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Prospective Comparison of Mammography, Sonography, and MRI in Patients Undergoing Neoadjuvant Chemotherapy for Palpable Breast Cancer

Eren Yeh1,2, Priscilla Slanetz3, Daniel B. Kopans1, Elizabeth Rafferty1, Dianne Georgian-Smith1, Linda Moy4, Elkan Halpern1, Richard Moore1, Irene Kuter2,5 and Alphonse Taghian2,6

1 Department of Radiology, Massachusetts General Hospital, 15 Parkman St., ACC-219, Boston, MA 02114.
2 Harvard Medical School, Boston, MA.
3 Saint Elizabeth's Medical Center, Brighton, MA.
4 New York University Medical Center, New York, NY.
5 Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital, Boston, MA 02114.
6 Department of Radiation-Oncology, Massachusetts General Hospital, Boston, MA 02114.



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  		Fig. 1. —Schematic diagram of sequence of protocol used for our pilot study. Patients were randomized (R) to neoadjuvant chemotherapy (CT), either doxorubicin (ADR, Pharmacia Inc.) followed by paclitaxel (Taxol, Bristol-Myers Squibb Company) or vice versa. Physical examination and imaging (i.e., mammography, breast sonography, and breast MRI) were performed. Each patient received single-agent neoadjuvant chemotherapy; then physical examination and imaging examinations were repeated. Second chemotherapeutic agent was given to patient, and physical examination and imaging examinations were repeated. Patient underwent surgery, either lumpectomy or mastectomy, and final pathology results were obtained.

 


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  		Fig. 2A. —46-year-old woman with left breast lump. After chemotherapy, patient had lumpectomy with pathology results showing dense sclerosis and no residual tumor. Left breast craniocaudal mammogram shows dense parenchyma and was interpreted as negative.

 


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  		Fig. 2B. —46-year-old woman with left breast lump. After chemotherapy, patient had lumpectomy with pathology results showing dense sclerosis and no residual tumor. Left breast mediolateral oblique mammogram shows dense parenchyma and was interpreted as negative.

 


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  		Fig. 2C. —46-year-old woman with left breast lump. After chemotherapy, patient had lumpectomy with pathology results showing dense sclerosis and no residual tumor. Sonogram obtained before chemotherapy shows irregular hypoechoic shadowing and 2.1-cm mass (arrows) in left breast at 2-o'clock position in transverse plane.

 


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  		Fig. 2D. —46-year-old woman with left breast lump. After chemotherapy, patient had lumpectomy with pathology results showing dense sclerosis and no residual tumor. Sonogram obtained after chemotherapy shows discrete residual mass (large arrows) in transverse plane. Micromark clip is present within mass (small arrow).

 


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  		Fig. 2E. —46-year-old woman with left breast lump. After chemotherapy, patient had lumpectomy with pathology results showing dense sclerosis and no residual tumor. Axial subtraction MRI obtained before chemotherapy shows extensive enhancement (arrows) in left breast. Before patient received chemotherapy, more tumor was detected on MRI (10 cm) than initially was suspected on basis of physical examination (3 cm), mammography (dense negative), or sonography (2.1 cm) findings.

 


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  		Fig. 2F. —46-year-old woman with left breast lump. After chemotherapy, patient had lumpectomy with pathology results showing dense sclerosis and no residual tumor. Axial subtraction MRI obtained after chemotherapy shows complete resolution of enhancement (arrows).

 

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