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Breast Oncology: Techniques, Indications, and Interpretation pp 103–120Cite as

Magnetic Resonance Imaging and Neoadjuvant Chemotherapy

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Abstract

Neoadjuvant chemotherapy (NAC) is now widely used internationally to provide improved surgical outcomes, recurrent free survival, and overall survival in certain subtypes of breast cancer. Therefore, the opportunity to monitor treatment response in vivo and as early in the treatment as possible to identify non-responders is critical. Early initiation of systemic therapy can improve overall and disease-free survival for patients with locally advanced breast cancer (LABC) or inflammatory cancer even though these patients usually receive mastectomies despite complete response after NAC. For non-responders, the sooner these patients are identified, the quicker changes to treatment plans can be made to identify a more ideal regimen for them in a timely manner. Physical examination, mammography, and sonography have all been used to assess the response to NAC, primarily by measuring the size of the residual tumor. Internationally, the ‘Response Evaluation Criteria in Solid Tumors” (RECIST) is commonly used to standardize the assessment of response to therapy, based on the tumor size. Unfortunately size assessment does not take into account treatment-induced fibrosis or inflammation which can result in overestimation or underestimation of the residual disease. Magnetic resonance imaging (MRI) with intravenous contrast and advanced MRI techniques provide new opportunities for assessing tumor morphologic changes, tumor vascularity, tumor cellularity, and tumor metabolic features. MRI has been shown to be more accurate and reliable than physical examination, mammography, or sonography. The combination of contrast-enhanced MRI with diffusion-weighted imaging (DWI) and better understanding of tumor biology and genomics improve our ability to predict responders from non-responders. To date, there is still no consensus on the role of MRI for assessing response to NAC or on a standardized MRI examination in patients receiving NAC.

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Abbreviations

AC:

Anthracycline-cyclophosphamide

ACRIN:

American College of Radiology Imaging Network

ADC:

Apparent diffusion coefficient map

NAC:

Neoadjuvant chemotherapy

DCE-MRI:

Dynamic contrast-enhanced MRI

DWI:

Diffusion-weighted imaging

FTV:

Functional tumor volume

HER 2+ tumor:

Human epidermal growth factor receptor 2–positive breast cancer

HR:

Hormone receptor

I-SPY TRIAL:

Investigation of Serial studies to Predict Your Therapeutic Response with Imaging And moLecular analysis Trial

LABC:

Locally advanced breast cancer

NCCN:

National Comprehensive Cancer Network

OS:

Overall survival

pCR:

Pathological complete response to therapy

RCB:

Residual cancer burden

RECIST:

Response Evaluation Criteria in Solid Tumors

RFS:

Recurrent free survival

TNBC:

Triple negative breast cancer

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Authors and Affiliations

  1. Department of Radiology, MD Anderson Cancer Center, Houston, TX, USA

    H. T. Carisa Le-Petross MD

  2. Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Bora Lim MD

  3. Department of Radiology, University of California, San Francisco, San Francisco, CA, USA

    Nola Hylton PhD

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  1. H. T. Carisa Le-Petross MD
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Correspondence to H. T. Carisa Le-Petross MD .

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  1. Department of Radiology, New York University Langone Medical Center New York University School of Medicine, New York, USA

    Samantha L. Heller

  2. Department of Radiology, New York University Langone Medical Center New York University School of Medicine, New York, USA

    Linda Moy

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Carisa Le-Petross, H.T., Lim, B., Hylton, N. (2017). Magnetic Resonance Imaging and Neoadjuvant Chemotherapy. In: Heller, S., Moy, L. (eds) Breast Oncology: Techniques, Indications, and Interpretation. Springer, Cham. https://doi.org/10.1007/978-3-319-42563-4_5

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