Annals of Surgical Oncology

, 18:3160 | Cite as

Accuracy of Clinical Examination, Digital Mammogram, Ultrasound, and MRI in Determining Postneoadjuvant Pathologic Tumor Response in Operable Breast Cancer Patients

  • Randal Croshaw
  • Hilary Shapiro-Wright
  • Erik Svensson
  • Kathleen Erb
  • Thomas Julian
American Society of Breast Surgeons



To determine the accuracy, positive predictive value (PPV), and negative predictive value (NPV) of clinical examination and breast imaging techniques in determining pathologic complete response in patients with locally advanced breast cancer after neoadjuvant therapy.


A retrospective review was performed of data collected from patients treated with either neoadjuvant hormonal or chemotherapy between January 2005 and September 2010. Patients were evaluated by one of three surgical breast oncologists before neoadjuvant therapy and within 1 month before surgery by clinical breast examination (CBE), digital mammogram, breast ultrasound, and/or magnetic resonance imaging (MRI). The accuracy, NPV, and PPV of each modality was calculated on the basis of the final pathologic report. Available data from the literature was synthesized.


Sixty-two tumors in 61 patients with a mean age of 56 (range 34–87) years were evaluated. Overall accuracy ranged from 54% (CBE) to 80% (breast ultrasound). All modalities had a PPV greater than 75% for identifying the presence of residual disease. The PPV of each modality was generally higher in the younger patients. The NPV of all methods was less than 50%. The accuracy and NPV were compromised even further in younger patients. The combination of our own data with data available from the literature revealed MRI to be superior with regard to accuracy and PPV, but the NPV of MRIs remained poor at 65%.


All measured tests are good at predicting the presence of disease on final pathology, but none are able to reliably predict a pathologic complete response.


  1. 1.
    Ring A, Webb A, Ashley S, et al. Is surgery necessary after complete clinical remission following neoadjuvant chemotherapy for early breast cancer? J Clin Oncol. 2003;21:4540–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Clouth B, Chandrasekharan S, Inwang R, Smith S, Davidson N, Sauven P. The surgical management of patients who achieve a complete pathological response after primary chemotherapy for locally advanced breast cancer. Eur J Surg Oncol. 2007;33:961–6.PubMedCrossRefGoogle Scholar
  3. 3.
  4. 4.
    Peintinger F, Kuerer HM, Anderson K, et al. Accuracy of the combination of mammography and sonography in predicting tumor response in breast cancer patients after neoadjuvant chemotherapy. Ann Surg Oncol. 2006;13:1443–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Segara D, Krop IE, Garber JE, et al. Does MRI predict pathologic tumor response in women with breast cancer undergoing preoperative chemotherapy? J Surg Oncol. 2007;96:474–80.PubMedCrossRefGoogle Scholar
  6. 6.
    Prati R, Minami CA, Gornbein JA, Debruhl N, Chung D, Chang HR. Accuracy of clinical evaluation of locally advanced breast cancer in patients receiving neoadjuvant chemotherapy. Cancer. 2009;115:1194–202.PubMedCrossRefGoogle Scholar
  7. 7.
    Altman DG, Bland JM. Diagnostic tests 1: sensitivity and specificity. BMJ. 1994;308:1552.PubMedGoogle Scholar
  8. 8.
    Altman DG, Bland JM. Diagnostic tests 2: predictive values. BMJ. 1994;309:102.PubMedGoogle Scholar
  9. 9.
    Guggenmoos-Holzmann I, van Houwelinger HC. The (in)validity of sensitivity and specificity. Stat Med. 2000;19:1783–92.PubMedCrossRefGoogle Scholar
  10. 10.
    Abraham DC, Jones RC, Jones SE, et al. Evaluation of neoadjuvant chemotherapeutic response of locally advanced breast cancer by magnetic resonance imaging. Cancer. 1996;78:91–100.PubMedCrossRefGoogle Scholar
  11. 11.
    Yeh E, Slanetz P, Kopans DB, et al. Prospective comparison of mammography, sonography, and MRI in patients undergoing neoadjuvant chemotherapy for palpable breast cancer. AJR Am J Roentgenol. 2005;184:868–77.PubMedGoogle Scholar
  12. 12.
    Schott AF, Roubidoux MA, Helvie MA, et al. Clinical and radiological assessments to predict breast cancer pathologic complete response to neoadjuvant chemotherapy. Breast Cancer Res. 2005;92:231–8.CrossRefGoogle Scholar
  13. 13.
    Chagpar AB, Middleton LP, Sahin AA, et al. Accuracy of physical examination, ultrasonography, and mammography in predicting residual pathologic tumor size in patients treated with neoadjuvant chemotherapy. Ann Surg. 2006;243:257–64.PubMedCrossRefGoogle Scholar
  14. 14.
    Chen JH, Feig B, Agrawal G, et al. MRI evaluation of pathologically complete response and residual tumors in breast cancer after neoadjuvant chemotherapy. Cancer. 2008;112:17–26.PubMedCrossRefGoogle Scholar
  15. 15.
    Bhattacharyya M, Ryan D, Carpenter R, Vinnicombe S, Gallagher CJ. Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer. Br J Cancer. 2008;98:289–93.PubMedCrossRefGoogle Scholar
  16. 16.
    Rouzier R, Extra JM, Carton M, et al. Primary chemotherapy for operable breast cancer: incidence and prognostic significance of ipsilateral breast tumor recurrence after breast-conserving surgery. J Clin Oncol. 2001;19:3828–35.PubMedGoogle Scholar
  17. 17.
    Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst. 2001;30:96–102.Google Scholar

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Randal Croshaw
    • 1
  • Hilary Shapiro-Wright
    • 2
  • Erik Svensson
    • 3
  • Kathleen Erb
    • 1
  • Thomas Julian
    • 1
    • 4
  1. 1.Department of Human Oncology, Division of Breast Surgical OncologyAllegheny General HospitalPittsburghUSA
  2. 2.St. Clare HospitalSSM HealthcareFentonUSA
  3. 3.Department of General SurgeryAllegheny General HospitalPittsburghUSA
  4. 4.National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations OfficePittsburghUSA

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