Comparison of Pathologic Response Evaluation Systems After Neoadjuvant Chemotherapy in Breast Cancers: Correlation With Computer-Aided Diagnosis of MRI Features

AJR Am J Roentgenol. 2019 Oct;213(4):944-952. doi: 10.2214/AJR.18.21016. Epub 2019 Jun 25.

Abstract

OBJECTIVE. The objective of our study was to compare pathologic response assessment systems with dynamic contrast-enhanced MRI (DCE-MRI) features and evaluate the predictive performance of DCE-MRI features relative to different pathologic response assessment systems after neoadjuvant chemotherapy (NAC). MATERIALS AND METHODS. This retrospective study included 223 women (mean age, 47.2 years; age range, 31-71 years) who underwent DCE-MRI before and after completing NAC before definitive surgery between January and December 2015. Six MRI features (i.e., tumor size; angio volume; peak enhancement; and persistent, plateau, and washout enhancing components) were measured and correlated with the Miller-Payne grading system, residual cancer burden (RCB) class, and modified in-breast RCB index. Percentage changes in MRI features were correlated with pathologic assessment systems using the Spearman rank correlation test; ROC curves were analyzed to predict pathologic outcomes. RESULTS. All six MRI features correlated most strongly with the in-breast RCB index (r = -0.75 to -0.51, p < 0.001) followed by the Miller-Payne system (r = 0.47-0.72, p < 0.001) and RCB class (r = -0.58 to -0.41, p < 0.001). The in-breast RCB index correlated most strongly with the angio volume reduction rate (r = -0.75, p < 0.001) followed by maximum diameter (r = -0.69, p < 0.001), peak enhancement (r = -0.67, p < 0.001), washout component (r = -0.60, p < 0.001), plateau component (r = -0.59, p < 0.001), and persistent component (r = -0.51, p < 0.001). CONCLUSION. The in-breast RCB index correlated best with changes in DCE-MRI features, and the MRI-measured angio volume reduction rate correlated best with pathologic tumor responses.

Keywords: MRI; breast cancer; chemotherapy.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / diagnostic imaging*
  • Breast Neoplasms / drug therapy*
  • Breast Neoplasms / pathology*
  • Chemotherapy, Adjuvant
  • Contrast Media
  • Diagnosis, Computer-Assisted*
  • Female
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Middle Aged
  • Neoadjuvant Therapy
  • Neoplasm Grading
  • Neoplasm, Residual
  • Retrospective Studies
  • Tumor Burden

Substances

  • Contrast Media