Preoperative Breast Magnetic Resonance Imaging as a Predictor of Response to Neoadjuvant Chemotherapy

Abstract

Introduction: The ability to accurately predict pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in breast cancer would improve patient selection for specific treatment strategies, would provide important information for patients to aid in the treatment selection process, and could potentially avoid the need for more extensive surgery. The diagnostic performance of magnetic resonance imaging (MRI) in predicting pCR has previously been studied, with mixed results. Magnetic resonance imaging performance may also be influenced by tumour and patient factors.

Methods: Eighty-seven breast cancer patients who underwent NAC were studied. Pre-NAC and post-NAC MRI findings were compared with pathologic findings postsurgical excision. The impact of patient and tumour characteristics on MRI accuracy was evaluated.

Results: The mean (SD) age of participants was 48.7 (10.3) years. The rate of pCR based on post-NAC MRI was 19.5% overall (19/87). The sensitivity, specificity, positive predictive value (PPV), negative predictive value, and accuracy in predicting pCR were 52.9%, 77.1%, 36.0%, 87.1%, and 72.4%, respectively. Positive predictive value was the highest in nonluminal versus Luminal A disease (45.0% vs 25.0%, P < .001), with higher rates of false positivity in nonluminal subtypes (P = .002). Tumour grade, T category, and histological subtype were all independent predictors of MRI accuracy regarding post-NAC tumour size.

Conclusion: Magnetic resonance imaging alone is insufficient to accurately predict pCR in breast cancer patients post-NAC. Magnetic resonance imaging predictions of pCR are more accurate in nonluminal subtypes. Tumour grade, T category, and histological subtype should be considered when evaluating post-NAC tumour sizes.

Keywords: Breast cancer; MRI; grade; neoadjuvant chemotherapy; pathology.

Figure 1.

MRI indicates magnetic resonance imaging; NAC, neoadjuvant chemotherapy.

Figure 2.

HER2 indicates human epidermal growth factor 2; MRI, magnetic resonance imaging; NAC, neoadjuvant chemotherapy.

Figure 3.

Discrepancy between post-NAC tumour size as measured on MRI versus pathologic specimen based on molecular subtype (mm): (mean ± SD), Luminal A (25.5 ± 29.2), Luminal B (15.6 ± 11.1), HER2/neu (9.6 ± 12.9), and triple negative (7.6 ± 10.3). CI indicates confidence interval; HER2, human epidermal growth factor 2; MRI, magnetic resonance imaging; NAC, neoadjuvant chemotherapy.