Contrast-Enhanced Spectral Mammography is Comparable to MRI in the Assessment of Residual Breast Cancer Following Neoadjuvant Systemic Therapy
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).
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.
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.
CESM was comparable to MRI in assessing residual malignancy after completion of NST.
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.
- 1.Bear HD, Anderson S, Smith RE, Geyer CE Jr, Mamounas EP, Fisher B, et al. Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer:National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol. 2006;24(13):2019–27.CrossRefPubMedGoogle Scholar
- 5.Marinovich ML, Macaskill P, Irwig L, Sardanelli F, Mamounas E, von Minckwitz G, et al. Agreement between MRI and pathologic breast tumor size after neoadjuvant chemotherapy, and comparison with alternative tests: individual patient data meta-analysis. Bmc Cancer. 2015;15(1):662.CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Shin HJ, Kim HH, Ahn JH, Kim SB, Jung KH, Gong G, et al. Comparison of mammography, sonography, MRI and clinical examination in patients with locally advanced or inflammatory breast cancer who underwent neoadjuvant chemotherapy. Br J Radiol. 2011;84(1003):612–20.Google Scholar
- 16.Lobbes MB, Prevos R, Smidt M, Tjan-Heijnen VC, van Goethem M, Schipper R, et al. The role of magnetic resonance imaging in assessing residual disease and pathologic complete response in breast cancer patients receiving neoadjuvant chemotherapy: a systematic review. Insights Imaging. 2013;4(2):163–75.CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Millet I, Pages E, Hoa D, Merigeaud S, Curros Doyon F, Prat X, et al. Pearls and pitfalls in breast MRI. Br J Radiol. 2012;85(1011):197–207.Google Scholar
- 19.Jochelson MS, Dershaw DD, Sung JS, Heerdt AS, Thornton C, Moskowitz CS, et al. Bilateral contrast-enhanced dual-energy digital mammography: feasibility and comparison with conventional digital mammography and MR imaging in women with known breast carcinoma. Radiology. 2013;266(3):743–51.CrossRefPubMedPubMedCentralGoogle Scholar