIST 1.1 criteria (Response Evaluation Criteria in Solid Tumors). Results: Low-energy images tend to overestimate residual lesions (6.28 mm) and subtraction images tend to underestimate them (2.75 mm). The sensitivity of low-energy images in forecasting CR amounted to 33.33%, while the specificity was 92.86%. In the case of subtraction CESM, the sensitivity amounted to 85.71% and the specificity to 71.42%. Conclusions: CESM is characterized by high sensitivity in the assessment of CR after NAC. The use of only morphological assessment is insufficient. CESM correlates well with the size of residual lesions on histopathological examination but tends to underestimate the dimensions.
Highlights
Neoadjuvant chemotherapy (NAC) is currently one of the basic methods of treatment of locally advanced breast cancer [1,2]
The average size of the tumors varied from 34.4 mm for low-energy contrast-enhanced spectral mammography (CESM) to 34.3 mm for CESM subtraction images
The average reduction of the tumors reached 52.22% of the initial tumor mass based on low-energy images, and this even reached 78.76% in the case of CESM subtraction images
Summary
Neoadjuvant chemotherapy (NAC) is currently one of the basic methods of treatment of locally advanced breast cancer [1,2]. In the case of massive yet operable tumors, NAC provides a decrease of their mass to a size that makes conservative surgical treatment possible. Besides reducing the tumor mass and enabling thereby offering better conditions for local treatment (breast-conserving therapy (BCT)), NAC provides unique opportunities for in vivo chemotherapeutic evaluation of cancer cells’ sensitivity, as well as for the search for new biomarkers of therapeutic response. Our study aimed to evaluate the effectiveness of lowenergy and subtraction contrast-enhanced spectral mammography (CESM) images in the detection of complete response (CR) for neoadjuvant chemotherapy (NAC) in breast cancer. CESM correlates well with the size of residual lesions on histopathological examination but tends to underestimate the dimensions
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