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Does preoperative MRI accurately stratify early-stage HER2 + breast cancer patients to upfront surgery vs neoadjuvant chemotherapy?

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Abstract

Purpose

HER2 +- amplified breast cancer patients derive benefit from treatment with anti-HER2-targeted therapy. Though adjuvant treatment is based on final pathology, decisions regarding neoadjuvant chemotherapy are made in the preoperative setting with imaging playing a key role in staging. We examined the accuracy of pre-operative imaging in determining pathological tumor size  (pT) in patients undergoing upfront surgery.

Methods

Early (cT1–T2N0) HER2 + breast cancer patients who underwent upfront surgery between 2015 and 2016 were identified from a prospective institutional database. We compared data for both clinical and final pathologic stage. Only those who underwent magnetic resonance imaging (MRI), mammography, and ultrasound in the preoperative setting were included in the analysis. Adjuvant treatment regimens were reviewed.

Results

We identified 87 cT1–2N0 patients with invasive HER2 + breast cancer who underwent upfront surgery. Median age was 52 years (IQR 43, 58) and median tumor size was 1.1 cm (IQR 0.5, 1.6). Fifteen patients (17%) were upstaged to stage II/III based on final pathology. Thirty-seven patients were T1cN0 on final pathology; 8 were cT1a–bN0 preop and 12 had pT overestimated by MRI by an average of 1.5 cm (> 0.5–1.5 cm). Compared to both mammography and MRI, the imaging modality most predictive of pT was ultrasound (p = 0.000072 ultrasound vs mammography and 0.000042 ultrasound vs MRI).

Conclusion

For small HER2 + cN0 tumors undergoing upfront surgery, ultrasound was the imaging modality most predictive of pT. MRI overestimated tumor size in approximately 40% of patients. MRI may not accurately discriminate low-volume tumor burden in the breast and carries the potential of overtreatment in the upfront setting.

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Acknowledgements

Jessica Moore, Shan-san Wu, Tiana Le, Summer Koop, and Jessica Massler from Memorial Sloan Kettering Cancer Center assisted with editing and submission. Emanuela Ferraro is funded by the American–Italian Cancer Foundation Post-Doctoral Fellowship.

Funding

This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.

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Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA

    Astrid Botty van den Bruele, Tiana Le, Monica Morrow & Virgilio Sacchini

  2. Breast Medicine Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA

    Emanuela Ferraro & Monica N. Fornier

  3. Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA

    Varadan Sevilimedu

  4. Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA

    Molly P. Hogan & Sidra Javed-Tayyab

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  1. Astrid Botty van den Bruele
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Contributions

AB, EF, and VS conceptualized and designed the project and performed the interpretation. VS performed the data analysis. TL performed the data acquisition and HH and SJ verified the data. AB drafted the initial manuscript. AB, EF, MM, and MF assisted in the critical revision of the manuscript. All authors approved the final manuscript as submitted.

Corresponding author

Correspondence to Virgilio Sacchini.

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The authors have no conflicts of interest to disclose.

Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Memorial Sloan Kettering Cancer Center approved this study.

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Botty van den Bruele, A., Ferraro, E., Sevilimedu, V. et al. Does preoperative MRI accurately stratify early-stage HER2 + breast cancer patients to upfront surgery vs neoadjuvant chemotherapy?. Breast Cancer Res Treat 189, 307–315 (2021). https://doi.org/10.1007/s10549-021-06331-3

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