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Breast-Conserving Surgery After Chemotherapy: Value of MDCT for Determining Tumor Distribution and Shrinkage Pattern

Mitsuhiro Tozaki1, Tadashi Kobayashi2, Shinji Uno2, Keisuke Aiba2, Hiroshi Takeyama3, Hisashi Shioya3, Isao Tabei3, Yasuo Toriumi3, Masafumi Suzuki4 and Kunihiko Fukuda1

1 Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan.
2 Department of Clinical Oncology, The Jikei University School of Medicine, Tokyo 105-8461, Japan.
3 Department of Surgery, The Jikei University School of Medicine, Tokyo 105-8461, Japan.
4 Department of Pathology, The Jikei University School of Medicine, Tokyo 105-8461, Japan.


Figure 1
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  		Fig. 1A —Distribution patterns of enhancing lesions. Diagrams show distribution patterns of enhancing lesions on CT performed before neoadjuvant chemotherapy.

 

Figure 2
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  		Fig. 1B —Distribution patterns of enhancing lesions. Diagrams show distribution patterns of enhancing lesions on CT performed before neoadjuvant chemotherapy.

 

Figure 3
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  		Fig. 1C —Distribution patterns of enhancing lesions. Diagrams show distribution patterns of enhancing lesions on CT performed before neoadjuvant chemotherapy.

 

Figure 4
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  		Fig. 1D —Distribution patterns of enhancing lesions. Diagrams show distribution patterns of enhancing lesions on CT performed before neoadjuvant chemotherapy.

 

Figure 5
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  		Fig. 1E —Distribution patterns of enhancing lesions. Diagrams show distribution patterns of enhancing lesions on CT performed before neoadjuvant chemotherapy.

 

Figure 6
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  		Fig. 2A —48-year-old woman with inflammatory carcinoma of left breast (replaced lesion: T4d N1). Early phase CT image of left breast acquired before neoadjuvant chemotherapy shows diffuse enhancement in all quadrants. Craniocaudal and transverse lines are drawn crossing over nipple.

 

Figure 7
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  		Fig. 2B —48-year-old woman with inflammatory carcinoma of left breast (replaced lesion: T4d N1). Early phase CT image acquired after neoadjuvant chemotherapy reveals significantly decreased enhancement effect.

 

Figure 8
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  		Fig. 2C —48-year-old woman with inflammatory carcinoma of left breast (replaced lesion: T4d N1). Late phase CT image acquired after neoadjuvant chemotherapy shows diffuse enhancement in original tumor bed (total field of tumor). Histologic evaluation of mastectomy specimen revealed 9.0-cm invasive and in situ ductal carcinomas.

 

Figure 9
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  		Fig. 3A —Shrinkage patterns after neoadjuvant chemotherapy. In partial response group with nonreplaced lesions, MDCT revealed pattern 1a (A), concentric shrinkage without surrounding lesions; pattern 1b (B), concentric shrinkage with surrounding lesions; and pattern 2 (C), shrinkage with residual multinodular lesions.

 

Figure 10
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  		Fig. 3B —Shrinkage patterns after neoadjuvant chemotherapy. In partial response group with nonreplaced lesions, MDCT revealed pattern 1a (A), concentric shrinkage without surrounding lesions; pattern 1b (B), concentric shrinkage with surrounding lesions; and pattern 2 (C), shrinkage with residual multinodular lesions.

 

Figure 11
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  		Fig. 3C —Shrinkage patterns after neoadjuvant chemotherapy. In partial response group with nonreplaced lesions, MDCT revealed pattern 1a (A), concentric shrinkage without surrounding lesions; pattern 1b (B), concentric shrinkage with surrounding lesions; and pattern 2 (C), shrinkage with residual multinodular lesions.

 

Figure 12
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  		Fig. 4A —68-year-old woman with invasive ductal carcinoma of left breast (solitary lesion: T3 N1). Early phase CT image acquired before neoadjuvant chemotherapy shows localized enhancement in upper outer quadrant of left breast.

 

Figure 13
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  		Fig. 4B —68-year-old woman with invasive ductal carcinoma of left breast (solitary lesion: T3 N1). Early phase CT image acquired after neoadjuvant chemotherapy shows pattern 1a shrinkage. Histologic evaluation of lumpectomy specimen revealed 2.5-cm invasive ductal carcinoma.

 

Figure 14
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  		Fig. 5A —45-year-old woman with inflammatory carcinoma of right breast (separated lesion: T4d N1). Early phase CT image acquired before neoadjuvant chemotherapy shows localized enhancing masses in lower inner quadrant (long arrow) and outer region of right breast (short arrow).

 

Figure 15
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  		Fig. 5B —45-year-old woman with inflammatory carcinoma of right breast (separated lesion: T4d N1). Late phase CT image acquired after neoadjuvant chemotherapy shows pattern 1a shrinkage. Histologic evaluation of mastectomy specimen revealed 0.9-cm invasive ductal carcinoma (arrow) in lower inner quadrant. False-negative lesions were 3-mm invasive foci in outer region that corresponded to enhancing mass seen on CT performed before neoadjuvant chemotherapy.

 

Figure 16
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  		Fig. 6A —44-year-old woman with invasive ductal carcinoma of left breast (grouped lesion: T3 N0). Early phase CT image of left breast acquired before neoadjuvant chemotherapy shows localized enhancing mass with surrounding spotty enhancement in upper outer quadrant.

 

Figure 17
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  		Fig. 6B —44-year-old woman with invasive ductal carcinoma of left breast (grouped lesion: T3 N0). Late phase CT image acquired after neoadjuvant chemotherapy shows pattern 1b shrinkage. Histologic evaluation of lumpectomy specimen revealed 3.5-cm invasive ductal carcinoma with surrounding invasive and in situ ductal carcinoma.

 

Figure 18
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  		Fig. 7A —52-year-old woman with invasive ductal carcinoma of left breast (solitary lesion: T3 N1). Early phase CT image of left breast acquired before neoadjuvant chemotherapy shows localized enhancement in upper outer quadrant.

 

Figure 19
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  		Fig. 7B —52-year-old woman with invasive ductal carcinoma of left breast (solitary lesion: T3 N1). Late phase CT image acquired after neoadjuvant chemotherapy shows pattern 2 shrinkage. Histologic evaluation of mastectomy specimen revealed 5.5-cm invasive and in situ ductal carcinomas.

 

Figure 20
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  		Fig. 8 —Difference between size estimates based on histology and those based on MDCT was significantly smaller (p < 0.01) in cases of pattern 1 shrinkage compared with pattern 2 shrinkage.

 

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