Fax: (205) 978-3928
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
Article first published online: 21 FEB 2013
Copyright © 2013 American Cancer Society
Volume 119, Issue 10, pages 1776–1783, 15 May 2013
How to Cite
De Los Santos, J. F., Cantor, A., Amos, K. D., Forero, A., Golshan, M., Horton, J. K., Hudis, C. A., Hylton, N. M., McGuire, K., Meric-Bernstam, F., Meszoely, I. M., Nanda, R. and Hwang, E. S. (2013), Magnetic resonance imaging as a predictor of pathologic response in patients treated with neoadjuvant systemic treatment for operable breast cancer. Cancer, 119: 1776–1783. doi: 10.1002/cncr.27995
We are grateful to all of the patients who were included in this study and to the Translational Breast Cancer Research Consortium investigators and data managers for their efforts. We are very appreciative of funding support from the Translational Breast Cancer Research Consortium from the AVON Foundation, the Breast Cancer Research Foundation, and Susan G. Komen for the Cure. We gratefully acknowledge the American College of Radiology Imaging Network (ACRIN) for granting permission to include patients who were treated on the ACRIN 6657/I-SPY Trial (supported by National Cancer Institute grants U01 CA079778 and U01 CA080098).
- Issue published online: 6 MAY 2013
- Article first published online: 21 FEB 2013
- Manuscript Revised: 8 JAN 2013
- Manuscript Received: 15 OCT 2012
- Manuscript Accepted: 9 JAN 2012
- breast cancer;
- neoadjuvant chemotherapy;
- magnetic resonance imaging;
- pathologic complete response
Increased pathologic complete response (pCR) rates observed with neoadjuvant chemotherapy (NCT) for some subsets of patients with invasive breast cancer have prompted interest in whether patients who achieved a pCR can be identified preoperatively and potentially spared the morbidity of surgery. The objective of this multicenter, retrospective study was to estimate the accuracy of preoperative magnetic resonance imaging (MRI) in predicting a pCR in the breast.
MRI studies at baseline and after the completion of NCT plus data regarding pathologic response were collected retrospectively from 746 women who received treatment at 8 institutions between 2002 and 2011. Tumors were characterized by immunohistochemical phenotype into 4 categories based on receptor expression: hormone (estrogen and progesterone) receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative (n = 327), HR-positive/HER2-positive, (n = 148), HR-negative/HER2-positive, (n = 101), and triple-negative (HR-negative/HER2 negative; n = 155). In all, 194 of 249 patients (78%) with HER2-positive tumors received trastuzumab. Univariate and multivariate analyses of factors associated with radiographic complete response (rCR) and pCR were performed.
For the total group, the rCR and pCR rates were 182 of 746 patients (24%) and 179 of 746 patients (24%), respectively, and the highest pCR rate was observed for the triple-negative subtype (57 of 155 patients; 37%) and the HER2-positive subtype (38 of 101 patients; 38%). The overall accuracy of MRI for predicting pCR was 74%. The variables sensitivity, negative predictive value, positive predictive value, and accuracy differed significantly among tumor subtypes, and the greatest negative predictive value was observed in the triple-negative (60%) and HER2-positive (62%) subtypes.
The overall accuracy of MRI for predicting pCR in invasive breast cancer patients who were receiving NCT was 74%. The performance of MRI differed between subtypes, possibly influenced by differences in pCR rates between groups. Future studies will determine whether MRI in combination with directed core biopsy improves the predictive value of MRI for pathologic response. Cancer 2013. © 2013 American Cancer Society.