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Monitoring Response to Primary Chemotherapy in Breast Cancer using Dynamic Contrast-enhanced Magnetic Resonance Imaging

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Abstract

Purpose. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) allows analysis of both tumor volume and contrast enhancement pattern using a single tool. We sought to investigate whether DCE-MRI could be used to predict histological response in patients undergoing primary chemotherapy (PCT) for breast cancer.

Patients and methods. Thirty patients with breast cancer, clinical diameter >3 cm or stage III A/B, received anthracycline and taxane based PCT. DCE-MRI was performed at the baseline, after two cycles and after four cycles of PCT, before surgery. Histological response was assessed using a five-point scheme. Grade 4 (small cluster of dispersed residual cancer cells) and grade 5 (no residual viable cancer cell) were defined as a major histopathological response (MHR).

Results. Univariate analysis showed that a >65% reduction in the tumor volume and a reduction in the early enhancement ratio (ECU) after two cycles of PCT were associated with a MHR. Multivariate analysis revealed that tumor volume reduction after two cycles of PCT was independently associated with a MHR (odds ratio [OR] 39.968, 95% confidence interval [CI] 3.438–464.962, p < 0.01). ECU reduction was still associated with a MHR (OR 2.50, 95% CI 0.263–23.775), but it did not retain statistical significance (p = 0.42). Combining tumor volume and ECU reduction after two cycles of PCT yielded a 93% diagnostic accuracy in identifying tumors achieving a pathological complete response (pCR) (histopathological grade 5).

Conclusions. DCE-MRI allows prediction of the effect of neoadjuvant chemotherapy in breast cancer. Although in our study tumor volume reduction after two cycles had the strongest predictive value, DCE-MRI has the potential to provide functional parameters that could be integrated to optimize neoadjuvant chemotherapy strategies.

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Authors and Affiliations

  1. Department of Diagnostic Imaging, Institute for Cancer Research and Treatment, Candiolo, Torino, Italy

    Laura Martincich, Vincenzo Marra, Stefano Cirillo & Daniele Regge

  2. Department of Medical Oncology, Institute for Cancer Research and Treatment, Candiolo, Torino, Italy

    Filippo Montemurro & Massimo Aglietta

  3. Department of Surgical Pathology, Institute for Cancer Research and Treatment, Candiolo, Torino, Italy

    Giovanni De Rosa & Ivana Sarotto

  4. Department of Gynecological Oncology, Institute for Cancer Research and Treatment, Candiolo, Torino, Italy

    Riccardo Ponzone, Nicoletta Biglia & Piero Sismondi

  5. Department of Radiation Therapy, Institute for Cancer Research and Treatment, Candiolo, Torino, Italy

    Marco Gatti

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  1. Laura Martincich
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  2. Filippo Montemurro
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  3. Giovanni De Rosa
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  4. Vincenzo Marra
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Martincich, L., Montemurro, F., De Rosa, G. et al. Monitoring Response to Primary Chemotherapy in Breast Cancer using Dynamic Contrast-enhanced Magnetic Resonance Imaging. Breast Cancer Res Treat 83, 67–76 (2004). https://doi.org/10.1023/B:BREA.0000010700.11092.f4

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