Study Type
Study Type
Study Objective(Purpose of Study)
Study Objective(Purpose of Study)
Study Results
Study Results
Study Quality
Study Quality
1. Dialani V, Chadashvili T, Slanetz PJ. Role of imaging in neoadjuvant therapy for breast cancer. Ann Surg Oncol. 2015;22(5):1416-1424. Review/Other-Dx N/A To review the role of imaging before and after neoadjuvant therapy and discuss the advantages and limitations of currently available modalities, including mammography, ultrasonography, magnetic resonance imaging, and nuclear imaging. No results stated in abstract. 4
2. Khan A, Sabel MS, Nees A, et al. Comprehensive axillary evaluation in neoadjuvant chemotherapy patients with ultrasonography and sentinel lymph node biopsy. Ann Surg Oncol. 2005;12(9):697-704. Observational-Dx 91 patients To report the accuracy of comprehensive pre-neoadjuvant CTX and post-neoadjuvant CTX axillary staging via ultrasound imaging, fine-needle aspiration (FNA) biopsy, and SLN biopsy. Axillary staging was pathologically negative by pre-neoadjuvant CTX SLN biopsy in 53 cases (58%); these patients had no further axillary surgery. In 38 cases (42%), axillary metastases were confirmed at presentation by either ultrasound-guided FNA or SLN biopsy. These 38 patients underwent completion axillary lymph node dissection (ALND) after delivery of neoadjuvant CTX. Follow-up lymphatic mapping was attempted in 33 of these cases, and the SLN was identified in 32 (identification rate, 97%). One third of these cases were completely node negative on ALND. Residual metastatic disease was identified in 22 cases, and the SLN was falsely negative in 1 (4.5%). 3
3. Andrade WP, Lima EN, Osorio CA, et al. Can FDG-PET/CT predict early response to neoadjuvant chemotherapy in breast cancer? Eur J Surg Oncol. 2013;39(12):1358-1363. Experimental-Dx 40 patients To correlate the relative change in the standardized uptake value (SUV) of (18)F-2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET/CT) with pathologic response after NAC. The mean age was 41.9 years. Median primary tumor size was 6 cm. Pathologic complete response (pCR) was obtained in 12 (30%) patients. The tumor baseline mean maximum SUV (SUV(max)), and after second cycle were: 8.97 (sd.4.3) and 4.07 (sd.3.2), respectively. The relative change (DeltaSUV) after the second course of NAC was significantly higher for patients with pCR (-81.58%) when compared to the non-pCR patients (-40.18%) (p = 0.001). The optimal DeltaSUV threshold that discriminates between pCR and non-pCR was -71.8% (83.3% sensitivity; 78.5% specificity). Moreover, the optimal DeltaSUV threshold to discriminate between NAC responders and non-responders was -59.1% (68% sensitivity; 75.0% specificity). 1
4. National Cancer Institute. Imaging Response Criteria. Response Evaluation Criteria in Solid Tumors (RECIST). Available at: Review/Other-Dx N/A To describe a standard approach to solid tumor measurement and definitions for objective assessment of change in tumor size for use in adult and pediatric cancer clinical trials. No results stated in abstract. 4
5. Cocconi G, Di Blasio B, Alberti G, Bisagni G, Botti E, Peracchia G. Problems in evaluating response of primary breast cancer to systemic therapy. Breast Cancer Res Treat. 1984;4(4):309-313. Observational-Dx 49 patients Response to therapy was evaluated after 4 cycles of CMF or CMF plus tamoxifen in 49 patients with locally advanced breast cancer entering a prospective randomized trial In 35 patients response was evaluated by both physical examination and mammography. In some cases there was disagreement between physical examination and mammography in quantifying the magnitude of response. In 8 of 35 (22.9%), the overall response was overestimated by physical examination versus mammography, while in 3 of 35 (8.6%) the reverse was true. Taking into consideration different criteria in attributing the overall response, i.e. selecting physical examination only, mammography only, or the most favorable or the least favorable response between the two methods of assessment, the objective remission rates were 65.7%, 54.3%, 71.4% and 45.7%, respectively. 3
6. Berg WA, Gutierrez L, NessAiver MS, et al. Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 2004; 233(3):830-849. Observational-Dx 111 consecutive women To prospectively assess the diagnostic accuracy of mammography, clinical examination, US, and MRI in the preoperative imaging of breast cancer. Mammographic sensitivity was highest for invasive ductal carcinoma (IDC) in 89 of 110 (81%) cases versus 10 of 29 (34%) cases of invasive lobular carcinoma (ILC) (P .001) and 21 of 38 (55%) cases of DCIS (P .01). US showed higher sensitivity than did mammography for IDC, depicting 104 of 110 (94%) cases, and for ILC, depicting 25 of 29 (86%) cases (P .01 for each). US showed higher sensitivity for invasive cancer than DCIS (18 of 38 [47%], P .001). MR showed higher sensitivity than did mammography for all tumor types (P .01) and higher sensitivity than did US for DCIS (P .001), depicting 105 of 110 (95%) cases of IDC, 28 of 29 (96%) cases of ILC, and 34 of 38 (89%) cases of DCIS. In anticipation of conservation or no surgery after mammography and clinical examination in 96 breasts, additional tumor (which altered surgical approach) was present in 30. Additional tumor was depicted in 17 of 96 (18%) breasts at US and in 29 of 96 (30%) at MR, though extent was now overestimated in 12 of 96 (12%) at US and 20 of 96 (21%) at MR imaging. After combined mammography, clinical examination, and US, MR depicted additional tumor in another 12 of 96 (12%) breasts and led to overestimation of extent in another six (6%); US showed no detection benefit after MR imaging. Bilateral cancer was present in 10 of 111 (9%) patients; contralateral tumor was depicted mammographically in six and with both US and MR in an additional three. One contralateral cancer was demonstrated only clinically. In non-fatty breasts, US and MRI were more sensitive than mammography for invasive cancer, but both overestimated tumor extent. US showed no detection benefit after MRI. Combined mammography, clinical examination, and MRI were more sensitive than any other individual test or combination of tests. 3
7. Bosch AM, Kessels AG, Beets GL, et al. Preoperative estimation of the pathological breast tumour size by physical examination, mammography and ultrasound: a prospective study on 105 invasive tumours. Eur J Radiol. 2003;48(3):285-292. Observational-Dx 96 women To determine the most accurate clinical method (physical examination, mammography or ultrasound) to predict the histological invasive tumour size preoperatively. The correlation coefficient between ultrasound and pathological size (r=0.68) was significantly better than the correlations between physical examination and pathological size (r=0.42) and mammographic and pathological size (r=0.44). Physical examination overestimates and ultrasound underestimates breast tumour classification. The most accurate prediction formula was: Pathological tumour size (mm) equals sonographic tumour size (mm)+3 mm 2
8. Hieken TJ, Harrison J, Herreros J, Velasco JM. Correlating sonography, mammography, and pathology in the assessment of breast cancer size. Am J Surg. 2001;182(4):351-354. Observational-Dx 146 patients To compare the ability of mammography and ultrasonography to measure breast cancer size. In 69% of cases, US was better than or equivalent to mammography in determining tumor size. Both underestimated tumor size; mean (median) underestimation was 3.8 +/- 0.7 mm (1.7 mm) by US and 3.5 +/- 0.9 mm (2 mm) by mammogram. Maximal tumor dimension was accurate within 5 mm in 65% of cases by mammography and 75% of cases by US. For mammographically determined size (versus pathologic size) correlation, r, was 0.4 and for US it was 0.63 and improved for only T1 and T2 tumors. 2
9. Kald BA, Boiesen P, Ronnow K, Jonsson PE, Bisgaard T. Preoperative assessment of small tumours in women with breast cancer. Scand J Surg. 2005;94(1):15-20. Observational-Dx 131 patients To compare findings from preoperative mammography and ultrasonography with histopathological tumour size in patients treated with breast-conserving surgery. The study included 131 patients (median age was 59) years with grade I, II, and III cancers in 47, 71 and in 13 patients, respectively. The medium histological tumour size was 14 mm, range 4-45 mm. A wide 95% confidence interval between histopathological tumour size and preoperative mammography (standard deviation 4.8 mm) and ultrasonography (standard deviation 4.8 mm) was found. The combination of mammography and ultrasonography did not improve the results (standard deviation 4.3 mm). Preoperative mammography tended to over estimate the tumour size compared with histological tumour size whereas preoperative ultrasonography tended to underestimate the tumour size. 3
10. Madjar H, Ladner HA, Sauerbrei W, Oberstein A, Prompeler H, Pfleiderer A. Preoperative staging of breast cancer by palpation, mammography and high-resolution ultrasound. Ultrasound Obstet Gynecol. 1993;3(3):185-190. Observational-Dx 100 patients To compare the ability of mammography and ultrasonography to measure breast cancer size. Using a high-resolution real-time system, 98 tumors were visible. It was possible to detect not only early tumors under 1 cm in diameter, but also intraductal tumor components. This contributed greatly to the accuracy of the diagnosis. The sonographic measurement of tumor size demonstrated a correlation coefficient of 0.91 and was thus superior to mammography (0.79) and palpation (0.77). Measurement of the total tumor spread, including 39 multicentric lesions, showed an overestimation of 5% for the mammographic measurements and an overestimation of 4% for the sonographic measurements. Tumor extension was underestimated in 33% of the mammograms but in only 3% using ultrasound examination. 3
11. Haas BM, Kalra V, Geisel J, Raghu M, Durand M, Philpotts LE. Comparison of tomosynthesis plus digital mammography and digital mammography alone for breast cancer screening. Radiology. 2013;269(3):694-700. Observational-Dx 13,158 patients To compare screening recall rates and cancer detection rates of tomosynthesis plus conventional digital mammography to those of conventional digital mammography alone. A total of 13 158 patients presented for screening mammography; 6100 received tomosynthesis. The overall recall rate was 8.4% for patients in the tomosynthesis group and 12.0% for those in the conventional mammography group (P < .01). The addition of tomosynthesis reduced recall rates for all breast density and patient age groups, with significant differences (P < .05) found for scattered fibroglandular, heterogeneously dense, and extremely dense breasts and for patients younger than 40 years, those aged 40-49 years, those aged 50-59 years, and those aged 60-69 years. These findings persisted when multivariate logistic regression was used to control for differences in age, breast density, and elevated risk of breast cancer. The cancer detection rate was 5.7 per 1000 in patients receiving tomosynthesis versus 5.2 per 1000 in patients receiving conventional mammography alone (P = .70). 3
12. McCarthy AM, Kontos D, Synnestvedt M, et al. Screening outcomes following implementation of digital breast tomosynthesis in a general-population screening program. J Natl Cancer Inst. 2014;106(11). Observational-Dx 15,571 women screened with DBT and 10,728 screened with DM alone To report the impact on screening outcomes for DBT screening implemented in an entire clinic population. DBT screening showed a statistically significant reduction in recalls compared to DM alone. For the entire population, there were 16 fewer recalls (8.8% vs 10.4%, P <.001, adjusted OR = 0.80, 95% confidence interval [CI] = 0.74 to 0.88, P < .001) and 0.9 additional cancers detected per 1000 screened with DBT compared to DM alone. There was a statistically significant increase in PPV1 (6.2% vs 4.4%, P = .047). In women younger than age 50 years screened with DBT, there were 17 fewer recalls (12.3% vs 14.0%, P = .02) and 3.6 additional cancer detected per 1000 screened (5.7 vs 2.2 per 1000, P = .02). 3
13. Mun HS, Kim HH, Shin HJ, et al. Assessment of extent of breast cancer: comparison between digital breast tomosynthesis and full-field digital mammography. Clin Radiol. 2013;68(12):1254-1259. Observational-Dx 173 lesions in 169 patients To compare the accuracy of digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) in preoperative assessment of local extent of breast cancer. The dataset included 173 malignant breast lesions (mean size 23.8 mm, 43% of lesions were </=2 cm in size) in 169 patients, two-thirds of which had heterogeneously or extremely dense breasts. Overall, the percentage of lesions mis-sized at DBT was significantly lower than at FFDM (19% versus 29%, p = 0.003). There was significantly less mis-sizing at DBT in both heterogeneously dense breasts (11.1% difference between DBT and FFDM, p = 0.016) and extremely dense breasts (15.8% difference, p = 0.024). DBT also had significantly less mis-sizing than FFDM in the subgroup of lesions that were </=2 cm in size (14.7% difference, p = 0.005) 2
14. Lang K, Andersson I, Zackrisson S. Breast cancer detection in digital breast tomosynthesis and digital mammography-a side-by-side review of discrepant cases. Br J Radiol. 2014;87(1040):20140080. Observational-Dx 26 discrepant cases resulting from 24 females with 25 cancer lesions in 24 breasts. To analyse discrepant breast cancer detection in digital breast tomosynthesis (DBT) and digital mammography (DM). The proportion of lesion periphery in fatty tissue was statistically significantly larger, and there were significantly more spiculated masses in DBT compared with DM in the DBT only group (p = 0.018; p = 0.015). The main reasons for missing a lesion were poor lesion visibility when using DM and interpretative error when using DBT. 3
15. Durand MA, Haas BM, Yao X, et al. Early clinical experience with digital breast tomosynthesis for screening mammography. Radiology. 2015;274(1):85-92. Observational-Dx 17,955 screening mammograms To examine recall rates from screening mammography and the mammographic findings that caused recall in women who underwent digital breast tomosynthesis with conventional mammography (referred to as two-dimensional [ 2D two-dimensional ] with three-dimensional [ 3D three-dimensional ] imaging [ 2D two-dimensional + 3D three-dimensional ]) and in women who underwent conventional mammography alone (referred to as 2D two-dimensional ). This study included 17 955 screening mammograms; of the total, there were 8591 (47.8%) 2D two-dimensional + 3D three-dimensional screening examinations and 9364 (52.2%) 2D two-dimensional examinations. The recall rate was 7.8% (671 of 8592) for 2D two-dimensional + 3D three-dimensional and 12.3% (1154 of 9364) for 2D two-dimensional (P < .0001); the rate of recall was 36.6% lower in the 2D two-dimensional + 3D three-dimensional group than in the 2D two-dimensional group. Recall rates for the 2D two-dimensional + 3D three-dimensional group were significantly lower for patients with asymmetries, ( 2D two-dimensional + 3D three-dimensional vs 2D two-dimensional , 3.1% [267 of 8591] vs 7.4% [689 of 9364], respectively; P < .0001) and calcifications ( 2D two-dimensional + 3D three-dimensional vs 2D two-dimensional , 2.4% [205 of 8591] vs 3.2% [297 of 9364], respectively; P = .0014). For patients with masses and architectural distortion, the difference in recall rates was not significant (masses: 2D two-dimensional + 3D three-dimensional vs 2D two-dimensional , 2.5% [215 of 8591] vs 2.5% [237 of 9364], respectively; P = .90; architectural distortion: 2D two-dimensional + 3D three-dimensional vs 2D two-dimensional , 0.68% [58 of 8591] vs 0.69% [65 of 9364]; P = .88). Cancer detection was highest in the 2D two-dimensional + 3D three-dimensional group at 5.9 cancers per 1000 examinations, with 5.7 cancers per 1000 examinations in the concurrent 2D two-dimensional group, and 4.4 cancers per 1000 examinations in the historic control. 3
16. Brandt KR, Craig DA, Hoskins TL, et al. Can digital breast tomosynthesis replace conventional diagnostic mammography views for screening recalls without calcifications? A comparison study in a simulated clinical setting. AJR Am J Roentgenol. 2013;200(2):291-298. Observational-Dx 146 women To evaluate digital breast tomosynthesis (DBT) as an alternative to conventional diagnostic mammography in the workup of noncalcified findings recalled from screening mammography in a simulated clinical setting that incorporated comparison mammograms and breast ultrasound results. Agreement between DBT and diagnostic mammography BI-RADS categories was excellent for readers 1 and 2 (kappa = 0.91 and kappa = 0.84) and good for reader 3 (kappa = 0.68). For readers 1, 2, and 3, sensitivity and specificity of DBT for breast abnormalities were 100%, 100%, and 88% and 94%, 93%, and 89%, respectively. The clinical workup averaged three diagnostic views per abnormality and ultrasound was requested in 49% of the cases. DBT was adequate mammographic evaluation for 93-99% of the findings and ultrasound was requested in 33-55% of the cases. 2
17. Gennaro G, Hendrick RE, Toledano A, et al. Combination of one-view digital breast tomosynthesis with one-view digital mammography versus standard two-view digital mammography: per lesion analysis. Eur Radiol. 2013;23(8):2087-2094. Observational-Dx 463 breasts of 250 patients To evaluate the clinical value of combining one-view mammography (cranio-caudal, CC) with the complementary view tomosynthesis (mediolateral-oblique, MLO) in comparison to standard two-view mammography (MX) in terms of both lesion detection and characterization. The 463 cases (breasts) reviewed included 258 with one to three lesions each, and 205 with no lesions. The 258 cases with lesions included 77 cancers in 68 breasts and 271 benign lesions to give a total of 348 proven lesions. The combination, DBT(MLO)+MX(CC), was superior to MX (CC+MLO) in both lesion detection (LDF) and lesion characterization (LCF) overall and for benign lesions. DBT(MLO)+MX(CC) was non-inferior to two-view MX for malignant lesions. 2
18. Waldherr C, Cerny P, Altermatt HJ, et al. Value of one-view breast tomosynthesis versus two-view mammography in diagnostic workup of women with clinical signs and symptoms and in women recalled from screening. AJR Am J Roentgenol. 2013;200(1):226-231. Observational-Dx 144 women To compare the diagnostic value of one-view digital breast tomosynthesis versus two-view full-field digital mammography (FFDM) alone, and versus a combined reading of both modalities. Eighty-six of the 144 patients were found to have breast cancer. The BI-RADS categories for one-view digital breast tomosynthesis were significantly better than those for two-view FFDM (p < 0.001) and were equal to those of the combined reading in both women admitted for diagnostic workup and women recalled from screening. The sensitivity and negative predictive values of digital breast tomosynthesis were superior to those of FFDM in fatty and dense breasts overall and in women admitted for diagnostic workup and in women recalled from screening. Only 11% of digital breast tomosynthesis examinations required additional imaging, compared with 23% of FFDMs. 3
19. Yang TL, Liang HL, Chou CP, Huang JS, Pan HB. The adjunctive digital breast tomosynthesis in diagnosis of breast cancer. Biomed Res Int. 2013;2013:597253. Observational-Dx 59 breasts of 57 patients. To compare the diagnostic performance of digital breast tomosynthesis (DBT) and digital mammography (DM) for breast cancers. A total of 59 breast cancers were reviewed, including 17 (28.8%) mass lesions, 12 (20.3%) focal asymmetry/density, 6 (10.2%) architecture distortion, 23 (39.0%) calcifications, and 1 (1.7%) intracystic tumor. Combo DBT was perceived to be more informative in 58.8% mass lesions, 83.3% density, 94.4% architecture distortion, and only 11.6% calcifications. As to the forced BIRADS score, 84.4% BIRADS 0 on DM was upgraded to BIRADS 4 or 5 on DBT, whereas only 27.3% BIRADS 4A on DM was upgraded on DBT, as BIRADS 4A lesions were mostly calcifications. A significant P value (<0.001) between the BIRADS category and index lesions was noted 3
20. Hylton NM, Blume JD, Bernreuter WK, et al. Locally advanced breast cancer: MR imaging for prediction of response to neoadjuvant chemotherapy--results from ACRIN 6657/I-SPY TRIAL. Radiology. 2012;263(3):663-672. Experimental-Dx 216 women To compare magnetic resonance (MR) imaging findings and clinical assessment for prediction of pathologic response to neoadjuvant chemotherapy (NACT) in patients with stage II or III breast cancer. Data in 216 women (age range, 26-68 years) with two or more imaging time points were analyzed. For prediction of both pCR and RCB, MR imaging size measurements were superior to clinical examination at all time points, with tumor volume change showing the greatest relative benefit at the second MR imaging examination. AUC differences between MR imaging volume and clinical size predictors at the early, mid-, and posttreatment time points, respectively, were 0.14, 0.09, and 0.02 for prediction of pCR and 0.09, 0.07, and 0.05 for prediction of RCB. In multivariate analysis, the AUC for predicting pCR at the second imaging examination increased from 0.70 for volume alone to 0.73 when all four predictor variables were used. Additional predictive value was gained with adjustments for age and race. 1
21. Schott AF, Roubidoux MA, Helvie MA, et al. Clinical and radiologic assessments to predict breast cancer pathologic complete response to neoadjuvant chemotherapy. Breast Cancer Res Treat. 2005;92(3):231-238. Observational-Dx 43 patients To prospectively compare the ability of clinical examination, mammography, vascularity-sensitive ultrasound, and magnetic resonance imaging (MRI) to determine pathologic complete response (CR) in breast cancer patients undergoing neoadjuvant chemotherapy. 41 of 43 enrolled patients had a determination of pathologic response, and 4 patients had a pathologic CR to this chemotherapy (9.8%). The accuracy of physical examination, mammography, ultrasound, and MRI in determining pathologic CR was 75, 89, 82, and 89% respectively (NS). 2
22. Cox C, Holloway CM, Shaheta A, Nofech-Mozes S, Wright FC. What is the burden of axillary disease after neoadjuvant therapy in women with locally advanced breast cancer? Curr Oncol. 2013;20(2):111-117. Observational-Tx 116 patients (115 women and 1 man) To describe the extent of nodal metastases after neoadjuvant therapy (nat) in patients with locally advanced breast cancer (labc). Of the 116 patients identified, 115 were female (median age: 48.5). Before nat, 26 patients were clinically and radiologically node-negative; of those 26, 14 were histologically negative on final pathology. After serial sectioning and immunohistochemistry, 9 of 26 (35%) were node-negative. Of the 90 patients who had clinical or radiologic evidence of lymph node metastases before nat, 23 (26%) had no evidence of lymph node metastases on h&e staining. After serial sectioning and immunohistochemistry, 19 (21%) had no further axillary lymph node metastases. Overall, 76% of patients had pathology evidence of lymph node metastases after nat. 2
23. Aarsvold JN, Alazraki NP. Update on detection of sentinel lymph nodes in patients with breast cancer. Semin Nucl Med. 2005;35(2):116-128. Review/Other-Dx N/A To review the present state and roles of nuclear medicine protocols used in breast cancer sentinel lymph node biopsy procedures with emphasis on discussion of recent results, unresolved issues, and future considerations. No results stated in abstract. 4
24. Alvarado R, Yi M, Le-Petross H, et al. The role for sentinel lymph node dissection after neoadjuvant chemotherapy in patients who present with node-positive breast cancer. Ann Surg Oncol. 2012;19(10):3177-3184. Observational-Dx 150 patients To evaluate SLN dissection in node-positive patients and to determine whether postchemotherapy ultrasound could select patients for this technique. Median age was 52 years. Median tumor size at presentation was 2 cm. The SLN was identified in 93 % (139/150). In 111 patients in whom a SLN was identified and ALND performed, 15 patients had a false-negative SLN (20.8 %). In the 52 patients with normalized nodes on ultrasound, the false-negative rate decreased to 16.1 %. Multivariate analysis revealed smaller initial tumor size and fewer SLNs removed (<2) were associated with a false-negative SLN. There were 63 (42 %) patients with a pathologic complete response (pCR) in the nodes. Of those with normalized nodes on ultrasound, 38 (51 %) of 75 had a pCR. Only 25 (33 %) of 75 with persistent suspicious/malignant-appearing nodes had a pCR (p = 0.047). 3
25. Hieken TJ, Boughey JC, Jones KN, Shah SS, Glazebrook KN. Imaging response and residual metastatic axillary lymph node disease after neoadjuvant chemotherapy for primary breast cancer. Annals of Surgical Oncology. 20(10):3199-204, 2013 Oct. Observational-Dx 272 patients To evaluate post-NAC axillary imaging and surgical pathology to understand how imaging might direct axillary surgery. Pre-NAC axillary staging classified patients as AUS negative/no FNA (n = 61), FNA/LN negative (n = 42), and FNA/LN positive (n = 169). Post-NAC axillary imaging included AUS (n = 146), MRI (n = 139), and PET-CT (n = 38). At operation, 128 of 272 patients (47 %) were LN positive: 23.3 % (24 of 103) of cN0 and 61.5 % (104 of 169) of cN1-AUS/FNA-positive patients at presentation. Of the 65 cN1-ypN0 patients, 58.1 % (25 of 43) had an imaging CR by US, 58.6 % (17 of 29) by MRI, and 84.6 % (11 of 13) by PET-CT. The sensitivity of post-NAC axillary imaging in detecting persistent LN metastases for cN1-AUS/FNA-positive patients was 69.8 % for US, 61.0 % for MRI, and 63.2 % for PET-CT. 3
26. Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310(14):1455-1461. Observational-Dx 756 women To determine the false-negative rate (FNR) for sentinel lymph node surgery following chemotherapy in women initially presenting with biopsy-proven cN1 breast cancer. Seven hundred fifty-six women were enrolled in the study. Of 663 evaluable patients with cN1 disease, 649 underwent chemotherapy followed by both SLN surgery and ALND. An SLN could not be identified in 46 patients (7.1%). Only 1 SLN was excised in 78 patients (12.0%). Of the remaining 525 patients with 2 or more SLNs removed, no cancer was identified in the axillary lymph nodes of 215 patients, yielding a pathological complete nodal response of 41.0% (95% CI, 36.7%-45.3%). In 39 patients, cancer was not identified in the SLNs but was found in lymph nodes obtained with ALND, resulting in an FNR of 12.6% (90% Bayesian credible interval, 9.85%-16.05%). 3
27. Heusinger K, Lohberg C, Lux MP, et al. Assessment of breast cancer tumor size depends on method, histopathology and tumor size itself*. Breast Cancer Res Treat. 2005;94(1):17-23. Observational-Dx 503 patients To determine the accuracy of all diagnostic methods matched to each other, (b) to find subgroups with higher and lower accuracy depending on histopathological features (tumor type, grading, hormonal receptor status, HER2/neu-status, large tumors versus small tumors, proliferation assessed by MIB-1 and age) and (c) to ascertain the value of axillary ultrasound in our collective. Mammography correlated best with pT (r = 0.752). Mammography (mean (MG) = 2.17 cm) overestimated tumors in size (mean (pT) = 2.04 cm) rather than ultrasound (mean (BU) = 1.86 cm) and clinical examination (mean (cT) = 1.70 cm). pT of invasive ductal BC could be estimated significantly better than pT of invasive lobular BC. Smaller tumors were better to assess than larger ones. Tumors with a grading G1 were easier to estimate than tumors with G2/3. Best predictor of a pT > 2 cm was the mammography with an area under the curve of 0.876. The combination of all three modalities by linear regression performed even better with an AUC of 0.906. 3
28. Tardivon AA, Ollivier L, El Khoury C, Thibault F. Monitoring therapeutic efficacy in breast carcinomas. Eur Radiol. 2006;16(11):2549-2558. Review/Other-Dx N/A To discuss the role and the performance of the different imaging modalities (mammography, ultrasound, magnetic resonance imaging and FDG-PET imaging) for evaluating pathologic response early after the initiation of neoadjuvant therapy. Magnetic resonance imaging and FDG-PET imaging are very promising for predicting the response early after the initiation of neoadjuvant chemotherapy. 4
29. Shoma A, Moutamed A, Ameen M, Abdelwahab A. Ultrasound for accurate measurement of invasive breast cancer tumor size. Breast J. 2006;12(3):252-256. Observational-Dx 162 patients To compare clinical evaluation, mammography, and breast sonography for evaluating breast tumor size. Measurements were compared to the pathologic tumor size of the surgical specimen. Both mammographic and sonographic measurements tend to underestimate tumor size, while clinical assessment tends to overestimate it. Ultrasound was significantly more accurate in determining tumor size. The maximal tumor diameter measured was within 2 mm of the pathologic tumor size in 45.2% of cases measured by breast ultrasound, 28.2% of cases measured by mammography, and 14.5% of cases measured clinically. 3
30. Boonjunwetwat D, Prueksadee J, Sampatanukul P, Chatamra K. Does color Doppler ultrasound vascularity predict the response to neoadjuvant chemotherapy in breast cancer? J Med Assoc Thai. 2005;88(10):1367-1372. Observational-Dx 69 breast cancer patients To assess the proportions of response to neoadjuvant chemotherapy of breast cancer according to color Doppler ultrasound vascularity patterns The overall response rate in 70 breast cancers was 20%. Twenty-nine lesions (41%) showed hypervascularity and 41 lesions (59%) revealed hypovascularity. There were 5 vascularity patterns and each pattern had the proportion of responders as follows; 33.3% for hypovascularity with single-vessel feeding into the tumor, 25% for hypovascularity with single-vessel feeding at periphery of the tumor, 25% for no vascular feeding to the tumor, 16.7% for hypervascularity with vascular feeding at the periphery of the tumor and 13% for hypervascularity with vascular feeding into the tumor. The highest percentage of responsive group was the pattern of hypovascularity with single-vessel feeding into the tumor (33.3%) 4
31. Lobbes MB, Prevos R, Smidt M, et al. The role of magnetic resonance imaging in assessing residual disease and pathologic complete response in breast cancer patients receiving neoadjuvant chemotherapy: a systematic review. Insights Imaging. 2013;4(2):163-175. Review/Other-Dx 35 studies To assess the role of magnetic resonance imaging (MRI) in evaluating residual disease extent and the ability to detect pathologic complete response (pCR) after neoadjuvant chemotherapy for invasive breast cancer. A total of 35 eligible studies were selected. Correlation coefficients of residual tumour size assessed by MRI and pathology were good, with a median value of 0.698. Reported sensitivity, specificity, positive predictive value and negative predictive value for predicting pCR with MRI ranged from 25 to 100 %, 50-97 %, 47-73 % and 71-100 %, respectively. Both overestimation and underestimation were observed. MRI proved more accurate in determining residual disease than physical examination, mammography and ultrasound. Diagnostic accuracy of MRI after neoadjuvant chemotherapy could be influenced by treatment regimen and breast cancer subtype. 4
32. Giess CS, Yeh ED, Raza S, Birdwell RL. Background parenchymal enhancement at breast MR imaging: normal patterns, diagnostic challenges, and potential for false-positive and false-negative interpretation. Radiographics. 2014;34(1):234-247. Review/Other-Dx N/A To describe the influences on BPE, illustrate typical and unusual patterns of BPE, and discuss the potential for false-positive and false-negative interpretations due to BPE at screening and diagnostic MR imaging. Radiologists can improve their interpretive accuracy by increasing their understanding of various BPE patterns, influences on BPE, and the potential effects of BPE on MR imaging interpretation 4
33. Houssami N, Ciatto S, Macaskill P, et al. Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol. 2008;26(19):3248-3258. Review/Other-Dx 19 studies Systematic review and meta-analysis of the accuracy of MRI in detection of multifocal and/or multicentric cancer not identified on conventional imaging. Results data studies showed MRI detects additional disease in 16% of women with breast cancer (n=2,610). MRI incremental accuracy differed according to the reference standard (P=.016) decreasing from 99% to 86% as the quality of the reference standard increased. Summary positive predictive value was 66% (95% CI, 52%–77%) and true-positive: false positive ratio was 1.91 (95% CI, 1.09-3.34). Conversion from wide local excision to mastectomy was 8.1% (95% CI, 5.9-11.3), from wide local excision to more extensive surgery was 11.3% in multifocal/multicentric disease (95% CI, 6.8–18.3). Due to MRI-detected lesions (in women who did not have additional malignancy on histology) conversion from wide local excision to mastectomy was 1.1% (95% CI, 0.3–3.6) and from wide local excision to more extensive surgery was 5.5% (95% CI, 3.1–9.5). 4
34. Bahri S, Chen JH, Mehta RS, et al. Residual breast cancer diagnosed by MRI in patients receiving neoadjuvant chemotherapy with and without bevacizumab. Ann Surg Oncol. 2009;16(6):1619-1628. Observational-Dx 36 patients To investigate the impact of antiangiogenic therapy with bevacizumab on pathological response and the diagnostic performance of magnetic resonance imaging (MRI) in breast cancer patients. pCR rates and residual disease (nodular and scattered cell) patterns were comparable between the two groups. The diagnostic accuracy rate of MRI (true positive and true negative) was 13/17 (76%) for patients with bevacizumab, and 14/20 (70%) for patients without bevacizumab. The size measured on MRI was accurate for mass lesions that shrank down to nodules, showing <0.7 cm discrepancy from pathological size. For residual disease presenting as scattered cells within a large fibrotic region, MRI could not predict them correctly, resulting in a high false-negative rate and a large size discrepancy. 3
35. Marinovich ML, Houssami N, Macaskill P, et al. Meta-analysis of magnetic resonance imaging in detecting residual breast cancer after neoadjuvant therapy. [Review]. Journal of the National Cancer Institute. 105(5):321-33, 2013 Mar 06. Meta-analysis 44 studies including 2050 patients To examine MRI accuracy in detecting residual tumor, investigate variables potentially affecting MRI performance, and compare MRI with other tests. Forty-four studies (2050 patients) were included. The overall AUC of MRI was 0.88. Accuracy was lower for "standard" pCR definitions (referent category) than "less clearly described" (RDOR = 2.41, 95% confidence interval [CI] = 1.11 to 5.23) or "near-pCR" definitions (RDOR = 2.60, 95% CI = 0.73 to 9.24; P = .03.) Corresponding AUCs were 0.83, 0.90, and 0.91. Specificity was higher when negative MRI was defined as contrast enhancement less than or equal to normal tissue (0.83, 95% CI = 0.64 to 0.93) vs no enhancement (0.54, 95% CI = 0.39 to 0.69; P = .02), with comparable sensitivity (0.83, 95% CI = 0.69 to 0.91; vs 0.87, 95% CI = 0.80 to 0.92; P = .45). MRI had higher accuracy than mammography (P = .02); there was only weak evidence that MRI had higher accuracy than clinical examination (P = .10). No difference in MRI and ultrasound accuracy was found (P = .15). M
36. Yeh E, Slanetz P, Kopans DB, et al. Prospective comparison of mammography, sonography, and MRI in patients undergoing neoadjuvant chemotherapy for palpable breast cancer. AJR Am J Roentgenol. 2005;184(3):868-877. Observational-Dx 31 patients Prospective study to determine the relative accuracy of mammography, US, and MRI in predicting residual tumor after neoadjuvant chemotherapy for breast cancer as compared with the gold standards of physical examination and pathology. Agreement rates about the degree of response were 32%, 48%, and 55%, respectively, for mammography, US, and MRI compared with clinical evaluation and did not differ statistically. Agreement about the rate of response as measured by clinical examination, mammography, US, and MRI compared with the gold standard (pathology) was 19%, 26%, 35%, and 71%, respectively. MRI agreed with the gold standard significantly more often (P<0.002 for all 3 paired comparisons with MRI). 2
37. Kazama T, Nakamura S, Doi O, Suzuki K, Hirose M, Ito H. Prospective evaluation of pectoralis muscle invasion of breast cancer by MR imaging. Breast Cancer. 2005;12(4):312-316. Experimental-Dx 33 breasts To evaluate the usefulness of breast magnetic resonance (MR) imaging for the detection of tumor invasion of the pectoralis muscle in breast cancer patients. In 33 breasts, disruption of the fat plane between tumor and muscle was noted. Seven of 33 cases showed muscle enhancement contiguous to enhanced tumors. Pathology reports indicated that 5 of 7 of the tumors involved muscle invasion. Of the 2 false positive cases, one showed muscle enhancement because of a previous biopsy, and the other was incorrectly interpreted as showing muscle enhancement. Of the 26 breasts which did not demonstrate muscle enhancement, none were found at surgery to have tumor involvement. 2
38. Lehman CD, Gatsonis C, Kuhl CK, et al. MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med. 2007;356(13):1295-1303. Experimental-Dx 969 women To determine whether magnetic resonance imaging (MRI) could improve on clinical breast examination and mammography in detecting contralateral breast cancer soon after the initial diagnosis of unilateral breast cancer. MRI detected clinically and mammographically occult breast cancer in the contralateral breast in 30 of 969 women who were enrolled in the study (3.1%). The sensitivity of MRI in the contralateral breast was 91%, and the specificity was 88%. The negative predictive value of MRI was 99%. A biopsy was performed on the basis of a positive MRI finding in 121 of the 969 women (12.5%), 30 of whom had specimens that were positive for cancer (24.8%); 18 of the 30 specimens were positive for invasive cancer. The mean diameter of the invasive tumors detected was 10.9 mm. The additional number of cancers detected was not influenced by breast density, menopausal status, or the histologic features of the primary tumor. 1
39. Mitchell D, Hruska CB, Boughey JC, et al. 99mTc-sestamibi using a direct conversion molecular breast imaging system to assess tumor response to neoadjuvant chemotherapy in women with locally advanced breast cancer. Clin Nucl Med. 2013;38(12):949-956. Experimental-Dx 19 patients To determine the ability of breast imaging with 99mTc-sestamibi and a direct conversion-molecular breast imaging (MBI) system to predict early response to neoadjuvant chemotherapy (NAC). Nineteen patients completed imaging and proceeded to surgical resection after NAC. Mean reduction in tumor-to-background (T/B) ratio from baseline to 3 to 5 weeks for patients classified as RCB-0 (no residual disease), RCB-1 and RCB-2 combined, and RCB-3 (extensive residual disease) was 56% (SD, 0.20), 28% (SD, 0.20), and 4% (SD, 0.15), respectively. The reduction in the RCB-0 group was significantly greater than in RCB-1/2 (P = 0.036) and RCB-3 (P = 0.001) groups. The area under the receiver operator characteristic curve for determining the presence or absence of residual disease was 0.88. Using a threshold of 50% reduction in T/B ratio at 3 to 5 weeks, MBI predicted presence of residual disease at surgery with a diagnostic accuracy of 89.5% (95% confidence interval [CI], 0.64%-0.99%), sensitivity of 92.3% (95% CI, 0.74%-0.99%), and specificity of 83.3% (95% CI, 0.44%-0.99%). The reduction in tumor size at 3 to 5 weeks was not statistically different between RCB groups. 2
40. McDermott GM, Welch A, Staff RT, et al. Monitoring primary breast cancer throughout chemotherapy using FDG-PET. Breast Cancer Res Treat. 2007;102(1):75-84. Observational-Dx 96 patients To determine whether there is an optimal method for defining tumour volume and an optimal imaging time for predicting pathologic chemotherapy response. Only tumours with an initial tumour to background ratio (TBR) of greater than five showed a difference between response categories. In terms of response discrimination, there was no statistically significant advantage of any of the methods used for image quantification or any of the time points. The best discrimination was measured for mean SUV at the midpoint of therapy, which identified 77% of low responding tumours whilst correctly identifying 100% of high responding tumours and had an ROC area of 0.93. 2
41. Schwarz-Dose J, Untch M, Tiling R, et al. Monitoring primary systemic therapy of large and locally advanced breast cancer by using sequential positron emission tomography imaging with [18F]fluorodeoxyglucose. J Clin Oncol. 2009;27(4):535-541. Experimental-Dx 104 patients To evaluate positron emission tomography (PET) using [(18)F]fluorodeoxyglucose (FDG) for prediction of histopathologic response early during primary systemic therapy of large or locally advanced breast cancer. Seventeen (16%) of 104 patients were histopathologic responders and 87 were (84%) nonresponders. All patients for whom baseline SUV was less than 3.0 (n = 24) did not achieve a histopathologic response. SUV decreased by 51% +/- 18% after the first cycle of chemotherapy in histopathologic responders (n = 15), compared with 37% +/- 21% in nonresponders (n = 54; P = .01). A threshold of 45% decrease in SUV correctly identified 11 of 15 responders, and histopathologic nonresponders were identified with a negative predictive value of 90%. Similar results were found after the second cycle when using a threshold of 55% relative decrease in SUV. 2
42. Kalinyak JE, Berg WA, Schilling K, Madsen KS, Narayanan D, Tartar M. Breast cancer detection using high-resolution breast PET compared to whole-body PET or PET/CT. Eur J Nucl Med Mol Imaging. 2014;41(2):260-275. Observational-Dx 178 women To compare the performance characteristics of positron emission mammography (PEM) with those of whole-body PET (WBPET) and PET/CT in women with newly diagnosed breast cancer. The mean age of the women was 59 +/- 12 years (median 60 years, range 26-89 years), with a mean invasive index tumor size of 1.6 +/- 0.8 cm (median 1.5 cm, range 0.5-4.0 cm). PEM detected more index tumors (61/66, 92%) than WBPET (37/66, 56%; p < 0.001) or PET/CT (95/109, 87% vs. 104/109, 95% for PEM; p < 0.029). Sensitivity for the detection of additional ipsilateral malignancies was also greater with PEM (7/15, 47%) than with WBPET (1/15, 6.7%; p = 0.014) or PET/CT (3/23, 13% vs. 13/23, 57% for PEM; p = 0.003). Index tumor detection decreased with decreasing invasive tumor size for both WBPET (p = 0.002) and PET/CT (p < 0.001); PEM was not significantly affected (p = 0.20). FDG uptake, quantified in terms of maximum PEM uptake value, was lowest in ductal carcinoma in situ (median 1.5, range 0.7-3.0) and invasive lobular carcinoma (median 1.5, range 0.7-3.4), and highest in grade III invasive ductal carcinoma (median 3.1, range 1.4-12.9). 2
43. Berg WA, Madsen KS, Schilling K, et al. Breast cancer: comparative effectiveness of positron emission mammography and MR imaging in presurgical planning for the ipsilateral breast. Radiology. 2011;258(1):59-72. Experimental-Dx 380 women To determine the performance of positron emission mammography (PEM), as compared with magnetic resonance (MR) imaging, including the effect on surgical management, in ipsilateral breasts with cancer. Three hundred eighty-eight women (median age, 58 years; age range, 26-93 years; median estimated tumor size, 1.5 cm) completed the study. Additional cancers were found in 82 (21%) women (82 ipsilateral breasts; median tumor size, 0.7 cm). Twenty-eight (34%) of the 82 breasts were identified with both PEM and MR imaging; 21 (26%) breasts, with MR imaging only; 14 (17%) breasts, with PEM only; and seven (8.5%) breasts, with mammography and ultrasonography. Twelve (15%) cases of additional cancer were missed at all imaging examinations. Integration of PEM and MR imaging increased cancer detection-to 61 (74%) of 82 breasts versus 49 (60%) of 82 breasts identified with MR imaging alone (P < .001). Of 306 breasts without additional cancer, 279 (91.2%) were correctly assessed with PEM compared with 264 (86.3%) that were correctly assessed with MR imaging (P = .03). The positive predictive value of biopsy prompted by PEM findings (47 [66%] of 71 cases) was higher than that of biopsy prompted by MR findings (61 [53%] of 116 cases) (P = .016). Of 116 additional cancers, 61 (53%) were depicted by MR imaging and 47 (41%) were depicted by PEM (P = .043). Fifty-six (14%) of the 388 women required mastectomy: 40 (71%) of these women were identified with MR imaging, and 20 (36%) were identified with PEM (P < .001). Eleven (2.8%) women underwent unnecessary mastectomy, which was prompted by only MR findings in five women, by only PEM findings in one, and by PEM and MR findings in five. Thirty-three (8.5%) women required wider excision: 24 (73%) of these women were identified with MR imaging, and 22 (67%) were identified with PEM. 1
44. Chagpar AB, Middleton LP, Sahin AA, 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(2):257-264. Observational-Dx 189 patients To assess the accuracy of physical examination, ultrasonography, and mammography in predicting residual size of breast tumors following neoadjuvant chemotherapy. Size estimates by physical examination, ultrasonography, and mammography were only moderately correlated with residual pathologic tumor size after neoadjuvant chemotherapy (correlation coefficients: 0.42, 0.42, and 0.41, respectively), with an accuracy of +/-1 cm in 66% of patients by physical examination, 75% by ultrasonography, and 70% by mammography. Kappa values (0.24-0.35) indicated poor agreement between clinical and pathologic measurements. 3
45. Huber S, Medl M, Vesely M, Czembirek H, Zuna I, Delorme S. Ultrasonographic tissue characterization in monitoring tumor response to neoadjuvant chemotherapy in locally advanced breast cancer (work in progress). J Ultrasound Med. 2000;19(10):677-686. Review/Other-Dx 6 patients To evaluate the effects of neoadjuvant chemotherapy on tumor architecture by using a statistical pattern recognition technique demonstrated in six patients with locally advanced breast cancer. Characteristic trends of defined quantitative texture parameters (mean gradient, mean gray value, contrast from the co-occurrence matrix) corresponded to visually depictable changes of the B-mode image and underlying histopathologic changes. 4
46. Huber S, Wagner M, Zuna I, Medl M, Czembirek H, Delorme S. Locally advanced breast carcinoma: evaluation of mammography in the prediction of residual disease after induction chemotherapy. Anticancer Res. 2000;20(1B):553-558. Observational-Dx 44 patients To assess the mammographic features of locally advanced breast carcinoma treated with neoadjuvant chemotherapy and to evaluate morphological criteria that determine the value of mammography in therapy monitoring. Delineation of the tumor proved to be the most significant criterion. In 34 tumors more than 50% of the lesion was defined; these showed a high correlation between the mammographically determined tumor diameter and that determined on histopathological examination (r = 0.77). Less than 50% of the mass was definable in 14 tumors; here the correlation between mammographically and histopathologically determined tumor diameter was low (r = -0.19). 4
47. Helvie MA, Joynt LK, Cody RL, Pierce LJ, Adler DD, Merajver SD. Locally advanced breast carcinoma: accuracy of mammography versus clinical examination in the prediction of residual disease after chemotherapy. Radiology. 1996;198(2):327-332. Observational-Dx 56 women To determine the mammographic features of locally advanced breast carcinoma treated with neoadjuvant chemotherapy and to evaluate the accuracy of mammography in the prediction of residual carcinoma. Fifty-four (96%) of 56 women had a complete (n = 34 [61%]) or partial (n = 20 [36%]) clinical response. Thirteen (23%) of 56 women had no residual tumor. Sensitivity of mammography in the prediction of residual carcinoma was greater than that of clinical examination (79% vs 49%), but specificity was lower (77% vs 92%). In 24 women with inflammatory carcinoma, sensitivity of mammography was 78% while that of clinical examination was 39%; specificity was equal (83%). 3
48. Adrada BE, Huo L, Lane DL, Arribas EM, Resetkova E, Yang W. Histopathologic correlation of residual mammographic microcalcifications after neoadjuvant chemotherapy for locally advanced breast cancer. Annals of Surgical Oncology. 22(4):1111-7, 2015 Apr. Observational-Dx 106 patients To determine the histopathologic correlation at surgery of residual mammographic calcifications in patients after neoadjuvant chemotherapy (NAC) for locally advanced breast cancer (LABC). Of 494 patients who met the inclusion criteria, 106 demonstrated microcalcifications on pre-, post-chemotherapy, or both sets of mammograms and were included in this study. Of 106 women, 31 (29 %) had invasive ductal carcinoma (IDC) and 60 (57 %) had both IDC and ductal carcinoma in situ (DCIS). Microcalcifications decreased or remained stable in 76 (72 %) patients after completion of NAC. Correlation of microcalcifications with histopathology after NAC showed that 43 (40.6 %) patients had tumors associated with benign pathology. Of 32 patients with pathologic complete response, calcifications were associated with DCIS in 9 (9 %) and benign findings in 21 (22 %). The proportion of residual malignant calcifications was higher in ER+ versus ER- patients after NAC. 3
49. Weiss A, Lee KC, Romero Y, et al. Calcifications on mammogram do not correlate with tumor size after neoadjuvant chemotherapy. Annals of Surgical Oncology. 21(10):3310-6, 2014 Oct. Review/Other-Dx 136 patients To examine the correlation between the extent of calcification on mammography and actual tumor size after neoadjuvant chemotherapy (NAC) as well as magnetic resonance imaging (MRI) for comparison. There were 136 patients total. Average age was 51 years. Fifty-three patients had calcifications on imaging (calc+); 83 did not (calc-). In the calc- group, extent of disease measured by mammogram (MMG) and MRI correlated moderately well with pathological tumor size (0.46 and 0.48, p = not significant). In the calc+ group, MRI was more likely to correlate with pathology than MMG (0.55 vs. -0.12, p = 0.01). Twenty-five calc+ patients had increased calcification after NAC; six of these had complete pathologic response. MRI correlated better with tumor size on pathology in patients with anti-HER2neu-based regimens than in patients with cytotoxic chemotherapy-alone regimens (0.88 vs. 0.4, p = 0.0001). MRI also is more accurate at predicting pathological tumor size in patients with triple negative disease (p = 0.002). 4
50. Ollivier L, Balu-Maestro C, Leclere J. Imaging in evaluation of response to neoadjuvant breast cancer treatment. Cancer Imaging. 2005;5:27-31. Review/Other-Dx N/A To compare the value of the different conventional and functional imaging techniques for determining response to neoadjuvant chemotherapy in breast cancer treatment. Physical examination and conventional imaging techniques still have an important place in the evaluation of breast cancer treated by neoadjuvant chemotherapy. At this time, this morphologic evaluation is the only one recognized by the international criteria. The new functional and metabolic imaging modalities, particularly MRI and PET scan, can approach the nature of residual tumour, allow early detection of bad responders and depict multifocal tumours and metastases. The use of these techniques can change the planning of therapy. 4
51. Roubidoux MA, LeCarpentier GL, Fowlkes JB, et al. Sonographic evaluation of early-stage breast cancers that undergo neoadjuvant chemotherapy. J Ultrasound Med. 2005;24(7):885-895. Experimental-Dx 34 women To evaluate low-stage breast cancers treated with neoadjuvant chemotherapy using whole-volume sonography and color Doppler imaging. Three (11.3%) of 34 patients had a complete histologic response. After chemotherapy, correlation was r = 0.716 between final histologic and sonographic sizes. Compared with histologic residual tumors, sonography had 4 false-negative results, 3 false-positive results, and 27 true-positive results (sensitivity, 87%), with no false-negative results among a subgroup of tumors of 7 mm and larger (sensitivity, 100%). The 3 cases with false-positive results were histologic fibrosis or biopsy changes. Mean speed-weighted density was 0.015 before and 0.0082 after chemotherapy (P = .03). After chemotherapy, vascularity was less common within (P = .06) or adjacent to (P = .009) masses or in tumor sites (P = .05). Prechemotherapy variables of gray scale characteristics and vascularity were compared with final histologic size, and all had P > .20. 2
52. Croshaw R, Shapiro-Wright H, Svensson E, Erb K, Julian T. Accuracy of clinical examination, digital mammogram, ultrasound, and MRI in determining postneoadjuvant pathologic tumor response in operable breast cancer patients. Ann Surg Oncol. 2011;18(11):3160-3163. Observational-Dx 61 patients To determine the accuracy, positive predictive value (PPV), and negative predictive value (NPV) of clinical examination and breast imaging techniques in determining pathologic complete response in patients with locally advanced breast cancer after neoadjuvant therapy. Sixty-two tumors in 61 patients with a mean age of 56 (range 34-87) years were evaluated. Overall accuracy ranged from 54% (CBE) to 80% (breast ultrasound). All modalities had a PPV greater than 75% for identifying the presence of residual disease. The PPV of each modality was generally higher in the younger patients. The NPV of all methods was less than 50%. The accuracy and NPV were compromised even further in younger patients. The combination of our own data with data available from the literature revealed MRI to be superior with regard to accuracy and PPV, but the NPV of MRIs remained poor at 65%. 3
53. Keune JD, Jeffe DB, Schootman M, Hoffman A, Gillanders WE, Aft RL. Accuracy of ultrasonography and mammography in predicting pathologic response after neoadjuvant chemotherapy for breast cancer. Am J Surg. 2010;199(4):477-484. Observational-Dx 192 patients To assess the ability of mammography and ultrasound to predict residual tumor size following neoadjuvant chemotherapy. One hundred ninety-two patients with 196 primary breast cancers were studied. Of 104 tumors evaluated by both imaging modalities, ultrasound was able to size 91.3%, and mammography was able to size only 51.9% (chi(2)P < .001). Ultrasound also was more accurate than mammography in estimating residual tumor size (62 of 104 [59.6%] vs 33 of 104 [31.7%], P < .001). There was little difference in the ability of mammography and ultrasound to predict pathologic complete response (receiver operating characteristic, 0.741 vs 0.784). 3
54. Evans A, Armstrong S, Whelehan P, et al. Can shear-wave elastography predict response to neoadjuvant chemotherapy in women with invasive breast cancer? Br J Cancer. 2013;109(11):2798-2802. Observational-Dx 40 patients To ascertain whether tissue stiffness in breast cancers, as assessed by shear-wave elastography (SWE) before treatment, is associated with response. Statistically significant correlations were shown between stiffness and RCB scores and between stiffness and percentage tumour cellularity. The correlation between stiffness and percentage cellularity was strongest (CC 0.35 (P<0.0001) compared with CC 0.23 (P=0.004) for the RCB score). The results of a general linear model show that cellularity and RCB score maintain independent relationships with stiffness. By multiple linear regression, only cellularity maintained a significant relationship with stiffness. 3
55. Hayashi M, Yamamoto Y, Ibusuki M, et al. Evaluation of tumor stiffness by elastography is predictive for pathologic complete response to neoadjuvant chemotherapy in patients with breast cancer. Ann Surg Oncol. 2012;19(9):3042-3049. Observational-Dx 55 patients To evaluate if tumor stiffness by EG has the potential to provide additional information useful in predicting the response to chemotherapy in clinical setting. The mean EG scores were significant lower for the clinical and pathologic complete response (pCR) groups than for the others. When we categorized patients into two groups according to tumor stiffness, 26 patients were assigned to the low EG group (soft, scores from 1 to 3) and 29 patients were assigned to the high EG group (hard, score 4 and 5). The low EG group had significantly higher clinical complete response and pCR rates than the high EG group (clinical complete response, low EG group 38 % vs. high EG group 10 %, P = 0.024; pCR, low EG group 50 % vs. high EG group 14 %, P = 0.003, respectively). Furthermore, multivariate analysis indicated that estrogen receptor, human epidermal growth factor receptor 2, and low EG (odds ratio 13.04, 95 % confidence interval 1.19-458.28, P = 0.035) were independent predictive factors of pCR. 3
56. Cao X, Xue J, Zhao B. Potential application value of contrast-enhanced ultrasound in neoadjuvant chemotherapy of breast cancer. Ultrasound Med Biol. 2012;38(12):2065-2071. Observational-Dx 31 patients To investigate the value of contrast-enhanced ultrasound (CEUS) in evaluating the response of breast cancer to neoadjuvant chemotherapy (NAC). All patients were evaluated by both conventional ultrasound (US) and CEUS. The tumor sizes measured by CEUS were larger and more accurately imaged than those evaluated by US. Necrosis at the tumor center could be detected by CEUS, which showed a local blood perfusion defect in 26 cases (83.9%) before NAC and 27 cases (87.1%) after NAC, whereas US did not show liquefaction in any patient. The CEUS time-intensity curve displayed quantitatively the tumors' blood-perfusion changes; after NAC, blood perfusion reduced, enhancement intensity decreased, time to peak increased, peak intensity reduced, and the wash-in slope reduced (p < 0.05). 2
57. 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(11):946-953. Observational-Dx 45 women To assess the accuracy of magnetic resonance imaging (MRI) in evaluating residual disease after neoadjuvant chemotherapy in patients with large breast cancers. The sensitivity, specificity and accuracy of MRI in detecting residual disease was 90.5, 100, and 91.3%, respectively. The mean of largest diameters measured at histology and at MRI were 26 and 28.2mm, respectively. The tumour size correlation coefficient between MRI and pathology measurements was very high: r(2)=0.9657 (p<0.0001). The interclass correlation coefficient between preoperative imaging measurements and pathological measurements of residual disease was 0.944 (95% CI: 0.906-0.982). 2
58. Hollingsworth AB, Stough RG, O'Dell CA, Brekke CE. Breast magnetic resonance imaging for preoperative locoregional staging. Am J Surg. 2008;196(3):389-397. Observational-Dx 603 patients To correlate histology and breast MRI findings. Reoperation for positive margins after lumpectomy occurred in 8.8% of patients. Multicentricity was identified by MRI alone in 7.7% of patients, whereas 3.7% were found to have contralateral cancer by MRI. The sensitivity of MRI was 93% in detecting multicentric disease and 88% for contralateral disease, whereas sensitivity for conventional imaging was 46% and 19%, respectively. Unsuspected disease was identified by MRI equally for invasive ductal and ductal carcinoma in situ histology, whereas multicentricity was found more frequently with invasive lobular carcinoma. 3
59. Yuan Y, Chen XS, Liu SY, Shen KW. Accuracy of MRI in prediction of pathologic complete remission in breast cancer after preoperative therapy: a meta-analysis. AJR Am J Roentgenol. 2010;195(1):260-268. Meta-analysis 25 studies To determine the ability of MRI to predict pathologic complete remission in patients with breast cancer after preoperative therapy. Twenty-five studies were included in this meta-analysis. Pooled weighted estimates of sensitivity and specificity were 0.63 (range, 0.56-0.70) and 0.91 (range, 90.89-0.92), respectively. Heterogeneity between studies was highly influenced by the pathologic complete remission rate, with a regression coefficient of -6.160 (p = 0.020). Subgroup analysis showed that the specificity of MRI in studies with a pathologic complete remission rate of > or = 20% was lower than that in studies with a pathologic complete remission rate of < 20% (p = 0.0003). M
60. Semiglazov V. RECIST for Response (Clinical and Imaging) in Neoadjuvant Clinical Trials in Operable Breast Cancer. J Natl Cancer Inst Monogr. 2015;2015(51):21-23. Review/Other-Dx N/A To review the RECIST criteria for response in neoadjuvant clinical trials in operable breast cancer Magnetic resonance imaging (MRI) is superior to physical examination, ultrasound, and mammography in response evaluation during neoadjuvant systemic therapy. The accuracy of breast MRI to predict pCR has a moderate sensitivity, but high specificity. The accuracy of anatomic imaging to assess residual disease and predict pCR depended on anatomic radiographic imaging cancer subtypes. Response monitoring using breast is accurate in triple-negative or HER2-positive tumors. It was inaccurate in estrogen receptor-positive/HER2-negative subtype. Another approach currently under investigation is dynamic contrast-enhanced MRI and diffusion weighted-imaging, (18)F-fluorodeoxyglucose positron emission tomography, fluorodeoxyglucose positron emission tomography/computed tomography. 4
61. Straver ME, Loo CE, Rutgers EJ, et al. MRI-model to guide the surgical treatment in breast cancer patients after neoadjuvant chemotherapy. Ann Surg. 2010;251(4):701-707. Observational-Dx 208 patients To establish an magnetic resonance imaging (MRI)-based interpretation model to facilitate the selection of breast-conserving surgery (BCS) after neoadjuvant chemotherapy (NAC). The accuracy of MRI to detect residual disease was 76% (158/208). The positive and negative predictive value of MRI were 90% (130/144) and 44% (28/64), respectively. In 35 patients (17%), MRI underestimated the tumor size by >20 mm and in 27 patients (13%) this would have lead to incorrect indication of BCS. The features most predictive of indicating feasibility of BCS in tumors <30 mm on preoperative MRI were the largest diameter at the baseline MRI, the reduction in diameter and the tumor subtype based on hormone-, and human epidermal growth factor receptor 2-status (area under the curve: 0.78). 3
62. Vriens BE, de Vries B, Lobbes MB, et al. Ultrasound is at least as good as magnetic resonance imaging in predicting tumour size post-neoadjuvant chemotherapy in breast cancer. Eur J Cancer. 2016;52:67-76. Observational-Dx 182 patients To evaluate the accuracy of clinical imaging of the primary breast tumour post-neoadjuvant chemotherapy (NAC) related to the post-neoadjuvant histological tumour size (gold standard) and whether this varies with breast cancer subtype. MRI estimated residual tumour size with <10-mm discordance in 54% of patients, overestimated size in 28% and underestimated size in 18% of patients. With US, this was 63%, 20% and 17%, respectively. The negative predictive value in hormone receptor-positive tumours for both MRI and US was low, 26% and 33%, respectively. The median deviation in clinical tumour size as percentage of pathological tumour was 63% (P25=26, P75=100) and 49% (P25=22, P75=100) for MRI and US, respectively (P=0.06). 3
63. Hylton N. MR imaging for the prediction of breast cancer response to neoadjuvant chemotherapy. Radiology. 2013;266(1):367. Review/Other-Dx N/A Response to comments regarding the results of the American College of Radiology Imaging Network (ACRIN) 6657/Investigation of Serial Studies to Predict Your Therapeutic Response with Imaging and Molecular Analysis (I-SPY TRIAL) breast cancer trial. No results stated in abstract. 4
64. Akazawa K, Tamaki Y, Taguchi T, et al. Preoperative evaluation of residual tumor extent by three-dimensional magnetic resonance imaging in breast cancer patients treated with neoadjuvant chemotherapy. Breast J. 2006;12(2):130-137. Observational-Dx 38 patients To evaluate the usefulness of three-dimensional magnetic resonance imaging (3D MRI) for the preoperative assessment of residual tumor extent in breast cancer patients treated with neoadjuvant chemotherapy (NAC). The tumor size determined by calipers, ultrasonography, and 3D MRI after NAC was compared with that determined by pathologic examination. The tumor size determined by 3D MRI showed a strong correlation with that determined by pathologic examination (r = 0.896). Moderate, but significant correlations were found between measurements obtained with calipers and pathology (r = 0.554), and between ultrasonography and pathology (r = 0.484). The response rates to NAC were estimated at 84.2% with calipers, 58.0% with ultrasonography, and 44.7% with 3D MRI. Calipers and ultrasonography thus tended to overestimate the response to NAC compared to 3D MRI (p < 0.001 and 0.240, respectively). 2
65. Loo CE, Teertstra HJ, Rodenhuis S, et al. Dynamic contrast-enhanced MRI for prediction of breast cancer response to neoadjuvant chemotherapy: initial results. AJR Am J Roentgenol. 2008;191(5):1331-1338. Observational-Dx 54 patients To establish changes in contrast-enhanced MRI of breast cancer during neoadjuvant chemotherapy that are indicative of pathology outcome. Change in largest diameter of late enhancement during chemotherapy was the single most predictive MRI characteristic for tumor response in multivariate analysis (A(z) [area under the ROC curve] = 0.73, p < 0.00001). Insufficient (< 25%) decrease in largest diameter of late enhancement during chemotherapy was most indicative of residual tumor at final pathology. Using this criterion, the fraction of unfavorable responders indicated by MRI was 41% (22/54). Approximately half (44%, 14/32) of the patients who showed favorable response at MRI achieved complete remission at pathology. Conversely, 95% (21/22) of patients who showed unfavorable response at MRI had residual tumor at pathology. 3
66. Cheung YC, Chen SC, Hsieh IC, et al. Multidetector computed tomography assessment on tumor size and nodal status in patients with locally advanced breast cancer before and after neoadjuvant chemotherapy. Eur J Surg Oncol. 2006;32(10):1186-1190. Observational-Dx 28 patients To evaluate the utility of multidetector computed tomography (MCT) in assessing tumor size and nodal status in patients with advanced breast cancers before and after the neoadjuvant chemotherapy. The MCT measurements documented complete response in 3, partial response in 18, non-response in 8 and progressed in 1. The mean tumor diameters on pathology and post-chemotherapy MCT were 3.6cm (S.D.=+/-2.9cm) and 3.1cm (S.D.=+/-2.6cm), respectively. The Pearson correlation coefficient was 0.76 (p<0.001). The sensitivity, specificity, positive predictive valve, negative predictive valve and accuracy of MCT in diagnosing the axillary lymph node metastases after pre-operative neoadjuvant chemotherapy were counted, respectively, to 72%, 40%, 85.7%, 22.2% and 66.7%. All the 5 downstaged axillary nodal statuses from node-positive to node-negative on MCT had micrometastases. 2
67. Danishad KK, Sharma U, Sah RG, Seenu V, Parshad R, Jagannathan NR. Assessment of therapeutic response of locally advanced breast cancer (LABC) patients undergoing neoadjuvant chemotherapy (NACT) monitored using sequential magnetic resonance spectroscopic imaging (MRSI). NMR Biomed. 2010;23(3):233-241. Observational-Dx 30 patients To (a) investigate, the systematic changes in the signal-to-noise ratio (SNR) of tCho resonance (ChoSNR) using MRSI and the anatomical parameter (volume) of the tumor in LABC patients, and (b) determine the potential clinical utility of these parameters in the assessment of tumor response during the various stages of NACT. Sequential data of 25 patients were retrospectively analyzed by classifying them as clinical responders and non-responders. In 14 responders, the pre-therapy ChoSNR was 7.8 +/- 5.1. In 10/14 responders, no choline was observed after III NACT while in the remaining four patients the ChoSNR was reduced to 3.6 +/- 1.1 (p < 0.05). Non-responders showed no statistically significant change in ChoSNR. After III NACT, the tumor volume reduced by 84.0 +/- 14.8% in responders. Using receiver operating curve (ROC) analysis, cut-off values of 53% for ChoSNR and 47.5% for volume were obtained to differentiate responders from non-responders. The sensitivity to detect responders from non-responders using ChoSNR was 85.7% with 91% specificity while 100% sensitivity was observed for volume but with reduced specificity of 73%. 3
68. Delille JP, Slanetz PJ, Yeh ED, Halpern EF, Kopans DB, Garrido L. Invasive ductal breast carcinoma response to neoadjuvant chemotherapy: noninvasive monitoring with functional MR imaging pilot study. Radiology. 2003;228(1):63-69. Observational-Dx 14 women To investigate if the extraction flow product (EFP), as determined on dynamic contrast material-enhanced magnetic resonance (MR) images, could be a potential marker of tumor response to neoadjuvant chemotherapy in patients with locally advanced breast cancer. EFPmean after neoadjuvant chemotherapy in partial responders and nonresponders was 33 mL x 100 g-1 x min-1 +/- 9.8 and 54.2 mL x 100 g-1 x min-1 +/- 10.3, respectively (P <.005). EFPmean decreased after neoadjuvant chemotherapy in the responders and nonresponders by 37% +/- 30 and -5% +/- 35, respectively (P >.05). An increase in EFPmean values was observed only in nonresponders who received taxanes. For regimens without taxanes, EFPmean decreased regardless of the morphologic response. EFPcount decreased for all the responders by 77% +/- 33 and increased for all the nonresponders by 45% +/- 68 (P <.02). 3
69. Marinovich ML, Sardanelli F, Ciatto S, et al. Early prediction of pathologic response to neoadjuvant therapy in breast cancer: systematic review of the accuracy of MRI. Breast. 2012;21(5):669-677. Review/Other-Dx 13 studies To examine the evidence on MRI’s accuracy in early prediction of pathologic response, including comparisons with alternative assessment methods. Thresholds for identifying response varied across studies. Definitions of response included pathologic complete response (pCR), near-pCR, and residual tumour with evidence of NAC effect (range of response 0-58%). Heterogeneity across MRI parameters and the outcome definition precluded statistical meta-analysis. Based on descriptive presentation of the data, sensitivity/specificity pairs for prediction of pathologic response were highest in studies measuring reductions in Ktrans (near-pCR), ECU (pCR, but not near-pCR) and tumour volume (pCR or near-pCR), at high thresholds (typically >50%); lower sensitivity/specificity pairs were evident in studies measuring reductions in uni- or bidimensional tumour size. 4
70. Padhani AR, Hayes C, Assersohn L, et al. Prediction of clinicopathologic response of breast cancer to primary chemotherapy at contrast-enhanced MR imaging: initial clinical results. Radiology. 2006;239(2):361-374. Experimental-Dx 21 women To prospectively document changes in contrast agent kinetics in patients with primary breast cancer treated with systemic chemotherapy after one or two cycles and to determine whether kinetic measures can be used to predict final clinicopathologic response. After the first cycle of treatment, 12 of 14 clinical responders showed decreases in tumor size, and six of seven nonresponders showed increases or no change in tumor size (P < .001). Transfer constant changes did not differ between responders and nonresponders for either clinical or pathologic assessments. After two cycles of treatment, there were tumor size increases in five of six nonresponders compared with decreases in eight of nine responders (P < .001). Reductions in transfer constant range were also observed in responders for both clinical and pathologic assessments (P = .008 and .02, respectively). No other kinetic parameter change predicted response. Size and transfer constant range were equally accurate for predicting the absence of pathologic response after two cycles of treatment (sensitivity, specificity, and area under ROC curve were 100%, 90%, and 0.93, respectively, for size and 100%, 75%, and 0.94, respectively, for transfer constant range). 2
71. Abramson RG, Li X, Hoyt TL, et al. Early assessment of breast cancer response to neoadjuvant chemotherapy by semi-quantitative analysis of high-temporal resolution DCE-MRI: preliminary results. Magn Reson Imaging. 2013;31(9):1457-1464. Experimental-Dx 21 patients To evaluate whether semi-quantitative analysis of high temporal resolution dynamic contrast-enhanced MRI (DCE-MRI) acquired early in treatment can predict the response of locally advanced breast cancer (LABC) to neoadjuvant chemotherapy (NAC). All 21 patients completed NAC followed by surgery, with 9 patients achieving a pCR. No pretreatment imaging parameters were predictive of pCR. However, change after cycle 1 of NAC in percentage of voxels demonstrating washout kinetics with a 100% enhancement filter discriminated patients with an eventual pCR with an area under the receiver operating characteristic curve (AUC) of 0.77. Changes in other parameters, including lesion size, did not predict pCR. 2
72. Belli P, Costantini M, Ierardi C, et al. Diffusion-weighted imaging in evaluating the response to neoadjuvant breast cancer treatment. Breast J. 2011;17(6):610-619. Observational-Dx 51 women To investigate the role of diffusion imaging in the evaluation of response to neoadjuvant breast cancer treatment by correlating apparent diffusion coefficient (ADC) value changes with pathological response. Fifty-one women (mean age 48.41 years) were included in this study. Morphological MRI (RECIST classification) well evaluated the responder status after chemotherapy (TRG class; area-under-the-curve 0.865). Mean pretreatment ADC values obtained with the two different methods of ROI placement were 1.11 and 1.02 x 10(-3) mm(2) /seconds. Mean post-treatment ADC values were 1.40 and 1.35 x 10(-3) mm(2) /seconds, respectively. A significant inverse correlation between mean ADC increase and Mandard's classifications was observed for both the methods of ADC measurements. Diagnostic performance analysis revealed that the single ROI method has a superior diagnostic accuracy compared with the multiple ROIs method (accuracy: 82% versus 74%). 3
73. Fangberget A, Nilsen LB, Hole KH, 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(6):1188-1199. Observational-Dx 31 patients To explore the predictive value of MRI parameters and tumour characteristics before neoadjuvant chemotherapy (NAC) and to compare changes in tumour size and tumour apparent diffusion coefficient (ADC) during treatment, between patients who achieved pathological complete response (pCR) and those who did not. Before NAC, HER2 overexpression was the single significant predictor of pCR (p = 0.006). At Tp1 ADC, tumour size and changes in tumour size were all significantly different in the pCR and non-pCR groups. Using 1.42 x 10(-3) mm(2)/s as the cut-off value for ADC, pCR was predicted with sensitivity and specificity of 88% and 80%, respectively. Using a cut-off value of 83% for tumour volume reduction, sensitivity and specificity for pCR were 91% and 80%. 2
74. Iwasa H, Kubota K, Hamada N, Nogami M, Nishioka A. Early prediction of response to neoadjuvant chemotherapy in patients with breast cancer using diffusion-weighted imaging and gray-scale ultrasonography. Oncol Rep. 2014;31(4):1555-1560. Observational-Dx 24 female patients To evaluate the utility of the pretreatment apparent diffusion coefficient (ADC), which is calculated from diffusion-weighted imaging (DWI), the change in ADC after first administration of NACT, and the change in tumor greatest diameter on ultrasonography in the early prediction of the tumor response to NACT. Pearson's correlation test showed a significant correlation between % ADC and the response rate (r=0.597,p=0.016); none of the other three independent variables were correlated with the response rate. Therefore, only % ADC was evaluated by ROC analysis. The AUC of % ADC to differentiate between responders and non-responders on ROC analysis was 0.90 [95% confidence interval, 0.760-1.040]. Breast cancer lesions with high %ADC values responded to NACT, while those with low %ADC values did not. 2
75. Sharma U, Danishad KK, Seenu V, Jagannathan NR. Longitudinal study of the assessment by MRI and diffusion-weighted imaging of tumor response in patients with locally advanced breast cancer undergoing neoadjuvant chemotherapy. NMR Biomed. 2009;22(1):104-113. Experimental-Dx 56 patients with locally advanced breast cancer, 10 patients with benign tumors, and 15 controls To evaluate tumor response according to various MR parameters, such as ADC, volume and longest diameter, during the course of various cycles of NACT in a large cohort of patients with LABC. Mean ADC before treatment of malignant breast tissue was significantly lower than that of controls, disease-free contralateral tissue of the patients, and benign lesions, and gradually increased during the course of NACT. Analysis of the percentage change in ADC, volume and diameter after each cycle of NACT between clinical responders and non-responders showed that the change in ADC after the first cycle was statistically significant compared with volume and diameter, indicating its potential in assessing early response. After the third cycle, the sensitivity for differentiating responders from non-responders was 89% for volume and diameter and 68% for ADC, and the respective specificities were 50%, 70% and 100%. A sensitivity of 84% (specificity of 60% with an accuracy of 76%) was achieved when all three variables were taken together to predict the response. A cut-off value of ADC was also calculated using receiver operator characteristics analysis to discriminate between normal, benign and malignant breast tissue. Similarly, a cut-off value for ADC, volume and diameter was obtained after the second and third cycles of NACT to predict tumor response. 2
76. Shin HJ, Baek HM, Ahn JH, et al. Prediction of pathologic response to neoadjuvant chemotherapy in patients with breast cancer using diffusion-weighted imaging and MRS. NMR Biomed. 2012;25(12):1349-1359. Observational-Dx 90 patients To determine whether tumor size, MRS parameters and apparent diffusion coefficient (ADC) measurements could be applied to predict pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC). After NAC, 30 patients (33%) showed pCR and 60 (67%) showed non-pCR. At pretreatment, ADC was the only significant parameter in differentiating between pCR and non-pCR [(0.83 +/- 0.05) x 10(-)(3) versus (0.97 +/- 0.14) x 10(-)(3) mm(2)/s] (p = 0.014). Post-treatment measurements after completion of NAC and changes in tumor size (both p < 0.001), MRS parameters (p = 0.027 and p = 0.020 for absolute tCho integral, p = 0.036 and p = 0.023 for normalized tCho integral, and p = 0.032 and p = 0.061 for tCho SNR) and ADC (p = 0.003 and p < 0.001) were significantly different between the pCR and non-pCR groups, except for changes in tCho SNR. In ROC analysis, the areas under the ROC curve (AUCs) of 0.63-0.73 were obtained for tumor size and MRS parameters. AUCs for pre- and post-treatment ADC and changes in ADC were 0.75, 0.80 and 0.96, respectively. The optimal cut-off of the percentage change in ADC for predicting pCR was 40.7%, yielding 100% sensitivity and 91% specificity. 3
77. Park SH, Moon WK, Cho N, et al. Diffusion-weighted MR imaging: pretreatment prediction of response to neoadjuvant chemotherapy in patients with breast cancer. Radiology. 2010;257(1):56-63. Observational-Dx 53 patients To evaluate the potential of diffusion-weighted (DW) magnetic resonance (MR) imaging with an apparent diffusion coefficient (ADC) map in the prediction of response to neoadjuvant chemotherapy in patients with breast cancer. After chemotherapy, 36 (68%) patients were classified as responders, and 17 (32%) were classified as nonresponders. Pretreatment mean ADC ([1.036 +/- 0.015] x 10(-3) mm(2)/sec [standard error]) of responders was significantly lower than that of nonresponders ([1.299 +/- 0.079] x 10(-3) mm(2)/sec) (P = .004). Furthermore, mean percentage ADC increase of responders (47.9% +/- 4.8) was higher than that of nonresponders (18.1% +/- 4.5) (P < .001). The best pretreatment ADC cutoff with which to differentiate between responders and nonresponders was 1.17 x 10(-3) mm(2)/sec, which yielded a sensitivity of 94% (95% confidence interval [CI]: 81%, 99%) and a specificity of 71% (95% CI: 44%, 90%). 2
78. Hahn SY, Ko EY, Han BK, Shin JH, Ko ES. Role of diffusion-weighted imaging as an adjunct to contrast-enhanced breast MRI in evaluating residual breast cancer following neoadjuvant chemotherapy. Eur J Radiol. 2014;83(2):283-288. Observational-Dx 78 patients To investigate whether the addition of diffusion-weighted imaging (DWI) to dynamic contrast-enhanced MRI (DCE-MRI) improves diagnostic performance in predicting pathologic response and residual breast cancer size following neoadjuvant chemotherapy. Of the 78 patients, 59 (75.6%) had residual cancer. For detection of residual cancer, DCE-MRI plus DWI had higher specificity (80.0%), accuracy (91.0%), and PPV (93.2%) than DCE-MRI or DWI alone (P=0.004, P=0.007, and P=0.034, respectively). The ICC values for residual cancer size between MRI and histopathology were 0.891 for DCE-MRI plus DWI, 0.792 for DCE-MRI, and 0.773 for DWI. ADC values showed no significant differences between residual cancer and chemotherapeutic changes (P=0.130). 2
79. Chen JH, Bahri S, Mehta RS, et al. Impact of factors affecting the residual tumor size diagnosed by MRI following neoadjuvant chemotherapy in comparison to pathology. J Surg Oncol. 2014;109(2):158-167. Observational-Dx 98 patients To investigate accuracy of magnetic resonance imaging (MRI) for measuring residual tumor size in breast cancer patients receiving neoadjuvant chemotherapy (NAC). The mean (+/-SD) of the absolute difference between MRI and pathological residual tumor size was 1.0 +/- 2.0 cm (range, 0-14 cm). Univariate regression analysis showed tumor type, morphology, HR status, HER2 status, and MRI scanner (1.5 T or 3.0 T) were significantly associated with MRI-pathology size discrepancy (all P < 0.05). Multivariate regression analyses demonstrated that only tumor type, tumor morphology, and biomarker status considering both HR and HER-2 were independent predictors (P = 0.0014, 0.0032, and 0.0286, respectively). 2
80. De Los Santos JF, Cantor A, Amos KD, 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. 119(10):1776-83, 2013 May 15. Observational-Dx 746 women To estimate the accuracy of preoperative magnetic resonance imaging (MRI) in predicting a pCR in the breast. 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. 3
81. Londero V, Bazzocchi M, Del Frate C, et al. Locally advanced breast cancer: comparison of mammography, sonography and MR imaging in evaluation of residual disease in women receiving neoadjuvant chemotherapy. Eur Radiol. 2004;14(8):1371-1379. Experimental-Dx 15 patients The purpose of this study was to evaluate the diagnostic accuracy of different imaging methods (mammography, breast sonography and breast MRI) in the assessment of neoplastic residual tissue and the ability of each imaging method in the evaluation of the real extent of the disease after neoadjuvant chemotherapy in patients affected by locally advanced breast carcinoma. MRI identified 2/15 (13.3.%) clinically complete response (CR), 9/15 (60%) partial response (PR), 3/15 (20%) stable disease (SD) and 1/15 (6.7%) progressive disease. Mammography identified 1/15 (6.7%) clinically CR, 8/15 (53.3%) PR and 4/15 (27%) SD, and was not able to evaluate the disease in 2/15 (13%) cases. Sonography presented the same results as MRI. Therefore, MRI and sonography compared to mammography correctly identified residual disease in 100 vs. 86%. MRI resulted in two false-negative results because of the presence of microfoci of in situ ductal carcinoma (DCIS) and invasive lobular carcinoma (LCI). MRI was superior to mammography in cases of multifocal or multicentric disease (83 vs. 33%). Sonography performed after MRI improves the accuracy in evaluation of uncertain foci of multifocal disease seen on MR images with an increase of diagnostic accuracy from 73 to 84.5%. 2
82. Mann RM. The effectiveness of MR imaging in the assessment of invasive lobular carcinoma of the breast. Magn Reson Imaging Clin N Am. 2010;18(2):259-276, ix. Review/Other-Dx N/A To determine the effectiveness of MR imaging in the assessment of invasive lobular carcinoma of the breast No results stated in abstract. 4
83. McGuire KP, Toro-Burguete J, Dang H, et al. MRI staging after neoadjuvant chemotherapy for breast cancer: does tumor biology affect accuracy? Ann Surg Oncol. 2011;18(11):3149-3154. Observational-Dx 203 patients To determine the difference between tumor size as estimated by postchemotherapy MRI versus final surgical pathology, and to determine if the accuracy of MRI varies with tumor subtype. Two hundred three of 592 patients undergoing surgery after NAC for breast cancer had MRI staging pre and post chemotherapy. All patients had intact tumors prior to the initiation of chemotherapy. Average tumor size by MRI was 4.0 cm pre chemotherapy and 1.2 cm post chemotherapy. The average pathologic tumor size was 1.7 cm (range 0-13 cm). The difference between MRI and pathologic tumor size was greatest in luminal (1.1 cm) and least in triple-negative (TN) and human epidermal growth factor receptor 2 (HER2)-positive tumors (<0.1 cm) (p = 0.015). MRI was a good discriminator for pathologic complete response (pCR) [area under the curve (AUC) 0.777]. Its predictive value for pCR was much greater in TN and estrogen receptor(ER)-/HER2+ than in luminal tumors (73.6 vs. 27.3%) 3
84. Michishita S, Kim SJ, Shimazu K, et al. Prediction of pathological complete response to neoadjuvant chemotherapy by magnetic resonance imaging in breast cancer patients. Breast. 24(2):159-65, 2015 Apr. Observational-Dx 229 patients To evaluate whether the baseline breast MRI findings would be useful for the prediction for pathological complete response (pCR) by breast cancer patients to neoadjuvant chemotherapy. Before chemotherapy, breast MRI studies were performed. Breast tumors were dichotomized into round + oval and irregular types based on MRI morphology. The round + oval tumors showed a significantly higher pCR rate than the irregular tumors (42.0% vs 17.3%; P < 0.001). In addition, PAM50 analysis revealed that basal and HER2-enriched tumors were significantly more prevalent among round + oval than irregular type tumors (P = 0.015). 3
85. Richard R, Thomassin I, Chapellier M, et al. Diffusion-weighted MRI in pretreatment prediction of response to neoadjuvant chemotherapy in patients with breast cancer. European Radiology. 23(9):2420-31, 2013 Sep. Observational-Dx 118 women To evaluate the accuracy of the apparent diffusion coefficient (ADC) provided by diffusion-weighted imaging (DWI) in predicting the response to neoadjuvant chemotherapy (NACT) at baseline in patients according to their breast tumour phenotypes. After surgery, the pathologist recognized 24 complete responders (CRps) and 94 non-complete responders (NCRps). No difference was identified between the pretreatment ADCs of the CRp and NCRp patients. There were differences in pretreatment ADCs among the luminal A (1.001 +/- 0.143 x 10(-3) mm(2)/s), luminal B (0.983 +/- 0.150 x 10(-3) mm(2)/s), HER2-enriched (1.132 +/- 0.216 x 10(-3) mm(2)/s), and triple-negative (1.168 +/- 0.245 x 10(-3) mm(2)/s; P = 0.0003) tumour subtypes. In triple-negative tumours, the pretreatment ADC was higher in NCRp (1.060 +/- 0.143 x 10(-3) mm(2)/s) than in CRp patients (1.227 +/- 0.271 x 10(-3) mm(2)/s; P = 0.047). 3
86. Schelfout K, Van Goethem M, Kersschot E, et al. Preoperative breast MRI in patients with invasive lobular breast cancer. Eur Radiol. 2004;14(7):1209-1216. Observational-Dx 26 women To compared findings on preoperative MR imaging with mammography and US in 26 patients with invasive lobular cancer, using results from histopathological examination as gold standard. Most ILC presented on MRI as a single spiculated/irregular, inhomogeneous mass (pattern 1, n=12) or as a dominant lesion surrounded by multiple small enhancing foci (pattern 2, n=8). Multiple small enhancing foci with interconnecting enhancing strands (pattern 3) and an architectural distortion (pattern 4) were both described in three cases. There was one case of a focal area of inhomogeneous enhancement (pattern 5) and one normal MR examination (pattern 6). Unifocal and multifocal lesions were identified on MRI in four patients with normal conventional imaging. In nine women, multiple additional lesions or more extensive multiquadrant disease were correctly identified only on MRI. 3
87. Yeh ED, Slanetz PJ, Edmister WB, Talele A, Monticciolo D, Kopans DB. Invasive lobular carcinoma: spectrum of enhancement and morphology on magnetic resonance imaging. Breast J. 2003;9(1):13-18. Review/Other-Dx 19 patients To determine if there are specific morphologic and enhancement features that favor the diagnosis of ILC by retrospectively reviewing 19 patients with pathologically confirmed ILC and preoperative MRI. For the 15 cases of ILC that had echoplanar data, analysis showed peak EFs ranging between 25 and 120, and the majority showed EFs in the 30s. A substantial portion of two tumors enhanced in a similar fashion to normal breast tissue, with EFs in the low 20s. Morphologically MRI showed a focal mass in eight cases, regional enhancement in five, segmental enhancement in one, segmental enhancement with multiple small nodules in one, a mixture of a focal mass and regional enhancement in one, diffuse enhancement in one, multiple small nodules in one, and bilateral disease in one. Of the focal masses, seven were irregular in shape and one was round; six had ill-defined margins and two had spiculated margins. All eight enhanced heterogeneously. Four cases had multifocal disease and one case had unsuspected contralateral disease discovered only on MRI. 4
88. Ko ES, Han H, Han BK, et al. Prognostic Significance of a Complete Response on Breast MRI in Patients Who Received Neoadjuvant Chemotherapy According to the Molecular Subtype. Korean J Radiol. 2015;16(5):986-995. Observational-Dx 174 patients To evaluate the relationship between response categories assessed by magnetic resonance imaging (MRI) or pathology and survival outcomes, and to determine whether there are prognostic differences among molecular subtypes. There were 41 recurrences (9 locoregional and 32 distant recurrences). There were statistically significant differences in recurrence outcomes between patients who achieved a radiologic or a pCR and patients who did not achieve a radiologic or a pCR (recurrence hazard ratio, 11.02; p = 0.018 and recurrence hazard ratio, 3.93; p = 0.022, respectively). Kaplan-Meier curves for recurrence-free survival showed that triple-negative breast cancer was the only subtype that showed significantly better outcomes in patients who achieved a CR compared to patients who did not achieve a CR by both radiologic and pathologic assessments (p = 0.004 and 0.001, respectively). A multivariate analysis found that patients who achieved a rCR and a pCR did not display significantly different recurrence outcomes (recurrence hazard ratio, 2.02; p = 0.505 and recurrence hazard ratio, 1.12; p = 0.869, respectively). 2
89. Ko ES, Han BK, Kim RB, 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(8):2562-2568. Observational-Dx 166 patients To evaluate the accuracy of breast magnetic resonance imaging (MRI) to predict residual lesion size after neoadjuvant chemotherapy (NAC) and to determine the factors that influence the accuracy of response prediction. Of the 166 women, 40 achieved pCR. The overall sensitivity, specificity, and accuracy for diagnosing invasive residual disease by using MRI were 96, 65, and 89 %, respectively. The Pearson's correlation coefficient between the tumor sizes measured using MRI and pathology was 0.749 (P < 0.001). The size discrepancy was significantly greater in patients with estrogen receptor-positive cancer (P = 0.037), in cancers with low nuclear grade (P = 0.007), and in cancers shown as diffuse non-mass-like enhancement on MRI (P = 0.001). 3
90. Kim HJ, Im YH, Han BK, 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(7):996-1003. Observational-Dx 50 patients To evaluate the accuracy of magnetic resonance imaging (MRI) for estimating residual tumor size after neoadjuvant chemotherapy in patients with locally advanced breast cancer and assessed whether the tumor pattern on MRI after chemotherapy influenced the accuracy of the MRI measurement of the residual tumor size. The correlation coefficient between the residual tumor sizes determined by MRI and by pathology was 0.645. The MRI measurement agreed with the pathologically determined size in 36 patients (72%) and disagreed in 14 patients 928%), overestimating the size in 13 (26%) and underestimating the size in one (2%). disagreement appeared to be more frequent in the cases showing a nest or rim pattern than in those exhibiting a shrinkage pattern, although this was not statistically significant (p = 0.119). 2
91. Chen JH, Feig B, Agrawal G, et al. MRI evaluation of pathologically complete response and residual tumors in breast cancer after neoadjuvant chemotherapy. Cancer. 2008;112(1):17-26. Experimental-Dx 51 patients To investigate the role of magnetic resonance imaging (MRI) in evaluation of pathologically complete response and residual tumors in patients who were receiving neoadjuvant chemotherapy (NAC) for both positive and negative HER-2 breast cancer. Complete clinical response as seen through MRI, including CCR and probable CCR, was identified in 35 (35 of 51, 69%) patients. MRI correctly diagnosed pCR in 26 (26 of 35, 74%) patients, including 18 of 19 (95%) patients in the HER-2 positive group and 8 of 16 (50%) patients in the HER-2 negative group (P < .005). The accuracy of MRI in identifying pCR varied according to the chemotherapy agent that was administered. MRI was more accurate in identifying pCR in patients who were receiving trastuzumab and less accurate in patients receiving bevacizumab. The high false-negative rate found in HER-2 negative patients was associated with residual disease that presented as scattered cells or small foci. In cases with residual bulk tumor, the lesion size, determined by MRI, correlated highly with that found in histopathological measurements (r = 0.93). 2
92. Denis F, Desbiez-Bourcier AV, Chapiron C, Arbion F, Body G, Brunereau L. Contrast enhanced magnetic resonance imaging underestimates residual disease following neoadjuvant docetaxel based chemotherapy for breast cancer. Eur J Surg Oncol. 2004;30(10):1069-1076. Experimental-Dx 40 patients To compare the ability of magnetic resonance imaging (MRI) to measure residual breast cancer in patients treated with different neoadjuvant chemotherapy regimen. MRI over/underestimation of the spread of residual tumour was never superior to 15mm in FEC group, whereas it appeared in 11/28 (39%, 30-48%-95% CI) patients in DXL group (p=0.017). Tumour shrinkage led to single nodular residual lesions in FEC group, whereas vast numerous microscopic nests were observed in docetaxel group in pathology. 2
93. Wahner-Roedler DL, Boughey JC, Hruska CB, et al. The use of molecular breast imaging to assess response in women undergoing neoadjuvant therapy for breast cancer: a pilot study. Clin Nucl Med. 2012;37(4):344-350. Experimental-Dx 20 patients To report our findings from a prospective pilot study evaluating the accuracy of molecular breast imaging (MBI) in assessing tumor response to neoadjuvant therapy (NT) for breast cancer. Three patients in whom post-NT MBI could not be performed because of scheduling problems were excluded from analysis. Eighteen cancers were diagnosed in 17 patients. A correlation coefficient of r = 0.681 (P = 0.002) was found between MBI and residual tumor size. The average T/B ratio on MBI decreased from a pretreatment value of 3.0 to a posttreatment value of 1.4. The relative decrease in T/B ratio did not appear to be predictive of response. 2
94. Dunnwald LK, Gralow JR, Ellis GK, et al. Residual tumor uptake of [99mTc]-sestamibi after neoadjuvant chemotherapy for locally advanced breast carcinoma predicts survival. Cancer. 2005;103(4):680-688. Observational-Dx 62 patients To test whether MIBI uptake post neoadjuvant chemotherapy predicts survival. Patients with high uptake on the last observed MIBI scan (i.e., the L:N ratio was greater than the median value) had poorer DFS and OS (P<0.01 and P=0.01, respectively). Residual MIBI uptake retained independent prognostic significance in preliminary multivariate analysis that included other established prognostic markers 2
95. Lee HS, Ko BS, Ahn SH, et al. Diagnostic performance of breast-specific gamma imaging in the assessment of residual tumor after neoadjuvant chemotherapy in breast cancer patients. Breast Cancer Res Treat. 2014;145(1):91-100. Observational-Dx 122 patients To evaluate the diagnostic performance of breast-specific gamma imaging (BSGI) in the assessment of residual tumor after neoadjuvant chemotherapy (NAC) in breast cancer patients, The sensitivity and specificity of BSGI for residual tumor detection in 122 enrolled patients were 74.0 and 72.2 %, respectively, and were comparable to those of MRI (81.7 and 72.2 %; P > 0.100). The residual tumor size was significantly underestimated by BSGI in the luminal subtype (P = 0.008) and by MRI in the luminal (P < 0.001) and HER2 subtypes (P = 0.032), with a significantly lesser degree of underestimation by BSGI than MRI in both subtypes. In the triple-negative subtype, both BSGI and MRI generated accurate tumor size measurements. The residual cellularity of triple-negative tumors was significantly higher than that of the non-triple-negative tumors (P = 0.017). The diagnostic performance of BSGI in the assessment of residual tumor is comparable to that of MRI in breast cancer patients. 3
96. Bassa P, Kim EE, Inoue T, et al. Evaluation of preoperative chemotherapy using PET with fluorine-18-fluorodeoxyglucose in breast cancer. J Nucl Med. 1996;37(6):931-938. Observational-Dx 16 patients To investigate the value of PET with fluorine-18 fluorodeoxyglucose (FDG) for preoperative chemotherapy response in patients with locally advanced breast cancer. Sensitivity for detection of pathologically proven primary lesions was 100%, 62.5% and 87.5% with FDG-PET, mammography and US, respectively; and sensitivity for detection of initial nodal involvement was 77%, 70% and 87.5%, respectively. Sensitivity for detection of residual primary tumor was 75%, 71.4% and 87.5%, respectively; and sensitivity for detection of residual nodal involvement was 41.6%, 71.4% and 66.6%, respectively. The mean SUV value of primary lesions was 9.4 (range 2.0-20.7, n = 16), with only two lesions showing an SUV below 3. Clinical improvement of primary lesions was seen in all patients; improvement with smaller size and less FDG uptake was visible as early as the second study in 11 patients (69%). Mean SUV values obtained at the second and third studies decreased significantly from those obtained in the first study. In four patients, the disease recurred after breast surgery with high SUV values. The mammograms and sonograms obtained before surgery showed a decrease in the diameter of 6 and 12 primary lesions of the 13 and 14 patients examined, respectively. 2
97. Duch J, Fuster D, Munoz M, et al. PET/CT with [18F] fluorodeoxyglucose in the assessment of metabolic response to neoadjuvant chemotherapy in locally advanced breast cancer. Q J Nucl Med Mol Imaging. 2012;56(3):291-298. Experimental-Dx 50 patients To prospectively evaluate FDG PET/CT in the assessment of metabolic response to neoadjuvant chemotherapy and correlation with tumor cellularity in locally advanced breast cancer. Baseline mean tumor size was 4.4+/-1.6 cm. Thirty eight patients were considered responders and 12 nonresponders. According to M&P scale, 10 patients had good prognosis (grades 4-5) and 40 patients had bad prognosis (grades 1-3). All patients with grade 5 M&P had no significant postchemotherapy FDG uptake. Patients with bad prognosis had lower SUVmax variation (SUVmax) than patients with good prognosis (60.7% vs. 80.5%, P=0.0016). SUVmax was lower in nonresponders than in partial responders according to RECIST criteria (38.9% vs. 67.6%, p<0.001), and was also lower in partial responders than complete responders (67.6% vs. 85.4%, P=0.005). A cut-off SUVmax value of 52% differentiates responders from nonresponders with a sensitivity of 86% and a specificity of 90%. Probability densities of the SUVmax (%) for stable disease (<45), partial (>45 to <82) and complete response (>82) showed an overall accuracy of 78% (Weighted Kappa=0.74). 2
98. Cheng X, Li Y, Liu B, Xu Z, Bao L, Wang J. 18F-FDG PET/CT and PET for evaluation of pathological response to neoadjuvant chemotherapy in breast cancer: a meta-analysis. Acta Radiol. 2012;53(6):615-627. Meta-analysis 17 studies including 781 subjects To determinate the diagnostic performance of 18F-fluorodeoxyglucose position emission tomography/computed tomography (FDG PET/CT) and FDG PET for evaluating response to neoadjuvant chemotherapy in patients with breast cancer. Seventeen studies (a total of 781 subjects) met the inclusion criteria. The pooled sensitivity was 0.840 (95% confidence interval [CI] 0.796-0.878). The pooled specificity was 0.713 (95% CI 0.667-0.756). For FDG PET/CT (10 studies included), the pooled sensitivity was 0.847 (95% CI 0.793-0.892), the pooled specificity was 0.661 (95% CI 0.598-0.720). The pooled likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR) were 2.835 (95% CI 1.640-4.900), 0.221 (95% CI 0.160-0.305), and 17.628 (95% CI 7.431-41.818). The area under the SROC curve (AUC) was 0.8934. For FDG PET (7 studies included), the pooled sensitivity and specificity were 0.826 (95% CI 0.741-0.892) and 0.789 (95% CI 0.719-0.849). The pooled LR + , LR-, and DOR were 3.601 (95% CI 2.601-4.986), 0.242 (95% CI 0.157-0.374), and 13.641 (95% CI 7.433-25.030). The AUC was 0.8764. M
99. Choi JH, Lim HI, Lee SK, et al. The role of PET CT to evaluate the response to neoadjuvant chemotherapy in advanced breast cancer: comparison with ultrasonography and magnetic resonance imaging. J Surg Oncol. 2010;102(5):392-397. Observational-Dx 41 patients To estimate the predictive role of PET CT and other imaging modalities (ultrasound, MRI) through NAC. Seven patients (17.1%) showed pCR. As a result of comparison of the image index, all image indexes of MRI were predictive for pCR (P < 0.05). In contrast, only delta and RR of US, RR of PET CT were significant. The area under curve of delta and RR in MRI were higher (0.91, 0.90) than US (0.83, 0.80) and PET CT (0.62, 0.72). The MRI is superior to the US or PET CT. 3
100. Gebhart G, Gamez C, Holmes E, et al. 18F-FDG PET/CT for early prediction of response to neoadjuvant lapatinib, trastuzumab, and their combination in HER2-positive breast cancer: results from Neo-ALTTO. J Nucl Med. 2013;54(11):1862-1868. Experimental-Dx 86 patients To explore whether 18F-FDG PET imaging would capture a higher rate of metabolic response with the dual HER2 blockade as opposed to single blockade. Seventy-seven of the 86 enrolled patients presented an evaluable baseline (18)F-FDG PET/CT scan; of these, 68 and 66 were evaluable at weeks 2 and 6, respectively. Metabolic responses in the primary tumors were evident after 2 wk of targeted therapy and correlated highly with metabolic responses at week 6 (R(2) = 0.81). pCRs were associated with greater SUVmax reductions at both time points. Mean SUVmax reductions for pCR and non-pCR, respectively, were 54.3% versus 32.8% at week 2 (P = 0.02) and 61.5% versus 34.1% at week 6 (P = 0.02). (18)F-FDG PET/CT metabolic response rates at weeks 2 and 6 were 71.6% and 60%, respectively using European Organization for Research and Treatment of Cancer criteria; pCR rates were twice as high for (18)F-FDG PET/CT responders than nonresponders (week 2: 42% vs. 21%, P = 0.12; week 6: 44% vs. 19%, P = 0.05). 1
101. Groheux D, Giacchetti S, Hatt M, et al. HER2-overexpressing breast cancer: FDG uptake after two cycles of chemotherapy predicts the outcome of neoadjuvant treatment. Br J Cancer. 2013;109(5):1157-1164. Observational-Dx 30 women To investigate the ability of interim positron emission tomography (PET) regarding early prediction of pathology outcomes. Thirty women were prospectively included and 60 PET/CT examination performed. At baseline, 22 patients had PET+ axilla and in nine of them (1)(8)F-FDG uptake was higher than in the primary tumour. At surgery, 14 patients (47%) showed residual tumour (non-pCR), whereas 16 (53%) reached pCR. Best prediction was obtained when considering the absolute residual SUVmax value at PET(2) (AUC=0.91) vs 0.67 for SUVmax at PET(1) and 0.86 for DeltaSUVmax. The risk of non-pCR was 92.3% in patients with any site of residual uptake >3 at PET(2), no matter whether in breast or axilla, vs 11.8% in patients with uptake </=3 (P=0.0001). The sensitivity, specificity, PPV, NPV and overall accuracy of this cutoff were, respectively: 85.7%, 93.8%, 92.3%, 88.2% and 90%. 2
102. Humbert O, Cochet A, Riedinger JM, et al. HER2-positive breast cancer: (1)(8)F-FDG PET for early prediction of response to trastuzumab plus taxane-based neoadjuvant chemotherapy. Eur J Nucl Med Mol Imaging. 2014;41(8):1525-1533. Observational-Dx 57 patients To investigate the value of (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET/CT) to predict a pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) in women with human epidermal growth factor receptor 2 (HER2)-positive breast cancer. In univariate analysis, negative hormonal receptor status (p = 0.04), high tumor grade (p = 0.03), and low tumor PET(2).SUVmax (p = 0.001) were predictive of pCR. Tumor DeltaSUVmax correlated with pCR (p = 0.03), provided that tumors with low metabolic activity at baseline were excluded. DeltaTLG did not correlate with pCR. In multivariate analysis, tumor PET(2).SUVmax < 2.1 was the best independent predictive factor (Odds ratio =14.3; p = 0.004) with both negative and positive predictive values of 76 %. Although the metabolic features of the primary tumor did not depend on hormonal receptor status, both the baseline metabolism and early response of axillary nodes were higher if estrogen receptors were not expressed (p = 0.01 and p = 0.03, respectively). 3
103. Groheux D, Hindie E, Giacchetti S, et al. Triple-negative breast cancer: early assessment with 18F-FDG PET/CT during neoadjuvant chemotherapy identifies patients who are unlikely to achieve a pathologic complete response and are at a high risk of early relapse. J Nucl Med. 2012;53(2):249-254. Observational-Dx 20 patients to investigate whether early changes in (18)F-FDG tumor uptake during neoadjuvant chemotherapy (NAC) can predict outcomes. At surgery, 6 patients had a pathologic complete response, whereas 14 had residual tumor. Four patients showed early relapse (in the 2 y after surgery). There were 11 metabolic responders and 9 nonresponders using a 42% decrease in maximum standardized uptake value as a cutoff. In nonresponding patients, the risk of residual tumor at surgery was 100% (vs. 45% in responders; P = 0.014), and the risk of early relapse was 44% (vs. 0%; P = 0.024). 3
104. Avril N, Rose CA, Schelling M, et al. Breast imaging with positron emission tomography and fluorine-18 fluorodeoxyglucose: use and limitations. J Clin Oncol. 2000;18(20):3495-3502. Experimental-Dx 144 patients To evaluate the diagnostic value of positron emission tomography (PET) using fluorine-18 fluorodeoxyglucose (FDG) for the diagnosis of primary breast cancer. Breast carcinomas were identified with an overall sensitivity of 64.4% (CIR) and 80.3% (SIR). The increase in sensitivity (SIR) resulted in a noticeable decrease in specificity, from 94.3% (CIR) to 75.5% (SIR). At stage pT1, only 30 (68.2%) of 44 breast carcinomas were detected, compared with 57 (91.9%) of 62 at stage pT2. A higher percentage of invasive lobular carcinomas were false-negative (65.2%) compared with invasive ductal carcinomas (23.7%). Nevertheless, positive PET scans provided a high positive-predictive value (96.6%) for breast cancer. 2
105. Groheux D, Majdoub M, Sanna A, et al. Early Metabolic Response to Neoadjuvant Treatment: FDG PET/CT Criteria according to Breast Cancer Subtype. Radiology. 277(2):358-71, 2015 Nov. Observational-Dx 169 patients To investigate parameters based on fluorine 18 fluorodeoxyglucose (FDG) positron emission tomographic (PET) imaging that are best correlated with pathologic complete response (PCR) in human epidermal growth factor receptor type 2 (HER2)-positive cancer and triple-negative breast cancer (TNBC) and with partial or complete response in ER-positive/HER2-negative breast cancer. Included were 169 consecutive patients (mean age, 50 years). PCR was more frequent in HER2-positive tumors (16 of 33 patients [48.5%]) and TNBCs (20 of 54 patients [37%]) than in ER positive/HER2-negative tumors (four of 82 [4.9%]) (P < .001). Among patients with ER-positive/HER2-negative cancers, 33 patients had partial response. In TNBC, best association with PCR was obtained with change in SUV(max) (AUC, 0.86) or change in TLG (AUC, 0.88). In HER2-positive phenotype, absolute SUV(max) (or SUV(peak)) values at PET imaging after two cycles of chemotherapy (AUC for each cycle, 0.93) were better correlated with PCR than change in SUV(max) (AUC, 0.78; P = .11) or change in TLG (AUC, 0.62; P = .005). Regarding ER-positive/HER2-negative cancers, change in SUV(max) or change in TLG (AUC, 0.75) were parameters best correlated with partial or complete response. Baseline SUV(max) was higher in lymph nodes than in primary tumor in 31 patients. Findings were similar considering the site with highest FDG uptake. 3
106. Henry-Tillman R, Glover-Collins K, Preston M, et al. The SAVE review: sonographic analysis versus excision for axillary staging in breast cancer. Journal of the American College of Surgeons. 220(4):560-7, 2015 Apr. Observational-Dx 95 patients To compare the cost-effectiveness of axillary ultrasound-guided core needle biopsy (AUS-CNB) with sentinel lymph node biopsy (SLNB) when evaluating the status of the axilla in operable invasive breast cancer. The cohort of 95 patients was divided into 2 groups: clinically positive (CP) (32%) and negative (CN) (68%) axilla. In the CP group, 83% had a suspicious AUS, of which 90% were positive. In the CN group, AUS was suspicious in 70%, with a positive biopsy in 59%. The sensitivity and specificity of AUS-CNB were 90% (95% CI 84.8% to 98.8%) and 100% (95% CI 27% to 59.1%), respectively. Cost estimates comparing AUS-CNB with SLNB demonstrated a cost saving of $236,517 in the CP axilla and $248,490 in the CN axilla, for a total cost savings of $485,007. 2
107. Bedrosian I, Bedi D, Kuerer HM, et al. Impact of clinicopathological factors on sensitivity of axillary ultrasonography in the detection of axillary nodal metastases in patients with breast cancer. Ann Surg Oncol. 2003;10(9):1025-1030. Observational-Dx 208 patients To identify factors influencing the sensitivity of ultrasonography for detection of nodal metastasis. Of 208 patients, axillary ultrasonography was negative in 180 (86%) and suspicious or indeterminate in 28 (14%). FNA was performed in 22 patients whose findings were indeterminate or suspicious, and 3 were positive for malignancy. Final pathological examinations revealed positive nodes in 53 patients: 39 (22%) of 180 with negative ultrasonographic findings and 14 (50%) of 28 with indeterminate or suspicious ultrasonographic findings (P =.001). Excisional biopsy was more common for patients with indeterminate or suspicious findings on preoperative ultrasonography (P =.038). There were no significant differences in tumor size, histological features, size of nodal metastasis, or number of positive nodes between patients whose ultrasonography findings were negative and those whose findings were indeterminate or suspicious. 3
108. Dellaportas D, Koureas A, Contis J, et al. Contrast-Enhanced Color Doppler Ultrasonography for Preoperative Evaluation of Sentinel Lymph Node in Breast Cancer Patients. Breast Care (Basel). 2015;10(5):331-335. Observational-Dx 50 patients To evaluate the usefulness of contrast-enhanced ultrasonography in preoperative detection of malignant sentinel lymph nodes. Contrast-enhanced ultrasound scan identified a negative SLN in the axilla of 27 patients and final histopathology was negative for 30 cases in total, so negative predictive value was calculated as 90% and positive predictive value was 75%. Overall sensitivity was 83.33% and specificity was 84.38%. Moreover, the ability of contrast-enhanced ultrasound to differentiate between SLN status was only statistically significantly correlated with the actual final histopathological report (p < 0.001), while successful ultrasound prediction was not correlated with any factor. 3
109. Moorman AM, Bourez RL, de Leeuw DM, Kouwenhoven EA. Pre-operative Ultrasonographic Evaluation of Axillary Lymph Nodes in Breast Cancer Patients: For Which Group Still of Additional Value and in Which Group Cause for Special Attention? Ultrasound Med Biol. 2015;41(11):2842-2848. Observational-Dx 1124 patients To evaluate the diagnostic accuracy of axillary US and fine-needle aspiration cytology in a large cohort of breast cancer patients. The sensitivity and specificity of US and fine-needle aspiration cytology in our cohort of 1124 patients were 42.2% and 97.1%, respectively. As the number of axillary nodes increased, sensitivity increased. The percentage of false-negative US results was 18.9%; patients in this subgroup were significantly younger, had larger tumors, more often had lymph vascular invasion and were more likely to have estrogen receptor-positive tumors. 3
110. Javid S, Segara D, Lotfi P, Raza S, Golshan M. Can breast MRI predict axillary lymph node metastasis in women undergoing neoadjuvant chemotherapy. Ann Surg Oncol. 2010;17(7):1841-1846. Observational-Dx 74 women To evaluate the predictive value of breast magnetic resonance imaging (MRI) in detecting axillary lymph node metastases prior to initiation of neoadjuvant chemotherapy (NAC) and in detecting residual lymph node metastases after NAC in women found to be node positive prior to NAC. Seventy-four women completed NAC and underwent surgery. Sensitivity of MRI in detecting axillary node involvement prior to NAC was 64.7% and specificity was 100%, with positive and negative predictive values of MRI of 100% and 77.8%, respectively. Sensitivity and specificity of MRI to identify residual pathologic axillary lymph node disease following NAC were 85.7% and 89%, respectively, while the positive and negative predictive values were 92% and 80.9%, respectively 2
111. Garcia Vicente AM, Soriano Castrejon A, Leon Martin A, et al. Early and delayed prediction of axillary lymph node neoadjuvant response by (18)F-FDG PET/CT in patients with locally advanced breast cancer. Eur J Nucl Med Mol Imaging. 2014;41(7):1309-1318. Experimental-Dx 76 patients To determine the utility of (18)F-FDG (FDG) PET/CT performed in an early and delayed phase during neoadjuvant chemotherapy in the prediction of lymph node histopathological response in patients with locally advanced breast cancer. Lymph node pCR was seen in 34 patients. The sensitivity, specificity, and positive and negative predictive values of PET-2 and PET-3 in establishing the final status of the axilla after chemotherapy were 52 %, 45 %, 50 % and 47 %, and 33 %, 84 %, 67 % and 56 %, respectively. No significant relationship was observed between mCR on PET-2 and PET-3 and pCR (p = 0.31 and 0.99, respectively). Lymph node metabolism on PET-1 was not able to predict the final histopathological status, whereas basal carcinomas showed a higher rate of pCR (70.6 %) than the other groups (p = 0.03). 2
112. Wahl RL, Siegel BA, Coleman RE, Gatsonis CG. Prospective multicenter study of axillary nodal staging by positron emission tomography in breast cancer: a report of the staging breast cancer with PET Study Group. J Clin Oncol. 2004;22(2):277-285. Experimental-Dx 360 women To determine the accuracy of positron emission tomography with fluorine-18-labeled 2-fluoro-2-deoxy-d-glucose (FDG-PET) in detecting axillary nodal metastases in women with primary breast cancer. For detecting axillary nodal metastasis, the mean estimated area under the receiver operator curve for the three readers was 0.74 (range, 0.70 to 0.76). If at least one probably or definitely abnormal axillary focus was considered positive, the mean (and range) sensitivity, specificity, and positive and negative predictive values for PET were 61% (54% to 67%), 80% (79% to 81%), 62% (60% to 64%), and 79% (76% to 81%), respectively. False-negative axillae on PET had significantly smaller and fewer tumor-positive lymph nodes (2.7) than true-positive axillae (5.1; P <.005). Semiquantitative analysis of axillary FDG uptake showed that a nodal standardized uptake value (lean body mass) more than 1.8 had a positive predictive value of 90%, but a sensitivity of only 32%. Finding two or more intense foci of tracer uptake in the axilla was highly predictive of axillary metastasis (78% to 83% positive predictive value), albeit insensitive (27%). 1
113. Koolen BB, Valdes Olmos RA, Elkhuizen PH, et al. Locoregional lymph node involvement on 18F-FDG PET/CT in breast cancer patients scheduled for neoadjuvant chemotherapy. Breast Cancer Res Treat. 2012;135(1):231-240. Observational-Dx 311 patients To assess the value of 18F-FDG PET/CT for detecting locoregional lymph node metastases in primary breast cancer patients scheduled for NAC. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FDG-avid nodes for the detection of axillary metastases (score 2 or 3) were 82, 92, 98, 53, and 84 %, respectively. Of 28 patients with questionable axillary FDG uptake (score 1), 23 (82 %) were node-positive. Occult lymph node metastases in the internal mammary chain and periclavicular area were detected in 26 (8 %) and 32 (10 %) patients, respectively, resulting in changed regional radiotherapy planning in 50 (16 %) patients. In breast cancer patients scheduled for NAC, PET/CT renders pre-chemotherapy SLNB unnecessary in case of an FDG-avid axillary node, enables axillary response monitoring during or after NAC, and leads to changes in radiotherapy for a substantial number of patients because of detection of occult N3-disease. 2
114. Koolen BB, Valdes Olmos RA, Wesseling J, et al. Early assessment of axillary response with (1)(8)F-FDG PET/CT during neoadjuvant chemotherapy in stage II-III breast cancer: implications for surgical management of the axilla. Ann Surg Oncol. 2013;20(7):2227-2235. Observational-Dx 219 patients To evaluate the value of sequential (18)F fluorodeoxyglucose (FDG) PET/CTs during NAC for axillary response monitoring in stage II-III breast cancer A total of 32 (40 %) patients experienced axillary pCR. The relative decrease in SUVmax was significantly higher in patients with pCR than in those without, both on PET/CT2 (p < 0.001) and PET/CT3 (p = 0.025). The area under the receiver operating characteristic curve values for PET/CT2 and PET/CT3 were 0.80 (95 % confidence interval 0.68-0.92) and 0.65 (95 % confidence interval 0.52-0.79), respectively. A relative decrease of >/=60 % on PET/CT2 had an excellent specificity (35 of 37, 95 %), a high positive predictive value (12 of 14, 86 %), and a sensitivity of 48 %-that is, it accurately identified histologic pCR in 12 of 25 patients with disease that responded to therapy. 2
115. Holwitt DM, Swatske ME, Gillanders WE, et al. Scientific Presentation Award: The combination of axillary ultrasound and ultrasound-guided biopsy is an accurate predictor of axillary stage in clinically node-negative breast cancer patients. Am J Surg. 2008;196(4):477-482. Observational-Dx 256 patients To determine the accuracy of axillary ultrasound (AUS) and fine-needle aspiration biopsy (FNAB)/needle core biopsy in axillary breast cancer staging. AUS-guided FNAB/needle core biopsy and final pathology were positive in 72 of 256 patients (28%). In 125 of 256 cases (49%), the AUS and final pathology were negative. Two of 110 patients had a false-positive FNAB (1.8%); both received neoadjuvant chemotherapy. Nine patients (8%) had a false-negative FNAB/needle core biopsy; the median size of lymph node metastasis was 3 mm. The sensitivity and specificity of AUS-guided FNAB/needle core biopsy was 71% and 99%, respectively, with a negative predictive value of 84% and a positive predictive value of 97%. 3
116. Jain A, Haisfield-Wolfe ME, Lange J, et al. The role of ultrasound-guided fine-needle aspiration of axillary nodes in the staging of breast cancer. Ann Surg Oncol. 2008;15(2):462-471. Observational-Dx 68 patients To evaluate ultrasound-guided fine-needle aspiration (USFNA) of normal and abnormal axillary nodes in breast cancer patients. Of 65 axillae analyzed, 39 (60%) were positive, four (6%) were non-diagnostic, and 22 (34%) were negative by USFNA. USFNA had 89% sensitivity, 100% specificity, and 100% positive predictive value (PPV) in patients with palpable or ultrasonographically suspicious nodes. USFNA sensitivity dropped significantly for nonpalpable, ultrasonographically normal nodes (54%), while specificity and PPV remained 100%. None of the primary tumor features predicted concordance of USFNA and SLND/ALND. 3
117. Sauer T, Suciu V. The role of preoperative axillary lymph node fine needle aspiration in locoregional staging of breast cancer. Ann Pathol. 2012;32(6):e24-28, 410-414. Review/Other-Dx N/A To review the recent data in the literature regarding the diagnostic accuracy of lymph node FNAC in breast cancer staging, and present the experience of the Breast Diagnostic Centre of Oslo University Hospital Ullevaal, Norway, in this context. No results stated in abstract. 4
118. Iwase H, Yamamoto Y, Kawasoe T, Ibusuki M. Advantage of sentinel lymph node biopsy before neoadjuvant chemotherapy in breast cancer treatment. Surg Today. 2009;39(5):374-380. Review/Other-Dx N/A To discuss improvements in SLN mapping, the timing of SLNB in relation to delivery of NAC, and a new decision tree for operable breast cancer involving SLNB and NAC. To identify the initial cancer stage in patients who will be treated by systemic therapy before surgery, SLNB should be performed prior to systemic treatments, using a well-developed navigating tool, such as SPECT/CT. 4
119. Rousseau C, Devillers A, Campone M, et al. FDG PET evaluation of early axillary lymph node response to neoadjuvant chemotherapy in stage II and III breast cancer patients. Eur J Nucl Med Mol Imaging. 2011;38(6):1029-1036. Experimental-Dx 52 patients To assess sequential [(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET) findings as early predictors of axillary lymph node response to neoadjuvant chemotherapy in stage II and III breast cancer patients. The sensitivity, specificity and accuracy of axillary node staging was higher with PET (75, 87 and 80%) than with US (50, 83 and 65%), and even more so when PET images were corrected for partial volume effects (86, 83 and 84%). While FDG uptake did not vary much in non-responders, as confirmed by histopathological analysis, it markedly decreased to baseline levels in responders (p < 10(-5)). Fifty per cent of baseline SUV was considered the best cutoff value to distinguish responders from non-responders. The sensitivity, specificity, negative predictive value and accuracy of FDG PET after one course of chemotherapy were, respectively, 96, 75, 95 and 84%. 2
120. Mamounas EP. Sentinel lymph node biopsy after neoadjuvant systemic therapy. Surg Clin North Am. 2003;83(4):931-942. Review/Other-Dx N/A To discuss the feasibility and accuracy of sentinel node biopsy following neoadjuvant chemotherapy. No results stated in abstract. 4
121. Tennant S, Evans A, Macmillan D, et al. CT staging of loco-regional breast cancer recurrence. A worthwhile practice? Clin Radiol. 2009;64(9):885-890. Review/Other-Dx 63 patients To assess the usefulness of computed tomography of the chest, abdomen, and pelvis (CTCAP) in the detection of metastatic disease in patients presenting with loco-regional recurrence of breast cancer, and to identify subgroups particularly likely to have metastases. Twenty-one patients (32%) had metastases, including bony (n=5, 8%), liver (n=7, 11%), and thoracic disease (n=11, 17%). Patients with recurrence in a conserved breast had lower rates of metastasis on CT than those with other sites of recurrence [three of 21 (14%) versus 18 of 44 (41%), p=0.03]. Patients younger than 50 years at primary diagnosis or younger than 60 years at recurrence had statistically significantly higher rates of metastasis than older patients [10 of 16 (63%) versus 11 of 48 (23%), p=0.003, and 13 of 23 (57%) versus eight of 42 (19%), p=0.002, respectively]. 4
122. Kumar R, Chauhan A, Zhuang H, Chandra P, Schnall M, Alavi A. Clinicopathologic factors associated with false negative FDG-PET in primary breast cancer. Breast Cancer Res Treat. 2006;98(3):267-274. Observational-Dx 111 patients To determine the clinicopathologic factors that predict FN FDG–PET results in patients with primary breast cancer. Of 116 breast lesions, 85 were malignant and 31 were benign on histopathology. Of the 85 malignant lesions, 41 were true positive (TP) and 44 were FN. Among the 31 benign lesions, 30 were true negative and one was false positive. There was significant difference in the tumor size (p=0.003) and tumor grade (p=0.001) in patients with TP and FN PET results. Multivariate logistic regression demonstrated that tumor size (< or =10 mm) and low tumor grade were independently associated with FN results. No significant relationship of FN PET results was found with age, menopausal status, tumor type, c-erbB-2, estrogen and progesterone receptors, sentinel lymph node or distant metastasis, parenchymal density and multifocality of primary breast tumor. 2
123. Groheux D, Espie M, Giacchetti S, Hindie E. Performance of FDG PET/CT in the clinical management of breast cancer. [Review]. Radiology. 266(2):388-405, 2013 Feb. Review/Other-Dx N/A To review the role of metabolic imaging with fluorine 18 fluorodeoxyglucose (FDG) in breast cancer. FDG PET/CT is very useful for restaging of cancer in patients with documented breast cancer recurrence or in those who are suspected of having breast cancer recurrence and is more efficient than PET alone and conventional imaging methods. FDG PET/CT is also efficient to perform the staging of locally advanced and inflammatory breast cancer. It allows detection of extraaxillary lymph nodes and distant metastases. PET/CT also brings valuable information in the staging of clinical stage IIB and primary operable stage IIIA breast carcinoma. In contrast, the spatial resolution of PET (approximately 5–6 mm) is not sufficient to allow the detection of early axillary node involvement and micrometastases. PET/CT cannot replace staging by using the sentinel node procedure. Also, PET is not recommended for the initial assessment of stage I breast cancer. The metabolic information provided by using PET has been shown to be valuable for the early assessment of response to chemotherapy (at the neoadjuvant and metastasis settings), but this indication remains to be validated. 4
124. Groheux D, Giacchetti S, Espie M, et al. The yield of 18F-FDG PET/CT in patients with clinical stage IIA, IIB, or IIIA breast cancer: a prospective study. Journal of Nuclear Medicine. 52(10):1526-34, 2011 Oct. Observational-Dx 131 patients To prospectively evaluate the role of (18)F-FDG PET/CT in patients with stage IIA, IIB, or IIIA breast cancer. Of the 131 examined patients, 36 had clinical stage IIA (34 T2N0 and 2 T1N1), 48 stage IIB (20 T3N0 and 28 T2N1), and 47 stage IIIA (29 T3N1, 9 T2N2, and 9 T3N2). (18)F-FDG PET/CT modified staging for 5.6% of stage IIA patients, for 14.6% of stage IIB patients, and for 27.6% of stage IIIA patients. However, within stage IIIA, the yield was specifically high among the 18 patients with N2 disease (56% stage modification). When considering stage IIB and primary operable IIIA (T3N1) together, the yield of (18)F-FDG PET/CT was 13% (10/77); extraaxillary regional lymph nodes were detected in 5 and distant metastases in 7 patients. In this series, (18)F-FDG PET/CT outperformed bone scanning, with only 1 misclassification versus 8 for bone scanning (P = 0.036). 3
125. Groheux D, Giacchetti S, Moretti JL, et al. Correlation of high 18F-FDG uptake to clinical, pathological and biological prognostic factors in breast cancer. Eur J Nucl Med Mol Imaging. 2011;38(3):426-435. Experimental-Dx 132 women To determine the impact of the main clinicopathological and biological prognostic factors of breast cancer on (18)F-fluorodeoxyglucose (FDG) uptake. There was no influence of T and N stage on SUV. Invasive ductal carcinoma showed higher SUV than lobular carcinoma. However, the highest uptake was found for metaplastic tumours, representing 5% of patients in this series. Several biological features usually considered as bad prognostic factors were associated with an increase in FDG uptake: the median of SUV(max) was 9.7 for grade 3 tumours vs 4.8 for the lower grades (p < 0.0001); negativity for oestrogen receptors (ER) was associated with higher SUV (ER+ SUV = 5.5; ER- SUV = 7.6; p = 0.003); triple-negative tumours (oestrogen and progesterone receptor negative, no overexpression of c-erbB-2) had an SUV of 9.2 vs 5.8 for all others (p = 0005); p53 mutated tumours also had significantly higher SUV (7.8 vs 5.0; p < 0.0001). Overexpression of c-erbB-2 had no effect on the SUV value. 1
126. Berriolo-Riedinger A, Touzery C, Riedinger JM, et al. [18F]FDG-PET predicts complete pathological response of breast cancer to neoadjuvant chemotherapy. Eur J Nucl Med Mol Imaging. 2007;34(12):1915-1924. Experimental-Dx 47 women To evaluate, in breast cancer patients treated by neoadjuvant chemotherapy, the predictive value of reduction in FDG uptake with regard to complete pathological response (pCR). The relative decrease in FDG uptake (DeltaSUV) after the first course of neoadjuvant chemotherapy was significantly greater in the pCR group than in the non-pCR group (p < 0.000066). The four FDG uptake indices were all strongly correlated with each other. A decrease in SUV(max-BSA-G) of 85.4% +/- 21.9% was found in pCR patients, versus 22.6% +/- 36.6% in non-pCR patients. DeltaSUV(max-BSA-G) <-60% predicted the pCR with an accuracy of 87% and DeltaSUVs were found to be only factors predictive of the pCR at multivariate analysis. An elevated baseline SUV was associated with high mitotic activity (p < 0.0016), tumour grading (p < 0.004), high nuclear pleomorphism score (p < 0.03) and negative hormonal receptor status (p < 0.005). 3
127. Lee JH.. Radionuclide methods for breast cancer staging. [Review]. Seminars in Nuclear Medicine. 43(4):294-8, 2013 Jul. Review/Other-Dx N/A To discuss radionuclide imaging modalities (mainly fluorodeoxyglucose-positronemissiontomography[FDG-PET]) in locoregional staging. No results stated in abstract. 4
128. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: Review/Other-Dx N/A Guidance document on exposure of patients to ionizing radiation. No results stated in abstract. 4