Evaluation of the Tumor Response After Neoadjuvant Chemotherapy in Breast Cancer Patients: Correlation Between Dynamic Contrast-enhanced Magnetic Resonance Imaging and Pathologic Tumor Cellularity

Abstract

BackgroundWe evaluated the tumor response after neoadjuvant chemotherapy (NAC) in breast cancer patients using dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging parameters assessed using a commercially available computer-aided system. We also analyzed their correlation with pathologic tumor cellularity. Materials and MethodsWe retrospectively reviewed the data from 130 patients with breast cancer who had undergone NAC followed by surgery from January to October 2013. Maximum diameter, volume, peak enhancement, and persistent, plateau, and washout-enhancing components were measured using a computer-aided system on DCE MR images and correlated with the Miller-Payne grading system. Patients with a Miller-Payne grade of 5 were classified into the pathologic complete response (pCR) group. Patients with grades 1, 2, 3, and 4 were included in the non-pCR group. Diagnostic performance was evaluated using receiver operating characteristic curve analysis. ResultsTwenty patients were included in the pCR group and 110 patients in the non-pCR group. Of the 6 parameters, the rate of tumor volume reduction (r = 0.729, P < .001) showed the strongest correlation with the Miller-Payne grading system, followed by the maximum diameter (r = 0.706, P < .001) and washout component (r = 0.606, P < .001). The area under the receiver operating characteristic curve (Az value) was the largest for the rate of volume reduction (Az = 0.895), followed by the maximum diameter (Az = 0.891). ConclusionThe tumor volume changes in breast cancers before and after NAC, measured automatically using a commercially available computer-aided system and a clinical DCE MR imaging protocol might be the most accurate tool for evaluation of the pathologic response after NAC.