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Response in different subtypes of breast cancer followingneoadjuvant chemotherapy: correlation of MR imagingfindings with final pathology

Poster No.: C-0912

Congress: ECR 2014

Type: Scientific Exhibit

Authors: R. M. Lorente Ramos1, J. Azpeitia Arman1, M. T. Rivera García1,

M. A. Lara Alvarez2, I. Casado Fariñas1; 1Madrid/ES, 228009Madrid/ES

Keywords: Cancer, Comparative studies, MR, Breast

DOI: 10.1594/ecr2014/C-0912

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Aims and objectives

• To review and illustrate magnetic resonance (MR) imaging findings inpatients with advanced breast cancer and systemic primary treatment,and correlation of MR findings with pathological response, includingresidual tumor features and complete remission.

• To analyse the differente types of radiological response to neoadjuvanttherapy in different tumor subtypes.

Methods and materials

Study population:

We retrospectively reviewed 36 patients with locally advanced breast cancer whounderwent primary systemic therapy previous to surgery between January 2009 andSeptember 2013 . We exclude 5 patients with incomplete data and 1 patient who hadno surgery after treatment, so our study includes 30 patients.

Exams peformed:

Pre and posttreatment clinical evaluation and pretreatment dynamic MR and diffusion-weighted sequences were performed in all the patients. In 26 patients posttreatmentdynamic and diffusion-weighted MR was performed within 10 days after treatment.Postreatment MR was not performed in 4 patients to whom mastectomy was performed,and who refused MR.

After surgery, which was performed within 3 weeks from the end of treatment, pathologicevaluation of breast specimen was performed.

Parameters that were evaluated:

-On MR: T2 signal, lesion size, pre and posttreatment contrast enhancement kinetics,changes in size, type and percentage of response in posttreatment MR ( Fig. 1 on page4), apparent diffusion coefficient (ADC) , and response in lymph nodes.

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Fig. 1References: Radiology, UCR de la CAM. Hospital Infanta Leonor - Madrid/ES

- On pathology tumor response was clasified according to Miller-Payne System ( Fig.2 on page 5) based on changes in cellularity, grade and response in lymph nodeswas also stated. Complete response (pCR) consists of absence of invasive disease, butintraductal tumor may be present).

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Images for this section:

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Fig. 1

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Fig. 2

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Results

MR is useful in the evaluation of response to neoadjuvant chemotherapy (NAC). It canaccurately estimate the pathological size of the residual tumor and the presence ofcomplete response. Immunohystochemical subtypes of breast cancer allow to classifypatients with better outcome after neoadjuvant therapy.

In our study group ages ranged from 24-74 years, mean age 51 years.

Out of 30 patients, tumor subtypes were Luminal A 5 patients, Luminal B 13, Her2 in 5patients and triple negative 7 patients ( Fig. 3 on page 14 ).

Based on Her 2 status eleven patients had Her 2 positive tumors, and 19 Her 2 negative( Fig. 4 on page 14 ).


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Pathologic complete response (pCR) (absence of invasive disease, but intraductaltumor may be present) appeared in 9 patients, partial in 20 and minimal response(Miller Payne 1) was found in 1 patient. Residual tumor correlation was better in MR thanclinical evaluation ( Fig. 5 on page 15 ).

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MR response may be defined as complete if no lesion or enhancing area is found.Partial response may appear as lesion fragmentation, or tumor shrinkage. Bothresponse types may be found both in masses and non-mass enhancing areas, butshrinkage is most frequent in masses and fragmentation in non-enhancing areas.

On MR response was complete in 7 patients ( Fig. 6 on page 16 ) , and partial in 19:fragmentation in 6, and concentric shrinkage in 13 ( Fig. 7 on page 17 ).

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Fig. 7

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References: Radiology, UCR de la CAM. Hospital Infanta Leonor - Madrid/ES

We tried to correlate degree of response on MR with pathology. We clasified MRresponse as complete (no residual lesion), partial major (more than 50% response),partial minor (less than 50% response) and no response. No response was correlatedwith Miller Payne score 1 and 2, Partial minor and major on MR with Miller Payne score3 and 4 and complete response with Miller Payne 5( Fig. 8 on page 17 ).

Exact correlation between MR and pathologic response appeared in 18 patients, 8 Her2positive and 10 Her2 negative tumors ( Fig. 9 on page 18 ). Mistakes in correlationMR-pathology were found mostly in patients with fragmentation response when residualtumor consists of small or scattered foci ( Fig. 10 on page 19 ).


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Mean ADC (apparent diffusion coeficient) decreased from pretreatment toposttreatment values ( Fig. 11 on page 19 ). However we did not find a significantdifference in ADC change from pre to posttreatment values between patients withcomplete and partial response (Fig. 12 on page 19 ).

Fig. 11

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References: Radiology, UCR de la CAM. Hospital Infanta Leonor - Madrid/ES


Images for this section:

Fig. 3

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Fig. 4

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Fig. 5

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Fig. 6

Fig. 7

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Fig. 8

Fig. 9

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Fig. 10

Fig. 11

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Fig. 12

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Conclusion

MR correlation with pathology is high in the evaluation of response to neoadjuvantchemotherapy.

Response may be overestimated by MR in patients with fragmentation response whenresidual tumor consists of small or scattered foci.

We found no difference between Her-2 positive and negative tumors in MR - pathologycorrelation and ADC values, but due to our limited number of patients results should befurther analysed with larger samples.

Personal information

Rosa M. Lorente Ramos. Unidad Central de Radiodiagnóstico (UCR) de laComunidad de madrid. Department of Radiology Hospital Infanta Leonor. Madrid. [email protected]

Javier Azpeitia Armán. Unidad Central de Radiodiagnóstico (UCR) de la Comunidadde madrid. Department of Radiology Hospital Infanta Leonor. Madrid. Spain.

M. Teresa Rivera García. Department of Pathology Hospital Infanta Leonor. Madrid.Spain.

Miguel Angel Lara Alvarez. Department of Oncology Hospital Infanta Leonor. Madrid.Spain.

Isabel Casado Fariñas. Department of Pathology Hospital Infanta Leonor. Madrid.Spain.

References

- Ogston KN, Miller ID, Payne S, Hutcheon AW, Sarkar TK, Smith I, SchofieldA, Heys SD. A new histological grading system to assess response of breast

mailto:[email protected]

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- Londero V, Bazzocchi M, del Frate C, Puglisi F, Di Loreto C, Francescutti G, ZuianiC. locally advanced breast cancer: comparison of mammography, sonography andMR imaging in evaluation of residual disease in women receiving neoadjuvantchemotherapy. Eur Radiol 2004;14(8):1371:9

- Park SH, Moon WK, Cho N, Song IC, Chang JM, Park IA, Han W, Noh DY. Diffusion-weighted MR imaging: pretreatment prediction of response to neoadjuvantchemotherapy in patients with breast cancer. Radiology 2010;257:56-63.

- Le-Petross HC, Hylton N. Role of breast MR imaging in neoadjuvantchemotherapy. Magn Reson Imaging Clin N Am 2010;18:249-58.

response in different subtypes of breast cancer following ......with miller payne score 1 and 2,...

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