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Contrast-Enhanced Spectral Mammography is Comparable to MRI in the Assessment of Residual Breast Cancer Following Neoadjuvant Systemic Therapy

Annals of Surgical Oncology volume 25, pages 1350–1356 (2018)Cite this article

Abstract

Purpose

To evaluate the performance of contrast-enhanced spectral mammography (CESM) compared to MRI in the assessment of tumor response in breast cancer patients undergoing neoadjuvant systemic therapy (NST).

Methods

The institutional review board approved this study. From September 2014 to June 2017, we identified patients with pathologically confirmed invasive breast cancer who underwent NST. All patients had both CESM and MRI performed pre- and post-NST with pathological assessment after surgical management. Size of residual malignancy on post-NST CESM and MRI was compared with surgical pathology. Lin concordance and Pearson correlation coefficient were used to assess agreement. Bland–Altman plots were used to visualize the differences between tumor size on imaging and pathology.

Results

Sixty-five patients were identified. Mean age was 52.7 (range 30–76) years. Type of NST included chemotherapy in 53 (82%) and endocrine therapy in 12 (18%). Mean tumor size after NST was 14.6 (range 0–105) mm for CESM and 14.2 mm (range 0–75 mm) for MRI compared with 19.6 (range 0–100) mm on final surgical pathology. Equivalence tests demonstrated that mean tumor size measured by CESM (p = 0.009) or by MRI (p = 0.01) was equivalent to the mean tumor size measured by pathology within − 1 and 1-cm range. Comparing CESM versus MRI for assessment of complete response, the sensitivity was 95% versus 95%, specificity 66.7% versus 68.9%, positive predictive value 55.9% versus 57.6%, and negative predictive value 96.7% versus 96.9% respectively.

Conclusions

CESM was comparable to MRI in assessing residual malignancy after completion of NST.

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Fig. 1

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Acknowledgment

The authors thank Jennifer Palmieri, RT, and MaryAnn McDonough, RT, for help with data collection, Diana Almader-Douglas for help with literature search, and Marissa Pacheco and Yania Lopez-Alvarez, MD, for help with data analysis.

Conflict of interest

All authors attest that there is no conflict of interest in the publication of this manuscript.

Author information

Affiliations

  1. Department of Radiology, Mayo Clinic, Phoenix, AZ, USA

    Bhavika K. Patel MD & Matthew Covington MD

  2. Department of Internal Medicine, Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ, USA

    Talal Hilal MD & Donald W. Northfelt MD

  3. Department of Health Sciences Research, BioStatistics, Mayo Clinic, Phoenix, AZ, USA

    Nan Zhang MS & Heidi E. Kosiorek MS

  4. Department of Radiology, Maastricht University Medical Center, Masstricht, The Netherlands

    Marc Lobbes MD, PhD

  5. Department of Surgery, Mayo Clinic, Phoenix, AZ, USA

    Barbara A. Pockaj MD

Authors
  1. Bhavika K. Patel MD
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  2. Talal Hilal MD
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  3. Matthew Covington MD
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  4. Nan Zhang MS
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  5. Heidi E. Kosiorek MS
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  6. Marc Lobbes MD, PhD
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  7. Donald W. Northfelt MD
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  8. Barbara A. Pockaj MD
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Corresponding author

Correspondence to Talal Hilal MD.

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Patel, B.K., Hilal, T., Covington, M. et al. Contrast-Enhanced Spectral Mammography is Comparable to MRI in the Assessment of Residual Breast Cancer Following Neoadjuvant Systemic Therapy. Ann Surg Oncol 25, 1350–1356 (2018). https://doi.org/10.1245/s10434-018-6413-x

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  • DOI: https://doi.org/10.1245/s10434-018-6413-x

Keywords

  • Contrast-enhanced Spectral Mammography (CESM)
  • Neoadjuvant Systemic Therapy (NST)
  • Breast Cancer
  • Residual Malignancy
  • Underestimated Tumor Size