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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Copyright © 2005 by the American Roentgen Ray Society.
