Contrast-Enhanced Mammography (CEM) for Detecting Residual Disease after Neoadjuvant Chemotherapy: A Comparison with Breast Magnetic Resonance Imaging (MRI).

Filipe Ramos Barra,Gabriela Feitosa Lins de Albuquerque,Riccardo Pratesi,Mayra Teixeira Magalhães,Laira Rodrigues Aguiar,Luciano Farage,Renato Ramos Barra,Alaor Barra Sobrinho,Rodrigo Pepe Costa

doi:10.1155/2018/8531916

Filipe Ramos Barra, Gabriela Feitosa Lins de Albuquerque + Show 7 more

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https://doi.org/10.1155/2018/8531916

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Abstract

Objective To evaluate the performance of contrast-enhanced mammography (CEM) compared to magnetic resonance imaging (MRI) for estimating residual tumor size after neoadjuvant chemotherapy (NAC) in women with newly diagnosed breast cancer. Methods The institutional review board approved this study. This prospective study included women with newly diagnosed breast cancer who underwent breast CEM and MRI at the end of the last cycle of NAC and before definitive surgery. Size of residual malignancy on post-NAC CEM and MRI was compared with surgical pathology. Agreements and correlations of CEM and MRI measurements with histological size were assessed. Results Thirty-three patients were included with a mean age of 45 years (range 22–76). The sensitivity, specificity, and positive and negative predictive value for detection of residual disease of CEM were 76%, 87.5%, 95%, and 86.4%, and those of MRI were 92%, 75%, 92%, and 75%. Comparing CEM to MRI, the mean difference was −0.8 cm, concordance coefficient was 0.7, and Pearson correlation was 0.7 (p = 0.0003). The concordance coefficient between measurements of each imaging modality and pathologic tumor size was 0.7 for CEM and 0.4 for MRI. Pearson correlation was 0.8 for CEM and 0.5 for MRI. Mean differences between CEM, MRI, and residual histopathological tumor size were 0.8 cm and 1.8 cm, respectively. Conclusions CEM has good correlation and agreement with histopathology for measuring residual disease after NAC. CEM was comparable to MRI, showing high positive predictive value and specificity for detecting residual disease.

Highlights

Neoadjuvant chemotherapy (NAC) was used as a primary therapeutic strategy for locally advanced and inflammatory breast cancers
Breast magnetic resonance imaging (MRI) has proven to be superior to mammography and US in the assessment of tumor extent and presence of additional foci and highly sensitive in identifying residual disease following NAC [2,3,4,5,6]
Contrast-enhanced mammography (CEM) is a new imaging tool that uses a dual-energy technique to combine the benefits of digital mammography with intravenous contrast

Summary

Introduction

Neoadjuvant chemotherapy (NAC) was used as a primary therapeutic strategy for locally advanced and inflammatory breast cancers. It may decrease the extent of the tumor, increasing the chances of successful breast-conservation surgery, and provide prognostic information to evaluate treatment response [1]. Response to NAC is currently assessed by combining clinical examination and conventional imaging techniques such as mammography, breast magnetic resonance (MRI), and ultrasound (US). Breast MRI has proven to be superior to mammography and US in the assessment of tumor extent and presence of additional foci and highly sensitive in identifying residual disease following NAC [2,3,4,5,6]. Contrast-enhanced mammography (CEM) is a new imaging tool that uses a dual-energy technique to combine the benefits of digital mammography with intravenous contrast

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