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Can Routine Imaging After Neoadjuvant Chemotherapy in Breast Cancer Predict Pathologic Complete Response?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study evaluated breast imaging procedures for predicting pathologic complete response (pCR = ypT0) after neoadjuvant chemotherapy (NACT) for breast cancer to challenge surgery as a diagnostic procedure after NACT.

Methods

This retrospective, exploratory, monocenter study included 150 invasive breast cancers treated by NACT. The patients received magnetic resonance imaging (MRI), mammography (MGR), and ultrasound (US). The results were classified in three response subgroups according to response evaluation criteria in solid tumors. To incorporate specific features of MRI and MGR, an additional category [clinical near complete response (near-cCR)] was defined. Residual cancer in imaging and pathology was defined as a positive result. Negative predictive values (NPVs), false-negative rates (FNRs), and false-positive rates (FPRs) of all imaging procedures were analyzed for the whole cohort and for triple-negative (TN), HER2-positive (HER2+), and HER2-negative/hormone-receptor-positive (HER2−/HR+) cancers, respectively.

Results

In 46 cases (31 %), pCR (ypT0) was achieved. Clinical complete response (cCR) and near-cCR showed nearly the same NPVs and FNRs. The NPV was highest with 61 % for near-cCR in MRI and lowest with 44 % for near-cCR in MGR for the whole cohort. The FNRs ranged from 4 to 25 % according to different imaging methods. The MRI performance seemed to be superior, especially in TN cancers (NPV 94 %; FNR 5 %). The lowest FPR was 10 % in MRI, and the highest FPR was 44 % in US.

Conclusion

Neither MRI nor MGR or US can diagnose a pCR (ypT0) with sufficient accuracy to replace pathologic diagnosis of the surgical excision specimen.

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Disclosures

There are no conflicts of interests (e.g. employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications / registrations, and grants or other funding) by any of the authors.

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Author notes

    Authors and Affiliations

    1. Department of Gynecology, University Breast Unit, Heidelberg, Germany

      B. Schaefgen, M. Mati, M. Golatta MD, A. Hennigs MD, H. Richter, C. Domschke MD, F. Schuetz MD, C. Sohn MD, A. Schneeweiss MD & Joerg Heil MD

    2. Institute of Pathology, University of Heidelberg, Heidelberg, Germany

      H. P. Sinn MD

    3. Department of Diagnostic and Interventional Radiology, University Breast Unit, Heidelberg, Germany

      A. Stieber MD

    4. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany

      G. Rauch PhD

    5. National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany

      A. Schneeweiss MD

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    1. B. Schaefgen
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    Correspondence to Joerg Heil MD.

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    B. Schaefgen and M. Mati have contributed equally to this work.

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    Schaefgen, B., Mati, M., Sinn, H.P. et al. Can Routine Imaging After Neoadjuvant Chemotherapy in Breast Cancer Predict Pathologic Complete Response?. Ann Surg Oncol 23, 789–795 (2016). https://doi.org/10.1245/s10434-015-4918-0

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    • DOI: https://doi.org/10.1245/s10434-015-4918-0

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