Accuracy of MR Imaging for Revealing Residual Breast Cancer in Patients Who Have Undergone Neoadjuvant Chemotherapy
Savannah C. Partridge1,
Jessica E. Gibbs1,
Ying Lu1,
Laura J. Esserman2,
Dan Sudilovsky3 and
Nola M. Hylton1
1 Department of Radiology, University of California, San Francisco, Magnetic
Resonance Science Center, 1 Irving St., Rm. AC-109, San Francisco, CA
94143-1290.
2 Department of Surgery, University of California, San Francisco, Mount Zion
Cancer Center, 2356 Sutter St., San Francisco, CA 94115.
3 Department of Pathology, Marin General Hospital, 250 Bon Air Rd., Greenbrae,
CA 94904.
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Fig. 1. —43-year-old woman with mid-grade invasive ductal carcinoma.
Note focal enhancement (white box) on maximum-intensity-projection MR
image obtained before chemotherapy.
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Fig. 2. —60-year-old woman with mid-grade invasive ductal carcinoma.
Note moderately diffuse enhancement of lesion (white box) on
maximum-intensity-projection MR image obtained before chemotherapy.
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Fig. 3. —55-year-old woman with mid-grade invasive lobular carcinoma.
Note diffuse enhancement of lesion (white box) on
maximum-intensity-projection MR image obtained before chemotherapy.
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Fig. 4A. —62-year-old woman with mid-grade infiltrating ductal
carcinoma. Maximum-intensity-projection MR image acquired before chemotherapy
shows focal lesion in superior aspect of breast.
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Fig. 4B. —62-year-old woman with mid-grade infiltrating ductal
carcinoma. Maximum-intensity-projection MR image acquired after chemotherapy
shows change in lesion size and in signal enhancement.
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Fig. 5A. —52-year-old woman with mid-grade infiltrating lobular
carcinoma. Maximum-intensity-projection MR image acquired before chemotherapy
shows diffusely enhancing lesion in central region of breast.
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Fig. 5B. —52-year-old woman with mid-grade infiltrating lobular
carcinoma. Maximum-intensity-projection MR image acquired after chemotherapy
shows change in lesion size and in signal enhancement.
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Fig. 6A. —48-year-old woman with high-grade invasive ductal carcinoma.
Maximum-intensity-projection MR images show lesion in three dimensions.
Sagittal maximum-intensity-projection (MIP) image shows enhanced tumor
(white box) in anteroposterior and superior—inferior
dimensions. Longest diameter of tumor (black line) was measured on
this MIP.
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Fig. 6B. —48-year-old woman with high-grade invasive ductal carcinoma.
Maximum-intensity-projection MR images show lesion in three dimensions. Axial
MIP image shows enhanced tumor (white box) in anteroposterior and
lateral—medial dimensions.
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Fig. 7. —Scatterplot shows longest diameter of tumor (•) measured
on MR imaging and at pathology after chemotherapy for each patient (n
= 52). Note five cases for which results at pathology were questionable
( ). Correlation between measurements was strong with and without these
cases (r = 0.89 and r = 0.94, respectively; p <
0.001 for both). Trend line (black line) depicts least-squares fit
for data.
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Fig. 8. —Plot shows difference versus mean for each measurement of
residual tumor (O) obtained on MR image compared with pathologic findings.
Note five cases for which results at pathology were questionable (+).
Ninety-five percent confidence intervals (CI) are shown for analysis with
(----) and without (-.-.-) these cases. MR image shows almost O mean error
(..........) and tight CI.
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Fig. 9. —Scatterplot shows longest diameter of tumor (•) measured
at clinical examination and at pathology after chemotherapy (n = 51).
Note five cases for which results at pathology were questionable ().
Correlation between measurements was moderate with and without these cases
(r = 0.6 and r = 0.55, respectively; p < 0.001
for both). Clinical assessment of lesion size by palpation produced notably
less accurate lesion characterization than MR imaging. Trend line (black
line) depicts least-squares fit for data.
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Fig. 10. —Plot shows difference versus mean for each measurement of
residual disease (O) obtained at clinical examination compared with pathologic
findings. Note five cases for which results obtained at pathology were
questionable (+). Clinical examination systematically underestimated size of
residual disease at pathology, with mean error of -0.51 cm (.........) and
wide 95% confidence interval with (----) and without (-.-.-) problem
cases.
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Copyright © 2002 by the American Roentgen Ray Society.
