Abstract
.This meta-analysis assesses the prognostic value of quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted MRI (DW-MRI) performed during neoadjuvant therapy (NAT) of locally advanced breast cancer. A systematic literature search was conducted to identify studies of quantitative DCE-MRI and DW-MRI performed during breast cancer NAT that report the sensitivity and specificity for predicting pathological complete response (pCR). Details of the study population and imaging parameters were extracted from each study for subsequent meta-analysis. Metaregression analysis, subgroup analysis, study heterogeneity, and publication bias were assessed. Across 10 studies that met the stringent inclusion criteria for this meta-analysis (out of 325 initially identified studies), we find that MRI had a pooled sensitivity of 0.91 [95% confidence interval (CI), 0.80 to 0.96] and specificity of 0.81(95% CI, 0.68 to 0.89) when adjusted for covariates. Quantitative DCE-MRI exhibits greater specificity for predicting pCR than semiquantitative DCE-MRI (). Quantitative DCE-MRI and DW-MRI are able to predict, early in the course of NAT, the eventual response of breast tumors, with a high level of specificity and sensitivity. However, there is a high degree of heterogeneity in published studies highlighting the lack of standardization in the field.
Highlights
Neoadjuvant therapy (NAT) is widely considered the standard of care for the treatment of locally advanced breast cancer.[1,2] NAT increases the success rate for breast conservation surgery by reducing tumor burden and provides the opportunity to treat micrometastases at an earlier time point compared to adjuvant treatment
A number of MRI techniques have matured to the point where they can offer a quantitative description of tumor characteristics that have shown the ability to predict the response of locally advanced breast cancer to NAT.[17]. In this meta-analysis, we focus on the two MRI methods that have accumulated the largest body of data for predicting the response of locally advanced breast cancer to NAT: dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted MRI (DW-MRI)
Duplicate studies were removed to yield 260 studies. From this list of 260 eligible studies, two reviewers (A.G.S. and J.V.) independently reviewed all studies according to the following inclusion criteria: must be reported in the English language, must report on human subjects, must include 10 or more subjects, peer-reviewed original article, sufficient data to determine specificity and sensitivity, the outcome measure must be pathological complete response (pCR), MRI must be performed as a “predictive” measure (i.e., MRI must occur during the course of NAT, not after completion of NAT)
Summary
Neoadjuvant therapy (NAT) is widely considered the standard of care for the treatment of locally advanced breast cancer.[1,2] NAT increases the success rate for breast conservation surgery by reducing tumor burden and provides the opportunity to treat micrometastases at an earlier time point compared to adjuvant treatment. Patients who achieve a pathological complete response (pCR; i.e., complete absence of viable tumor cells in the breast or axilla at the time of surgery) in the neoadjuvant setting have increased survival compared with patients who have residual disease at the conclusion of NAT.[3,4,5,6,7] If it could be determined—early in the course of NAT—that a particular therapeutic regimen is unlikely to achieve a pCR, the treating physician could discontinue an ineffective treatment and substitute with an alternative regimen that may be more effective.
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