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MRI Performance in Detecting pCR After Neoadjuvant Chemotherapy by Molecular Subtype of Breast Cancer

  • Nancy Yu
  • Vivian W. Y. Leung
  • Sarkis MeterissianEmail author
Scientific Review
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Abstract

Background

MRI performance in detecting pathologic complete response (pCR) post-neoadjuvant chemotherapy (NAC) in breast cancer has been previously explored. However, since tumor response varies by molecular subtype, it is plausible that imaging performance also varies. Therefore, we performed a literature review on subtype-specific MRI performance in detecting pCR post-NAC.

Methods

Two reviewers searched Cochrane, PubMed, and EMBASE for articles published between 2013 and 2018 that examined MRI performance in detecting pCR post-NAC. After filtering, ten primary research articles were included. Statistical metrics, such as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were extracted per study for triple negative, HR+/HER2−, and HER2+ patients.

Results

Ten studies involving 2310 patients were included. In triple negative breast cancer, MRI showed NPV (58–100%) and PPV (72.7–94.7%) across 446 patients and sensitivity (45.5–100%) and specificity (49–94.4%) in 375 patients. In HR+/HER2− breast cancer patients, MRI showed NPV (29.4–100%) and PPV (21.4–95.1%) across 851 patients and sensitivity (43–100%) and specificity (45–93%) across 780 patients. In HER2+-enriched subtype, MRI showed NPV (62–94.6%) and PPV (34.9–72%) in 243 patients and sensitivity (36.2–83%) and specificity (47–90%) in 255 patients.

Conclusion

MRI accuracy in detecting pCR post-NAC by subtype is not as consistent, nor as high, as individual studies suggest. Larger studies using standardized pCR definition with appropriate timing of surgery and MRI need to be conducted. This study has shown that MRI is in fact not an accurate prediction of pCR, and thus, clinicians may need to rely on other approaches such as biopsies of the tumor bed.

Notes

Compliance with ethical standards

Conflict of interests

The authors declare that they have no conflict of interest.

Supplementary material

268_2019_5032_MOESM1_ESM.png (146 kb)
Supplementary material 1 (PNG 145 kb)

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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Nancy Yu
    • 1
  • Vivian W. Y. Leung
    • 1
  • Sarkis Meterissian
    • 1
    • 2
    • 3
    • 4
    Email author
  1. 1.Faculty of MedicineMcGill UniversityMontréalCanada
  2. 2.Department of OncologyMcGill UniversityMontréalCanada
  3. 3.Department of SurgeryMcGill UniversityMontréalCanada
  4. 4.Research Institute of MUHCMontrealCanada

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