Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jan 31;21(1):19.
doi: 10.1186/s13058-018-1091-y.

Radiologic complete response (rCR) in contrast-enhanced magnetic resonance imaging (CE-MRI) after neoadjuvant chemotherapy for early breast cancer predicts recurrence-free survival but not pathologic complete response (pCR)

Simon Peter Gampenrieder  1   2 , Andreas Peer  1 , Christian Weismann  3 , Matthias Meissnitzer  3 , Gabriel Rinnerthaler  1   2 , Johanna Webhofer  1 , Theresa Westphal  1 , Marina Riedmann  4 , Thomas Meissnitzer  3 , Heike Egger  3 , Frederike Klaassen Federspiel  5 , Roland Reitsamer  5 , Cornelia Hauser-Kronberger  6 , Katharina Stering  6 , Klaus Hergan  3 , Brigitte Mlineritsch  1 , Richard Greil  7   8
Affiliations

Radiologic complete response (rCR) in contrast-enhanced magnetic resonance imaging (CE-MRI) after neoadjuvant chemotherapy for early breast cancer predicts recurrence-free survival but not pathologic complete response (pCR)

Simon Peter Gampenrieder et al. Breast Cancer Res. .

Abstract

Background: Patients with early breast cancer (EBC) achieving pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT) have a favorable prognosis. Breast surgery might be avoided in patients in whom the presence of residual tumor can be ruled out with high confidence. Here, we investigated the diagnostic accuracy of contrast-enhanced MRI (CE-MRI) in predicting pCR and long-term outcome after NACT.

Methods: Patients with EBC, including patients with locally advanced disease, who had undergone CE-MRI after NACT, were retrospectively analyzed (n = 246). Three radiologists, blinded to clinicopathologic data, reevaluated all MRI scans regarding to the absence (radiologic complete remission; rCR) or presence (no-rCR) of residual contrast enhancement. Clinical and pathologic responses were compared categorically using Cohen's kappa statistic. The Kaplan-Meier method was used to estimate recurrence-free survival (RFS) and overall survival (OS).

Results: Overall rCR and pCR (no invasive tumor in the breast and axilla (ypT0/is N0)) rates were 45% (111/246) and 29% (71/246), respectively. Only 48% (53/111; 95% CI 38-57%) of rCR corresponded to a pCR (= positive predictive value - PPV). Conversely, in 87% (117/135; 95% CI 79-92%) of patients, residual tumor observed on MRI was pathologically confirmed (= negative predictive value - NPV). Sensitivity to detect a pCR was 75% (53/71; 95% CI 63-84%), while specificity to detect residual tumor and accuracy were 67% (117/175; 95% CI 59-74%) and 69% (170/246; 95% CI 63-75%), respectively. The PPV was significantly lower in hormone-receptor (HR)-positive compared to HR-negative tumors (17/52 = 33% vs. 36/59 = 61%; P = 0.004). The concordance between rCR and pCR was low (Cohen's kappa - 0.1), however in multivariate analysis both assessments were significantly associated with RFS (rCR P = 0.037; pCR P = 0.033) and OS (rCR P = 0.033; pCR P = 0.043).

Conclusion: Preoperative CE-MRI did not accurately predict pCR after NACT for EBC, especially not in HR-positive tumors. However, rCR was strongly associated with favorable RFS and OS.

Keywords: Breast cancer; MRI; Neoadjuvant chemotherapy; Prediction of complete pathologic response; Survival.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Ethics Committee of the province Salzburg, which waived the requirement to obtain informed consent (IRB number: 415-EP/73/648–2016).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram. NACT, neoadjuvant chemotherapy; MRI, magnetic resonance imaging; CE-MRI, contrast-enhanced magnetic resonance imaging; pCR, pathologic complete response
Fig. 2
Fig. 2
Cross-tabulation with numbers and percentages (in brackets) for radiologic complete response (rCR)/no rCR and pathologic complete response (pCR)/no pCR for the whole cohort
Fig. 3
Fig. 3
Cross-tabulation with numbers and percentages (in brackets) for radiologic complete response (rCR)/no rCR and pathologic complete response (pCR)/no pCR for breast cancer subtypes
Fig. 4
Fig. 4
Kaplan-Meier curves for recurrence-free survival according to pathologic complete response (pCR) (a) and radiologic complete response (rCR) (b) after neoadjuvant chemotherapy
Fig. 5
Fig. 5
Kaplan-Meier curves for recurrence-free survival (RFS) (a) and oveall survival (OS) (b) according to pathologic complete response (pCR) and radiologic complete response (rCR), respectively. Patients achieving both pCR and rCR (n = 53) had an excellent prognosis for both RFS (1 event) and overall survival (0 events). Patients achieving a pCR but no rCR (n = 18) had a significantly higher risk of recurrence (4 events), but not of death (1 event)
Fig. 6
Fig. 6
Kaplan-Meier curves for recurrence-free survival (a) and overall survival (b) according to radiologic response. rCR, radiologic complete response; rPR, radiologic partial response; rSD, radiologic stable disease; rPD, radiologic progressive disease
See this image and copyright information in PMC

References

    1. Chen XS, Yuan Y, Garfield DH, Wu JY, Huang O, Shen KW. Both carboplatin and bevacizumab improve pathological complete remission rate in neoadjuvant treatment of triple negative breast cancer: a meta-analysis. PLoS One. 2014;9(9):e108405. doi: 10.1371/journal.pone.0108405. - DOI - PMC - PubMed
    1. Schneeweiss A, Chia S, Hickish T, Harvey V, Eniu A, Hegg R, Tausch C, Seo JH, Tsai YF, Ratnayake J, et al. Pertuzumab plus trastuzumab in combination with standard neoadjuvant anthracycline-containing and anthracycline-free chemotherapy regimens in patients with HER2-positive early breast cancer: a randomized phase II cardiac safety study (TRYPHAENA) Ann Oncol. 2013;24(9):2278–2284. doi: 10.1093/annonc/mdt182. - DOI - PubMed
    1. Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, Bonnefoi H, Cameron D, Gianni L, Valagussa P, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014;384(9938):164–172. doi: 10.1016/S0140-6736(13)62422-8. - DOI - PubMed
    1. EBCTCG Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol. 2018;19(1):27–39. doi: 10.1016/S1470-2045(17)30777-5. - DOI - PMC - PubMed
    1. Curigliano G, Burstein HJ, E PW, Gnant M, Dubsky P, Loibl S, Colleoni M, Regan MM, Piccart-Gebhart M, Senn HJ, et al. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Ann Oncol. 2017;28(8):1700–1712. doi: 10.1093/annonc/mdx308. - DOI - PMC - PubMed

Publication types

MeSH terms