Advertisement

Annals of Surgical Oncology

, Volume 25, Issue 5, pp 1350–1356 | Cite as

Contrast-Enhanced Spectral Mammography is Comparable to MRI in the Assessment of Residual Breast Cancer Following Neoadjuvant Systemic Therapy

  • Bhavika K. Patel
  • Talal Hilal
  • Matthew Covington
  • Nan Zhang
  • Heidi E. Kosiorek
  • Marc Lobbes
  • Donald W. Northfelt
  • Barbara A. Pockaj
Breast Oncology

Abstract

Purpose

To evaluate the performance of contrast-enhanced spectral mammography (CESM) compared to MRI in the assessment of tumor response in breast cancer patients undergoing neoadjuvant systemic therapy (NST).

Methods

The institutional review board approved this study. From September 2014 to June 2017, we identified patients with pathologically confirmed invasive breast cancer who underwent NST. All patients had both CESM and MRI performed pre- and post-NST with pathological assessment after surgical management. Size of residual malignancy on post-NST CESM and MRI was compared with surgical pathology. Lin concordance and Pearson correlation coefficient were used to assess agreement. Bland–Altman plots were used to visualize the differences between tumor size on imaging and pathology.

Results

Sixty-five patients were identified. Mean age was 52.7 (range 30–76) years. Type of NST included chemotherapy in 53 (82%) and endocrine therapy in 12 (18%). Mean tumor size after NST was 14.6 (range 0–105) mm for CESM and 14.2 mm (range 0–75 mm) for MRI compared with 19.6 (range 0–100) mm on final surgical pathology. Equivalence tests demonstrated that mean tumor size measured by CESM (p = 0.009) or by MRI (p = 0.01) was equivalent to the mean tumor size measured by pathology within − 1 and 1-cm range. Comparing CESM versus MRI for assessment of complete response, the sensitivity was 95% versus 95%, specificity 66.7% versus 68.9%, positive predictive value 55.9% versus 57.6%, and negative predictive value 96.7% versus 96.9% respectively.

Conclusions

CESM was comparable to MRI in assessing residual malignancy after completion of NST.

Notes

Acknowledgment

The authors thank Jennifer Palmieri, RT, and MaryAnn McDonough, RT, for help with data collection, Diana Almader-Douglas for help with literature search, and Marissa Pacheco and Yania Lopez-Alvarez, MD, for help with data analysis.

Conflict of interest

All authors attest that there is no conflict of interest in the publication of this manuscript.

References

  1. 1.
    Bear HD, Anderson S, Smith RE, Geyer CE Jr, Mamounas EP, Fisher B, et al. Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer:National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol. 2006;24(13):2019–27.CrossRefPubMedGoogle Scholar
  2. 2.
    Hennigs A, Riedel F, Marme F, Sinn P, Lindel K, Gondos A, et al. Changes in chemotherapy usage and outcome of early breast cancer patients in the last decade. Breast Cancer Res Treat. 2016;160(3):491–9.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014;384(9938):164–72.CrossRefPubMedGoogle Scholar
  4. 4.
    Rosen EL, Blackwell KL, Baker JA, Soo MS, Bentley RC, Yu D, et al. Accuracy of MRI in the detection of residual breast cancer after neoadjuvant chemotherapy. AJR Am J Roentgenol. 2003;181(5):1275–82.CrossRefPubMedGoogle Scholar
  5. 5.
    Marinovich ML, Macaskill P, Irwig L, Sardanelli F, Mamounas E, von Minckwitz G, et al. Agreement between MRI and pathologic breast tumor size after neoadjuvant chemotherapy, and comparison with alternative tests: individual patient data meta-analysis. Bmc Cancer. 2015;15(1):662.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Patel BK, Lobbes MBI, Lewin J. Contrast-enhanced spectral mammography: a review. Semin Ultrasound CT MR. 2018;39(1):70–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Fallenberg EM, Dromain C, Diekmann F, Renz DM, Amer H, Ingold-Heppner B, et al. Contrast-enhanced spectral mammography: does mammography provide additional clinical benefits or can some radiation exposure be avoided? Breast Cancer Res Treat. 2014;146(2):371–81.CrossRefPubMedGoogle Scholar
  8. 8.
    Ali-Mucheru M, Pockaj B, Patel B, Pizzitola V, Wasif N, Stucky CC, et al. Contrast-Enhanced Digital Mammography in the Surgical Management of Breast Cancer. Ann Surg Oncol. 2016;23(Suppl 5):649–55.CrossRefPubMedGoogle Scholar
  9. 9.
    Lewis TC, Pizzitola VJ, Giurescu ME, Eversman WG, Lorans R, Robinson KA, et al. Contrast-enhanced digital mammography: a single-institution experience of the first 208 cases. Breast J. 2017;23(1):67–76.CrossRefPubMedGoogle Scholar
  10. 10.
    Lin LI. A concordance correlation coefficient to evaluate reproducibility. Biometrics. 1989;45(1):255–68.CrossRefPubMedGoogle Scholar
  11. 11.
    van la Parra RF, Kuerer HM. Selective elimination of breast cancer surgery in exceptional responders: historical perspective and current trials. Breast Cancer Res. 2016;18(1):28.CrossRefGoogle Scholar
  12. 12.
    Shin HJ, Kim HH, Ahn JH, Kim SB, Jung KH, Gong G, et al. Comparison of mammography, sonography, MRI and clinical examination in patients with locally advanced or inflammatory breast cancer who underwent neoadjuvant chemotherapy. Br J Radiol. 2011;84(1003):612–20.Google Scholar
  13. 13.
    Iotti V, Ravaioli S, Vacondio R, Coriani C, Caffarri S, Sghedoni R, et al. Contrast-enhanced spectral mammography in neoadjuvant chemotherapy monitoring: a comparison with breast magnetic resonance imaging. Breast Cancer Res. 2017;19(1):106.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Marinovich ML, Houssami N, Macaskill P, Sardanelli F, Irwig L, Mamounas EP, et al. Meta-analysis of magnetic resonance imaging in detecting residual breast cancer after neoadjuvant therapy. J Natl Cancer Inst. 2013;105(5):321–33.CrossRefPubMedGoogle Scholar
  15. 15.
    Marinovich ML, Macaskill P, Irwig L, Sardanelli F, von Minckwitz G, Mamounas E, et al. Meta-analysis of agreement between MRI and pathologic breast tumour size after neoadjuvant chemotherapy. Br J Cancer. 2013;109(6):1528–36.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Lobbes MB, Prevos R, Smidt M, Tjan-Heijnen VC, van Goethem M, Schipper R, et al. The role of magnetic resonance imaging in assessing residual disease and pathologic complete response in breast cancer patients receiving neoadjuvant chemotherapy: a systematic review. Insights Imaging. 2013;4(2):163–75.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Onega T, Hubbard R, Hill D, Lee CI, Haas JS, Carlos HA, et al. Geographic access to breast imaging for US women. J Am Coll Radiol. 2014;11(9):874–82.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Millet I, Pages E, Hoa D, Merigeaud S, Curros Doyon F, Prat X, et al. Pearls and pitfalls in breast MRI. Br J Radiol. 2012;85(1011):197–207.Google Scholar
  19. 19.
    Jochelson MS, Dershaw DD, Sung JS, Heerdt AS, Thornton C, Moskowitz CS, et al. Bilateral contrast-enhanced dual-energy digital mammography: feasibility and comparison with conventional digital mammography and MR imaging in women with known breast carcinoma. Radiology. 2013;266(3):743–51.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Fallenberg EM, Schmitzberger FF, Amer H, Ingold-Heppner B, Balleyguier C, Diekmann F, et al. Contrast-enhanced spectral mammography vs. mammography and MRI - clinical performance in a multi-reader evaluation. Eur Radiol. 2016;27(7):2752–2764.CrossRefPubMedGoogle Scholar
  21. 21.
    Lobbes MB, Lalji UC, Nelemans PJ, Houben I, Smidt ML, Heuts E, et al. The quality of tumor size assessment by contrast-enhanced spectral mammography and the benefit of additional breast MRI. J Cancer. 2015;6(2):144–50.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Patel BK, Gray RJ, Pockaj BA. Potential Cost Savings of Contrast-Enhanced Digital Mammography. AJR Am J Roentgenol. 2017;208(6):W231–W7.CrossRefPubMedGoogle Scholar
  23. 23.
    Hobbs MM, Taylor DB, Buzynski S, Peake RE. Contrast-enhanced spectral mammography (CESM) and contrast enhanced MRI (CEMRI): patient preferences and tolerance. J Med Imaging Radiat Oncol. 2015;59(3):300–5.CrossRefPubMedGoogle Scholar
  24. 24.
    Carpenter AP, Leemis LM, Papir AS, Phillips DJ, Phillips GS. Managing magnetic resonance imaging machines: support tools for scheduling and planning. Health Care Manag Sci. 2011;14(2):158–73.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  1. 1.Department of RadiologyMayo ClinicPhoenixUSA
  2. 2.Department of Internal Medicine, Division of Hematology/OncologyMayo ClinicPhoenixUSA
  3. 3.Department of Health Sciences Research, BioStatisticsMayo ClinicPhoenixUSA
  4. 4.Department of RadiologyMaastricht University Medical CenterMasstrichtThe Netherlands
  5. 5.Department of SurgeryMayo ClinicPhoenixUSA

Personalised recommendations