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Residual Breast Cancer Diagnosed by MRI in Patients Receiving Neoadjuvant Chemotherapy with and Without Bevacizumab

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the impact of antiangiogenic therapy with bevacizumab on pathological response and the diagnostic performance of magnetic resonance imaging (MRI) in breast cancer patients.

Methods

Thirty-six patients (aged 31–69 years) with breast cancer were included. Sixteen patients received neoadjuvant chemotherapy (NAC) containing bevacizumab, and 20 patients received the same NAC protocol without bevacizumab. Serial MRI studies were performed to evaluate response. All patients received surgery after completing NAC. The extent of residual disease was examined by histopathology, and classified into three types (pCR-pathologic complete response, confined nodules, and scattered cells). Fisher’s exact test and general logistic regression models were applied to analyze differences between two groups.

Results

pCR rates and residual disease (nodular and scattered cell) patterns were comparable between the two groups. The diagnostic accuracy rate of MRI (true positive and true negative) was 13/17 (76%) for patients with bevacizumab, and 14/20 (70%) for patients without bevacizumab. The size measured on MRI was accurate for mass lesions that shrank down to nodules, showing <0.7 cm discrepancy from pathological size. For residual disease presenting as scattered cells within a large fibrotic region, MRI could not predict them correctly, resulting in a high false-negative rate and a large size discrepancy.

Conclusion

The pathological response and the diagnostic performance of MRI are comparable between patients receiving NAC with and without bevacizumab. In both groups MRI has a limitation in detecting residual disease broken down to small foci and scattered cells/clusters. When MRI is used to evaluate the extent of residual disease for surgical treatment, the limitations, particularly for nonmass lesions, should be considered.

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Acknowledgement

This study was supported in part by NIH/NCI CA90437 and CA127927. The authors would also like to thank the referral physicians, Drs. John Butler, David Hsiang, Choong Baick, Karen Lane, the nurses, Donna Jackson and Toni Schubbert, and the study coordinator, Theresa Bergholz, for their assistance in this study.

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Authors and Affiliations

  1. Tu & Yuen Center for Functional Onco-Imaging, University of California, Irvine, CA, USA

    Shadfar Bahri MD, Jeon-Hor Chen MD, Ke Nie, Hon J. Yu PhD, Orhan Nalcioglu PhD & Min-Ying Su PhD

  2. Department of Radiology, China Medical University Hospital, Taichung, Taiwan

    Jeon-Hor Chen MD

  3. Department of Medicine, University of California, Irvine, CA, USA

    Rita S. Mehta MD

  4. Department of Pathology and Laboratory Medicine, University of California, Irvine, CA, USA

    Philip M. Carpenter MD & Soon-Young Kwon MD

  5. Department of Otolaryngology-Head and Neck Surgery, Korea University, Seoul, Republic of Korea

    Soon-Young Kwon MD

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  1. Shadfar Bahri MD
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Correspondence to Min-Ying Su PhD.

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Bahri, S., Chen, JH., Mehta, R.S. et al. Residual Breast Cancer Diagnosed by MRI in Patients Receiving Neoadjuvant Chemotherapy with and Without Bevacizumab. Ann Surg Oncol 16, 1619–1628 (2009). https://doi.org/10.1245/s10434-009-0441-5

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  • DOI: https://doi.org/10.1245/s10434-009-0441-5

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