Abstract
Background: Neoadjuvant chemotherapy (NAC) is commonly utilized in preoperative treatment for local breast cancer, and it gives high clinical response rates and can result in pathologic complete response (pCR) in 6–25% of patients. In recent years, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has been increasingly used to assess the pathological response of breast cancer to NAC. In present analysis, we assess the diagnostic performance of DCE-MRI in evaluating the pathological response of breast cancer to NAC.Materials and Methods: A systematic search in PubMed, the Cochrane Library, and Web of Science for original studies was performed. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess the methodological quality of the included studies. Patient, study, and imaging characteristics were extracted, and sufficient data to reconstruct 2 × 2 tables were obtained. Data pooling, heterogeneity testing, forest plot construction, meta-regression analysis and sensitivity analysis were performed using Stata version 12.0 (StataCorp LP, College Station, TX).Results: Eighteen studies (969 patients with breast cancer) were included in the present meta-analysis. The pooled sensitivity and specificity of DCE-MRI were 0.80 (95% confidence interval [CI]: 0.70, 0.88) and 0.84 (95% [CI]: 0.79, 0.88), respectively. Meta-regression analysis found no significant factors affecting heterogeneity. Sensitivity analysis showed that studies that set pathological complete response (pCR) (n = 14) as a responder showed a tendency for higher sensitivity compared with those that set pCR and near pCR together (n = 5) as a responder (0.83 vs. 0.72), and studies (n = 14) that used DCE-MRI to early predict the pathological response of breast cancer had a higher sensitivity (0.83 vs. 0.71) and equivalent specificity (0.80 vs. 0.86) compared to studies (n = 5) that assessed the response after NAC completion.Conclusion: Our results indicated that DCE-MRI could be considered an important auxiliary method for evaluating the pathological response of breast cancer to NAC and used as an effective method for dynamically monitoring the efficacy during NAC. DCE-MRI also performed well in predicting the pCR of breast cancer to NAC. However, due to the heterogeneity of the included studies, caution should be exercised in applying our results.
Highlights
With the primary clinical goals of downstaging the disease, improving operability, and allowing breast-conserving surgery, neoadjuvant chemotherapy (NAC) is commonly utilized in preoperative treatment for local breast cancer [1,2,3]
Ve, Dmax Kep, Ve pathologic complete response (pCR), pathological complete response; near pCR, residual tumor volume < 1 cm3, more than 90% of tumor cells disappeared, non-measurable isolated microscopic foci of reasons for the heterogeneity or in situ disease. *both methods of defining the pathological responder mentioned were analyzed; NR, not reported; R, retrospective; P, prospective. #dynamic contrast-enhanced magnetic resonance imaging (DCE-magnetic resonance imaging (MRI)) was performed to both early predict the response of breast cancer and assess the response after NAC completion;, change; Ktrans, transfer constant; Kep, rate constant; Ve, relative extravascular extracellular space; PRM, parametric response map; LD, longest diameter; RECIST, response evaluation criteria in solid tumors; Dmax, maximum diameter
In the present meta-analysis, we evaluated the diagnostic accuracy of DCE-MRI for evaluating the pathological response of breast cancer to NAC
Summary
With the primary clinical goals of downstaging the disease, improving operability, and allowing breast-conserving surgery, neoadjuvant chemotherapy (NAC) is commonly utilized in preoperative treatment for local breast cancer [1,2,3]. NAC gives high clinical response rates (∼80%) and can result in pathologic complete response (pCR) in 6–25% of breast cancer patients [4, 5]. Neoadjuvant chemotherapy (NAC) is commonly utilized in preoperative treatment for local breast cancer, and it gives high clinical response rates and can result in pathologic complete response (pCR) in 6–25% of patients. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has been increasingly used to assess the pathological response of breast cancer to NAC.
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