Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Evaluation of Post-Neoadjuvant Chemotherapy Pathologic Complete Response and Residual Tumor Size of Breast Cancer: Analysis on Accuracy of MRI and Affecting Factors

신보강화학요법 후 유방암의 병리학적 완전 관해 예측 및 잔류 암 평가: 유방자기공명영상의 정확도 및 영향인자 분석

  • Hyun Soo Ahn (Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Yeong Yi An (Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Ye Won Jeon (Department of Surgery, Division of Breast & Thyroid Surgical Oncology, College of Medicine, The Catholic University of Korea) ;
  • Young Jin Suh (Department of Surgery, Division of Breast & Thyroid Surgical Oncology, College of Medicine, The Catholic University of Korea) ;
  • Hyun-Joo Choi (Department of Pathology, College of Medicine, The Catholic University of Korea)
  • 안현수 (가톨릭대학교 의과대학 성빈센트병원 영상의학과) ;
  • 안영이 (가톨릭대학교 의과대학 성빈센트병원 영상의학과) ;
  • 전예원 (가톨릭대학교 의과대학 외과 유방갑상선종양분과) ;
  • 서영진 (가톨릭대학교 의과대학 외과 유방갑상선종양분과) ;
  • 최현주 (가톨릭대학교 의과대학 병리과)
  • Received : 2020.06.11
  • Accepted : 2020.08.11
  • Published : 2021.05.01
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Abstract

Purpose To evaluate the accuracy of MRI in predicting the pathological complete response (pCR) and the residual tumor size of breast cancer after neoadjucant chemotherapy (NAC), and to determine the factors affecting the accuarcy. Materials and Methods Eighty-eight breast cancer patients who underwent surgery after NAC at our center between 2010 and 2017 were included in this study. pCR was defined as the absence of invasive cancer on pathological evaluation. The maximum diameter of the residual tumor on post-NAC MRI was compared with the tumor size of the surgical specimen measured pathologically. Statistical analysis was performed to elucidate the factors affecting pCR and the residual tumor size-discrepancy between the MRI and the pathological measurements. Results The pCR rate was 10%. The diagnostic accuracy of MRI and the area under the curve for predicting pCR were 90.91% and 0.8017, respectively. The residual tumor sizes obtained using MRI and pathological measurements showed a strong correlation (r = 0.9, p < 0.001), especially in patients with a single mass lesion (p = 0.047). The size discrepancy between MRI and the pathological measurements was significantly greater in patients with the luminal type (p = 0.023) and multifocal tumors/non-mass enhancement on pre-NAC MRI (p = 0.047). Conclusion MRI is an accurate tool for evaluating pCR and residual tumor size in breast cancer patients who receive NAC. Tumor subtype and initial MRI features affect the accuracy of MRI.

목적 신보강화학요법을 시행한 유방암 환자에서 병리학적 관해와 잔류 암의 크기를 평가하는 데 있어 유방자기공명영상의 정확도를 분석하고 이에 영향을 미치는 인자들이 무엇인지 알아본다. 대상과 방법 2010년부터 2017년까지 본원에서 신보강화학요법 후 수술을 시행한 88명의 유방암 환자를 대상으로 하였다. 병리학적 관해는 수술 병리 결과에서 침윤성 유방암이 발견되지 않는 것으로 정의하였고 자기공명영상과 병리 조직의 잔류 암 크기 차이는 최대 직경으로 비교하였다. 병리학적 관해 및 자기공명영상과 병리 조직에서의 잔류 암 크기 차이에 영향을 미치는 인자를 알아보기 위해 통계분석을 시행하였다. 결과 전체 환자의 10%가 병리학적 관해에 도달하였다. 자기공명영상으로 관해를 예측할 때의 정확도와 곡선하부면적은 각각 90.91%, 0.8017이었다. 신보강화학요법 시행 후 유방자기 공명영상과 병리 조직에서 측정한 잔류 암의 크기는 매우 강한 연관성을 보였고(r = 0.9, p < 0.001), 특히 영상에서 단일 종괴로 보였던 병변에서(p = 0.047) 그러하였다. 자기공명영상과 병리 조직 간의 잔류 암 크기는 내강형(p = 0.023), 그리고 자기공명영상에서 다초점 종괴 및 비종괴성 조영증강을 보인(p = 0.047) 환자군에서 유의미하게 큰 차이를 보였다. 결론 자기공명영상은 유방암의 병리학적 완전 관해와 잔류 암 크기의 평가에 있어서 정확도가 높은 검사이다. 유방암 아형과 병변의 영상의학적 소견이 자기공명영상의 정확도에 영향을 미친다.

Keywords

References

  1. Mauri D, Pavlidis N, Ioannidis JP. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a metaanalysis. J Natl Cancer Inst 2005;97:188-194
  2. Trop I, LeBlanc SM, David J, Lalonde L, Tran-Thanh D, Labelle M, et al. Molecular classification of infiltrating breast cancer: toward personalized therapy. Radiographics 2014;34:1178-1195
  3. Kaufmann M, Von Minckwitz G, Bear HD, Buzdar A, McGale P, Bonnefoi H, et al. Recommendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer: new perspectives 2006. Ann Oncol 2007;18:1927-1934
  4. Mathew J, Asgeirsson KS, Cheung KL, Chan S, Dahda A, Robertson JF. Neoadjuvant chemotherapy for locally advanced breast cancer: a review of the literature and future directions. Eur J Surg Oncol 2009;35:113-122
  5. Rauch GM, Adrada BE, Kuerer HM, Van la Parra RF, Leung JW, Yang WT. Multimodality imaging for evaluating response to neoadjuvant chemotherapy in breast cancer. AJR Am J Roentgenol 2017;208:290-299
  6. Chagpar AB, Middleton LP, Sahin AA, Dempsey P, Buzdar AU, Mirza AN, et al. Accuracy of physical examination, ultrasonography, and mammography in predicting residual pathologic tumor size in patients treated with neoadjuvant chemotherapy. Ann Surg 2006;243:257-264
  7. Fangberget A, Nilsen LB, Hole KH, Holmen MM, Engebraaten O, Naume B, et al. Neoadjuvant chemotherapy in breast cancer-response evaluation and prediction of response to treatment using dynamic contrast-enhanced and diffusion-weighted MR imaging. Eur Radiol 2011;21:1188-1199
  8. Marinovich ML, Houssami N, Macaskill P, Sardanelli F, Irwig L, Mamounas EP, et al. Meta-analysis of magnetic resonance imaging in detecting residual breast cancer after neoadjuvant therapy. J Natl Cancer Inst 2013;105:321-333
  9. Montemurro F, Martincich L, De Rosa G, Cirillo S, Marra V, Biglia N, et al. Dynamic contrast-enhanced MRI and sonography in patients receiving primary chemotherapy for breast cancer. Eur Radiol 2005;15:1224-1233
  10. McGuire KP, Toro-Burguete J, Dang H, Young J, Soran A, Zuley M, et al. MRI staging after neoadjuvant chemotherapy for breast cancer: does tumor biology affect accuracy? Ann Surg Oncol 2011;18:3149-3154
  11. Bae MS, Shin SU, Ryu HS, Han W, Im SA, Park IA, et al. Pretreatment MR imaging features of triple-negative breast cancer: association with response to neoadjuvant chemotherapy and recurrence-free survival. Radiology 2016;281:392-400
  12. Esserman L, Kaplan E, Partridge S, Tripathy D, Rugo H, Park J, et al. MRI phenotype is associated with response to doxorubicin and cyclophosphamide neoadjuvant chemotherapy in stage III breast cancer. Ann Surg Oncol 2001;8:549-559
  13. Colleoni M, Viale G, Zahrieh D, Pruneri G, Gentilini O, Veronesi P, et al. Chemotherapy is more effective in patients with breast cancer not expressing steroid hormone receptors: a study of preoperative treatment. Clin Cancer Res 2004;10:6622-6628
  14. Houssami N, Macaskill P, Von Minckwitz G, Marinovich ML, Mamounas E. Meta-analysis of the association of breast cancer subtype and pathologic complete response to neoadjuvant chemotherapy. Eur J Cancer 2012;48:3342-3354
  15. Kawashima H, Inokuchi M, Furukawa H, Ikeda H, Kitamura S. Magnetic resonance imaging features of breast cancer according to intrinsic subtypes: correlations with neoadjuvant chemotherapy effects. Springerplus 2014;3:240
  16. Ballesio L, Gigli S, Di Pastena F, Giraldi G, Manganaro L, Anastasi E, et al. Magnetic resonance imaging tumor regression shrinkage patterns after neoadjuvant chemotherapy in patients with locally advanced breast cancer: correlation with tumor biological subtypes and pathological response after therapy. Tumour Biol 2017;39:1010428317694540
  17. Eom HJ, Cha JH, Choi WJ, Chae EY, Shin HJ, Kim HH. Predictive clinicopathologic and dynamic contrast-enhanced MRI findings for tumor response to neoadjuvant chemotherapy in triple-negative breast cancer. AJR Am J Roentgenol 2017;208:W225-W230
  18. De Los Santos J, Bernreuter W, Keene K, Krontiras H, Carpenter J, Bland K, et al. Accuracy of breast magnetic resonance imaging in predicting pathologic response in patients treated with neoadjuvant chemotherapy. Clin Breast Cancer 2011;11:312-319
  19. Chen JH, Feig B, Agrawal G, Yu H, Carpenter PM, Mehta RS, et al. MRI evaluation of pathologically complete response and residual tumors in breast cancer after neoadjuvant chemotherapy. Cancer 2008;112:17-26
  20. De Los Santos JF, Cantor A, Amos KD, Forero A, Golshan M, Horton JK, et al. Magnetic resonance imaging as a predictor of pathologic response in patients treated with neoadjuvant systemic treatment for operable breast cancer. Translational Breast Cancer Research Consortium trial 017. Cancer 2013;119:1776-1783
  21. Hayashi Y, Takei H, Nozu S, Tochigi Y, Ichikawa A, Kobayashi N, et al. Analysis of complete response by MRI following neoadjuvant chemotherapy predicts pathological tumor responses differently for molecular subtypes of breast cancer. Oncol Lett 2013;5:83-89
  22. Ko ES, Han BK, Kim RB, Ko EY, Shin JH, Hahn SY, et al. Analysis of factors that influence the accuracy of magnetic resonance imaging for predicting response after neoadjuvant chemotherapy in locally advanced breast cancer. Ann Surg Oncol 2013;20:2562-2568
  23. Loo CE, Straver ME, Rodenhuis S, Muller SH, Wesseling J, Vrancken Peeters MJ, et al. Magnetic resonance imaging response monitoring of breast cancer during neoadjuvant chemotherapy: relevance of breast cancer subtype. J Clin Oncol 2011;29:660-666
  24. Kim HJ, Im YH, Han BK, Choi N, Lee J, Kim JH, et al. Accuracy of MRI for estimating residual tumor size after neoadjuvant chemotherapy in locally advanced breast cancer: relation to response patterns on MRI. Acta Oncol 2007;46:996-1003
  25. Bouzon A, Acea B, Soler R, Iglesias A, Santiago P, Mosquera J, et al. Diagnostic accuracy of MRI to evaluate tumour response and residual tumour size after neoadjuvant chemotherapy in breast cancer patients. Radiol Oncol 2016;50:73-79
  26. Akashi-Tanaka S, Fukutomi T, Watanabe T, Katsumata N, Nanasawa T, Matsuo K, et al. Accuracy of contrast-enhanced computed tomography in the prediction of residual breast cancer after neoadjuvant chemotherapy. Int J Cancer 2001;96:66-73
  27. Belli P, Costantini M, Malaspina C, Magistrelli A, LaTorre G, Bonomo L. MRI accuracy in residual disease evaluation in breast cancer patients treated with neoadjuvant chemotherapy. Clin Radiol 2006;61:946-953
  28. Rosen EL, Blackwell KL, Baker JA, Soo MS, Bentley RC, Yu D, et al. Accuracy of MRI in the detection of residual breast cancer after neoadjuvant chemotherapy. AJR Am J Roentgenol 2003;181:1275-1282
  29. Yeh E, Slanetz P, Kopans DB, Rafferty E, Georgian-Smith D, Moy L, et al. Prospective comparison of mammography, sonography, and MRI in patients undergoing neoadjuvant chemotherapy for palpable breast cancer. AJR Am J Roentgenol 2005;184:868-877
  30. Bahri S, Chen JH, Mehta RS, Carpenter PM, Nie K, Kwon SY, et al. Residual breast cancer diagnosed by MRI in patients receiving neoadjuvant chemotherapy with and without bevacizumab. Ann Surg Oncol 2009;16:1619-1628
  31. Partridge SC, Gibbs JE, Lu Y, Esserman LJ, Sudilovsky D, Hylton NM. Accuracy of MR imaging for revealing residual breast cancer in patients who have undergone neoadjuvant chemotherapy. AJR Am J Roentgenol 2002;179:1193-1199
  32. Jeon YW, Kim TH, Youn HJ, Han S, Jung Y, Gwak G, et al. Multicenter phase II trial of neoadjuvant chemotherapy with docetaxel and gemcitabine in locally advanced breast cancer. J Breast Cancer 2017;20:340-346
  33. Schrading S, Kuhl CK. Breast cancer: influence of taxanes on response assessment with dynamic contrast-enhanced MR imaging. Radiology 2015;277:687-696