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Predicting response to neoadjuvant chemotherapy in primary breast cancer using volumetric helical perfusion computed tomography: a preliminary study

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Abstract

Objectives

To investigate whether CT-derived vascular parameters in primary breast cancer predict complete pathological response (pCR) to neoadjuvant chemotherapy (NAC).

Methods

Twenty prospective patients with primary breast cancer due for NAC underwent volumetric helical perfusion CT to derive whole tumour regional blood flow (BF), blood volume (BV) and flow extraction product (FE) by deconvolution analysis. A pCR was achieved if no residual invasive cancer was detectable on pathological examination. Relationships between baseline BF, BV, FE, tumour size and volume, and pCR were examined using the Mann–Whitney U test. Receiver operating characteristic (ROC) curve analysis was performed to assess the parameter best able to predict response. Intra- and inter-observer variability was assessed using Bland–Altman statistics.

Results

Seventeen out of 20 patients completed NAC with four achieving a pCR. Baseline BF and FE were higher in patients who achieved a pCR compared with those who did not (P = 0.032); tumour size and volume were not significantly different (P > 0.05). ROC analysis revealed that BF and FE were able to identify responders effectively (AUC = 0.87; P = 0.03). There was good intra- and inter-observer agreement.

Conclusions

Primary breast cancers which exhibited higher levels of perfusion before treatment were more likely to achieve a pCR to NAC.

Key Points

• CT-derived vascular parameters may be useful in breast cancer treatment.

• Perfusion CT can help predict response to neoadjuvant chemotherapy in breast cancer.

• Baseline blood flow and flow extraction product are higher in complete pathological responders.

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Acknowledgements

Kings College London receives funding from the National Institute for Health Research (NIHR) as a Comprehensive Biomedical Research Centre.

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Authors and Affiliations

  1. Academic Oncology Unit, Mount Vernon Cancer Centre, Northwood, Middlesex, HA6 2RN, UK

    Sonia P. Li & Andreas Makris

  2. Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, HA6 2RN, UK

    Andrew Gogbashian, Ian C. Simcock, J. James Stirling & Vicky Goh

  3. Division of Imaging Sciences, Kings College London, Lambeth Wing, St Thomas’ Hospital, Lambeth Palace Road, London, SE1 7EH, UK

    Vicky Goh

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  1. Sonia P. Li
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Correspondence to Vicky Goh.

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Li, S.P., Makris, A., Gogbashian, A. et al. Predicting response to neoadjuvant chemotherapy in primary breast cancer using volumetric helical perfusion computed tomography: a preliminary study. Eur Radiol 22, 1871–1880 (2012). https://doi.org/10.1007/s00330-012-2433-2

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  • DOI: https://doi.org/10.1007/s00330-012-2433-2

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