European Radiology

, Volume 28, Issue 7, pp 2986–2995 | Cite as

Contrast-enhanced MRI after neoadjuvant chemotherapy of breast cancer: lesion-to-background parenchymal signal enhancement ratio for discriminating pathological complete response from minimal residual tumour

  • Soo-Yeon Kim
  • Nariya ChoEmail author
  • Sung Ui Shin
  • Han-Byoel Lee
  • Wonshik Han
  • In Ae Park
  • Bo Ra Kwon
  • Soo Yeon Kim
  • Su Hyun Lee
  • Jung Min Chang
  • Woo Kyung Moon



To retrospectively investigate whether the lesion-to-background parenchymal signal enhancement ratio (SER) on breast MRI can distinguish pathological complete response (pCR) from minimal residual cancer following neoadjuvant chemotherapy (NAT), and compare its performance with the conventional criterion.


216 breast cancer patients who had undergone NAT and MRI and achieved pCR or minimal residual cancer on surgical histopathology were included. Clinical-pathological features, SER and lesion size on MR images were analysed. Multivariate logistic regression, ROC curve and McNemar’s test were performed.


SER on early-phase MR images was independently associated with pCR (odds ratio [OR], 0.286 [95% CI: 0.113–0.725], p = .008 for Reader 1; OR, 0.306 [95% CI: 0.111–0.841], p = .022 for Reader 2). Compared with the conventional criterion, SER ≤1.6 increased AUC (0.585–0.599 vs. 0.709–0.771, p=.001-.033) and specificity (21.9–27.4% vs. 80.8–86.3%, p <.001) in identifying pCR. SER ≤1.6 and/or size ≤0.2 cm criterion showed the highest specificity of 90.4%.


SER on early-phase MR images was independently associated with pCR, and showed improved AUC and specificity compared to the conventional criterion. The combined criterion of SER and size could be used to select candidates to avoid surgery in a future study.

Key points

Compared with conventional criterion, SER ≤ 1.6 criterion increased AUC and specificity.

Simple measurement of signal intensity could differentiate pCR from minimal residual cancer.

SER ≤1.6 and/or size≤0.2cm criterion showed the highest specificity of 90.4 %.

The combined criterion could be used for a study to avoid surgery.


Breast cancer Magnetic resonance imaging Neoadjuvant chemotherapy Signal enhancement ratio Pathological complete response 



Ductal carcinoma in situ


Human epidermal growth factor receptor type 2


Hormone receptor


Intraclass correlation coefficient


Neoadjuvant chemotherapy


Pathological complete response


Signal enhancement ratio



This research has received funding from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (NRF-2016R1D1A1B03933913).

Compliance with ethical standards


The scientific guarantor of this publication is Nariya Cho.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• diagnostic or prognostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Soo-Yeon Kim
    • 1
    • 2
    • 3
  • Nariya Cho
    • 1
    • 2
    • 3
    Email author
  • Sung Ui Shin
    • 1
    • 2
    • 3
  • Han-Byoel Lee
    • 4
  • Wonshik Han
    • 4
  • In Ae Park
    • 5
  • Bo Ra Kwon
    • 1
    • 2
    • 3
  • Soo Yeon Kim
    • 1
    • 2
    • 3
  • Su Hyun Lee
    • 1
    • 2
    • 3
  • Jung Min Chang
    • 1
    • 2
    • 3
  • Woo Kyung Moon
    • 1
    • 2
    • 3
  1. 1.Department of RadiologySeoul National University HospitalSeoulRepublic of Korea
  2. 2.Department of RadiologySeoul National College of MedicineSeoulRepublic of Korea
  3. 3.Institute of Radiation MedicineSeoul National University Medical Research CenterSeoulRepublic of Korea
  4. 4.Department of SurgerySeoul National University HospitalSeoulRepublic of Korea
  5. 5.Department of PathologySeoul National University HospitalSeoulRepublic of Korea

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