Accuracy of MRI in the detection of residual breast cancer after neoadjuvant chemotherapy.
01 Nov 2003-American Journal of Roentgenology (American Roentgen Ray Society)-Vol. 181, Iss: 5, pp 1275-1282
TL;DR: MRI can show residual malignancy after neoadjuvant chemotherapy better than physical examination, particularly in patients who have not had a complete clinical response to therapy.
Abstract: OBJECTIVE. This study was undertaken to evaluate the ability of MRI to accurately show residual primary breast malignancy in women treated with neoadjuvant chemotherapy.MATERIALS AND METHODS. Twenty-one patients with locally advanced primary breast carcinoma underwent contrast-enhanced MRI before and after treatment with neoadjuvant anthracycline-based chemotherapy. For each patient, the maximum extent of the MRI abnormality was measured both before and after treatment. These measurements were subsequently compared with physical examination findings and histologic results to determine the ability of MRI to accurately reveal tumor extent after neoadjuvant chemotherapy.RESULTS. MRI after chemotherapy showed a correlation coefficient of 0.75 with histology, which was better than physical examination (r = 0.61). MRI underestimated the extent of residual tumor in two patients by more than 1 cm (including one false-negative examination), was within 1 cm in 12 of 21 patients, and overestimated tumor extent by mo...
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University of Milan1, Maastricht University2, University of Geneva3, University of Modena and Reggio Emilia4, University of Aberdeen5, Medical University of Vienna6, University of Jena7, National University of Ireland, Galway8, University of Wales9, Argonne National Laboratory10, VU University Amsterdam11, European Institute of Oncology12, Guy's and St Thomas' NHS Foundation Trust13, Medical University of Graz14, Curie Institute15, The Royal Marsden NHS Foundation Trust16
TL;DR: The working group strongly suggests that all breast cancer specialists cooperate for an optimal clinical use of this emerging technology and for future research, focusing on patient outcome as primary end-point.
822 citations
TL;DR: MR imaging findings are a stronger predictor of pathologic response to NACT than clinical assessment, with the greatest advantage observed with the use of volumetric measurement of tumor response early in treatment.
Abstract: MR imaging findings are a stronger predictor of pathologic response after neoadjuvant chemotherapy than clinical assessment, with the greatest advantage observed with the use of volumetric measurement of tumor response early in treatment.
404 citations
TL;DR: An overview of the use of breast MR imaging in clinical patient care, the body of evidence that supports its use and a discussion is provided on the many controversies that exist regarding breast MR Imaging for preoperative staging and for screening.
Abstract: Magnetic resonance (MR) imaging is emerging as the most sensitive modality that is currently available for the detection of primary or recurrent breast cancer. Although this technique has been shown to be an extremely powerful diagnostic tool, it is still relatively rarely used in clinical practice, as compared with other applications of MR imaging such as for musculoskeletal or brain and spine imaging. This is the second of a two-part series on the current status of breast MR. Part two provides an overview of the use of breast MR imaging in clinical patient care, the body of evidence that supports its use. A discussion is provided on the many controversies that exist regarding breast MR imaging for preoperative staging and for screening.
369 citations
TL;DR: It is shown that neoadjuvant chemotherapy for early breast cancer can avoid mastectomy by shrinkage of tumour volume and the likelihood of recurrence is reduced.
Abstract: Background:
Neoadjuvant chemotherapy for early breast cancer can avoid mastectomy by shrinkage of tumour volume This review assesses the effectiveness of neoadjuvant chemotherapy on clinical outcome
Methods:
All randomized trials comparing neoadjuvant and adjuvant chemotherapy for early breast cancer were reviewed systematically and meta-analyses were performed
Results:
Fourteen studies randomizing 5500 women were eligible for analysis Overall survival was equivalent in both groups In the neoadjuvant group, the mastectomy rate was lower (relative risk 0·71 (95 per cent confidence interval (ci) 0·67 to 0·75)) without hampering local control (hazard ratio 1·12 (95 per cent ci 0·92 to 1·37)) Neoadjuvant chemotherapy was associated fewer adverse effects
Conclusion:
Neoadjuvant chemotherapy is an established treatment option for early breast cancer Copyright © 2007 British Journal of Surgery Society Ltd Published by John Wiley & Sons, Ltd
348 citations
TL;DR: In this paper, a review examines IBC's unique clinical presentation, pathology, epidemiology, imaging, and biology and details current multidisciplinary management of the disease, which comprises systemic therapy, surgery, and radiation therapy.
Abstract: Inflammatory breast cancer (IBC) is a rare and aggressive form of invasive breast cancer accounting for 2.5% of all breast cancer cases. It is characterized by rapid progression, local and distant metastases, younger age of onset, and lower overall survival compared with other breast cancers. Historically, IBC is a lethal disease with less than a 5% survival rate beyond 5 years when treated with surgery or radiation therapy. Because of its rarity, IBC is often misdiagnosed as mastitis or generalized dermatitis. This review examines IBC's unique clinical presentation, pathology, epidemiology, imaging, and biology and details current multidisciplinary management of the disease, which comprises systemic therapy, surgery, and radiation therapy.
312 citations
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TL;DR: Preoperative therapy reduced the size of most breast tumors and decreased the incidence of positive nodes in women with primary breast cancer and should be considered for the initial management of breast tumors judged too large for lumpectomy.
Abstract: PURPOSETo determine whether preoperative doxorubicin and cyclophosphamide (AC) permits more lumpectomies to be performed and decreases the incidence of positive nodes in women with primary breast cancer.PATIENTS AND METHODSWomen (n = 1,523) were randomized to National Surgical Adjuvant Breast and Bowel Project (NSABP) B-18; 759 eligible patients received postoperative AC and 747, preoperative AC. The clinical size of breast and axillary tumors was determined before each of four cycles of AC and before surgery. Tumor response to preoperative therapy was clinically complete (cCR), partial (cPR), stable (cSD), or progressive disease (cPD). Tissue from patients with a cCR was evaluated for a pathologic complete response (pCR).RESULTSBreast tumor size was reduced in 80% of patients after preoperative therapy; 36% had a cCR. Tumor size and clinical nodal status were independent predictors of cCR. Twenty-six percent of women with a cCR had a pCR. Clinical nodal response occurred in 89% of node-positive patients:...
1,677 citations
TL;DR: Marginally statistically significant treatment-by-age interactions appear to be emerging for survival and DFS, suggesting that younger patients may benefit from preoperative therapy, whereas the reverse may be true for older patients.
Abstract: National Surgical Adjuvant Breast and Bowel Project (NSABP) Protocol B-18 was initiated in 1988 to determine whether four cycles of doxorubicin/cyclophosphamide given preoperatively improve survival and disease-free survival (DFS) when compared with the same chemotherapy given postoperatively. Secondary aims included the evaluation of preoperative chemotherapy in downstaging the primary breast tumor and involved axillary lymph nodes, the comparison of lumpectomy rates and rates of ipsilateral breast tumor recurrence (IBTR) in the two treatment groups, and the assessment of the correlation between primary tumor response and outcome. Initially published findings were based on a follow-up of 5 years; this report updates results through 9 years of follow-up. There continue to be no statistically significant overall differences in survival or DFS between the two treatment groups. Survival at 9 years is 70% in the postoperative group and 69% in the preoperative group (P =.80). DFS is 53% in postoperative patients and 55% in preoperative patients (P =.50). A statistically significant correlation persists between primary tumor response and outcome, and this correlation has become statistically stronger with longer follow-up. Patients assigned to preoperative chemotherapy received notably more lumpectomies than postoperative patients, especially among patients with tumors greater than 5 cm at study entry. Although the rate of IBTR was slightly higher in the preoperative group (10.7% versus 7.6%), this difference was not statistically significant. Marginally statistically significant treatment-by-age interactions appear to be emerging for survival and DFS, suggesting that younger patients may benefit from preoperative therapy, whereas the reverse may be true for older patients.
1,194 citations
TL;DR: The use of preoperative chemotherapy yields similar results in terms of PFS, OS, and locoregional control compared with conventional postoperative chemotherapy and enables more patients to be treated with breast-conserving surgery.
Abstract: PURPOSE: To evaluate whether preoperative neoadjuvant chemotherapy in patients with primary operable breast cancer results in better overall survival (OS) and relapse-free survival rates and whether preoperative chemotherapy permits more breast-conserving surgery procedures than postoperative chemotherapy. PATIENTS AND METHODS: Six hundred ninety-eight breast cancer patients (T1c, T2, T3, T4b, N0 to 1, and M0) were enrolled onto a randomized phase III trial that compared four cycles of fluorouracil, epirubicin, and cyclophosphamide administered preoperatively versus the same regimen administered postoperatively (the first cycle administered within 36 hours after surgery). Patients were followed up for OS, progression-free survival (PFS), and locoregional recurrence (LRR). RESULTS: At a median follow-up of 56 months, there was no significant difference in terms of OS (hazards ratio, 1.16; P = .38), PFS (hazards ratio, 1.15; P = .27), and time to LRR (hazards ratio, 1.13; P = .61). Fifty-seven patients (23%...
1,001 citations
TL;DR: This review summarizes the basic principles that govern the relationships between thermal exposure (temperature and time of exposure) and thermal damage, with an emphasis on normal tissue effects and notes the critical lack of publications examining effects of chronic thermal exposures as might be encountered in occupational hazards.
Abstract: This paper is one of several in this Special Issue of the International Journal of Hyperthermia that discusses the current state of knowledge about the human health risks of hyperthermia This special issue emanated from a workshop sponsored by the World Health Organization in the Spring of 2002 on this topic It is anticipated that these papers will help to establish guidelines for human exposure to conditions leading to hyperthermia This comprehensive review of the literature makes it clear that much more work needs to be done to clarify what the thresholds for thermal damage are in humans This review summarizes the basic principles that govern the relationships between thermal exposure (temperature and time of exposure) and thermal damage, with an emphasis on normal tissue effects Methods for converting one time-temperature combination to a time at a standardized temperature are provided as well as a detailed discussion about the underlying assumptions that go into these calculations There are few in vivo papers examining the type and extent of damage that occurs in the lower temperature range for hyperthermic exposures (eg 39-42 degrees C) Therefore, it is clear that estimation of thermal dose to effect at these thermal exposures is less precise in that temperature range In addition, there are virtually no data that directly relate to the thermal sensitivity of human tissues Thus, establishment of guidelines for human exposure based on the data provided must be done with significant caution There is detailed review and presentation of thermal thresholds for tissue damage (based on what is detectable in vivo) The data are normalized using thermal dosimetric concepts Tables are included in an Appendix Database which compile published data for thresholds of thermal damage in a variety of tissues and species This database is available by request (contact MWD or PJH), but not included in this manuscript for brevity All of the studies reported are for single acute thermal exposures Except for brain function and physiology (as detailed in this issue by Sharma et al) one notes the critical lack of publications examining effects of chronic thermal exposures as might be encountered in occupational hazards This review also does not include information on the embryo, which is covered in detail elsewhere in this volume (see article by Edwards et al) as well as in a recent review on this subject, which focuses on thermal dose
863 citations
TL;DR: Technical requirements, potential clinical applications, and potential pitfalls and limitations of contrast-enhanced MR imaging as a method to help detect, diagnose, and stage breast cancer will be described.
Abstract: With the introduction of contrast agents, advances in surface coil technology, and development of new imaging protocols, contrast agent-enhanced magnetic resonance (MR) imaging has emerged as a promising modality for detection, diagnosis, and staging of breast cancer. The reported sensitivity of MR imaging for the visualization of invasive cancer has approached 100%. There are many examples in the literature of MR imaging--demonstrated mammographically, sonographically, and clinically occult breast cancer. Often, breast cancer detected on MR images has resulted in a change in patient care. Despite these results, there are many unresolved issues, including no defined standard technique for contrast-enhanced breast MR imaging, no standard interpretation criteria for evaluating such studies, no consensus on what constitutes clinically important enhancement, and no clearly defined clinical indications for the use of MR imaging. Furthermore, this technology remains costly, and issues of cost-effectiveness and cost competition from percutaneous biopsy have yet to be fully addressed. These factors along with the lack of commercially available MR imaging--guided localization and biopsy systems have slowed the transfer of this imaging technology from research centers to clinical breast imaging practices. Technical requirements, potential clinical applications, and potential pitfalls and limitations of contrast-enhanced MR imaging as a method to help detect, diagnose, and stage breast cancer will be described.
750 citations