Role of Advanced MRI Techniques in Evaluating the Response of Breast Cancer to Neoadjuvant Chemotherapy

Abstract

Background: Neoadjuvant chemotherapy (NAC) is the favored treatment of choice among locally advanced breast cancer patients because it significantly increases the possibility of breast-conserving surgery. However, for non-responders, an early prediction of response to NAC is essential. Magnetic resonance imaging (MRI) of the breast is an adjunct diagnostic procedure to mammography and ultrasound. Because of its high sensitivity and effectiveness in dense breast tissue, MRI can be a valuable addition to the diagnostic work-up of a patient with breast abnormality or biopsy-proven cancer. Aim of the Work: To highlight the role of advanced MRI techniques in the prediction and follow up of the response of breast cancer to neoadjuvant chemotherapy. Conclusion: Early change in tumor size measured on MR images is a good predictor of final response after Neoadjuvant chemotherapy (NAC). However, even if the cells respond to treatment, it takes some time for the tumor to shrink. Substantial research effort has been spent on investigating whether other information provided by MR imaging may serve as earlier response indicators than change in tumor size. Techniques that seem to be closest to clinical application, due to their feasibility and the promising results, are the pharmacokinetic analysis of DCE-MRI (Dynamic Contrast Enhanced- MRI), DW-MRI (Diffusion Weighted- MRI) and Spectroscopy.