MRI and prediction of pathologic complete response in the breast and axilla after neoadjuvant chemotherapy for breast cancer Journal Article

Authors: Weber, J. J.; Jochelson, M. S.; Eaton, A.; Zabor, E. C.; Barrio, A. V.; Gemignani, M. L.; Pilewskie, M.; Van Zee, K. J.; Morrow, M.; El-Tamer, M.
Article Title: MRI and prediction of pathologic complete response in the breast and axilla after neoadjuvant chemotherapy for breast cancer
Abstract: Background In the setting where determining extent of residual disease is key for surgical planning after neoadjuvant chemotherapy (NAC), we evaluate the reliability of MRI in predicting pathologic complete response (pCR) of the breast primary and axillary nodes after NAC. Study Design Patients who had MRI before and after NAC between June 2014 and August 2015 were identified in a prospective database after IRB approval. Post-NAC MRI of the breast and axillary nodes was correlated with residual disease on final pathology. Pathologic complete response was defined as absence of invasive and in situ disease. Results We analyzed 129 breast cancers. Median patient age was 50.8 years (range 27.2 to 80.6 years). Tumors were human epidermal growth factor receptor 2 amplified in 52 of 129 (40%), estrogen receptor-positive/human epidermal growth factor receptor 2-negative in 45 of 129 (35%), and triple negative in 32 of 129 (25%), with respective pCR rates of 50%, 9%, and 31%. Median tumor size pre- and post-NAC MRI were 4.1 cm and 1.45 cm, respectively. Magnetic resonance imaging had a positive predictive value of 63.4% (26 of 41) and negative predictive value of 84.1% (74 of 88) for in-breast pCR. Axillary nodes were abnormal on pre-NAC MRI in 97 patients; 65 had biopsy-confirmed metastases. The nodes normalized on post-NAC MRI in 33 of 65 (51%); axillary pCR was present in 22 of 33 (67%). In 32 patients with proven nodal metastases and abnormal nodes on post-NAC MRI, 11 achieved axillary pCR. In 32 patients with normal nodes on pre- and post-NAC MRI, 6 (19%) had metastasis on final pathology. Conclusions Radiologic complete response by MRI does not predict pCR with adequate accuracy to replace pathologic evaluation of the breast tumor and axillary nodes. © 2017 American College of Surgeons
Keywords: adult; human tissue; treatment response; aged; primary tumor; major clinical study; histopathology; nuclear magnetic resonance imaging; lymph node metastasis; lymph node dissection; sentinel lymph node biopsy; breast cancer; mastectomy; tumor volume; axillary lymph node; minimal residual disease; partial mastectomy; reliability; neoadjuvant chemotherapy; predictive value; triple negative breast cancer; gadolinium pentetate meglumine; tumor invasion; estrogen receptor positive breast cancer; human epidermal growth factor receptor 2 positive breast cancer; human; female; priority journal; article
Journal Title: Journal of the American College of Surgeons
Volume: 225
Issue: 6
ISSN: 1072-7515
Publisher: Elsevier Science, Inc.  
Date Published: 2017-12-01
Start Page: 740
End Page: 746
Language: English
DOI: 10.1016/j.jamcollsurg.2017.08.027
PROVIDER: scopus
PMCID: PMC5705460
PUBMED: 28919579
Notes: Article -- Export Date: 4 December 2017 -- Source: Scopus
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MSK Authors
  1. Andrea Veronica Barrio
    38 Barrio
  2. Monica Morrow
    450 Morrow
  3. Kimberly J Van Zee
    242 Van Zee
  4. Mary L Gemignani
    144 Gemignani
  5. Emily Craig Zabor
    131 Zabor
  6. Anne Austin Eaton
    117 Eaton
  7. Joseph John Weber
    2 Weber