MRI prediction of neoadjuvant chemotherapy response is equivalent in patients with or without mammographic calcifications: a step towards adapting surgical approach?
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| Title: | MRI prediction of neoadjuvant chemotherapy response is equivalent in patients with or without mammographic calcifications: a step towards adapting surgical approach? |
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| Authors: | Sella, Tamar1,2 (AUTHOR) tamarse@hadassah.org.il, Simor, Bar1,2,3,4 (AUTHOR), Adler - Levy, Yael1,2 (AUTHOR), Maly, Bella2,5 (AUTHOR), Kadouri, Luna2,6 (AUTHOR), Carmon, Einat7,8 (AUTHOR) |
| Source: | European Radiology. Oct2023, Vol. 33 Issue 10, p7168-7177. 10p. 1 Black and White Photograph, 1 Diagram, 4 Charts. |
| Subjects: | Neoadjuvant chemotherapy, Calcifications of the breast, Magnetic resonance mammography, Calcification, Magnetic resonance imaging, Digital mammography, Fisher exact test |
| Abstract: | Objectives: Current surgical policy recommends comprehensive excision of tumorous calcifications in breast cancer patients following neoadjuvant chemotherapy (NAC) regardless of MRI outcomes, despite MRI defining tumor response superior to mammography. The current study examines MRI prediction of response in tumors with vs without calcifications, using post-NAC surgical pathology as the standard of reference. Methods: Retrospective analysis of 114 NAC patients between 2011 and 2018 including demographics, mammography, 3 T-MRI, and pathology compared two sub-groups: without (n = 62) or with (n = 52) mammographic calcifications. In the calcification cohort, the mammographic extent of calcifications and MRI enhancement overlapped. MRI prediction of response to NAC was correlated with pathology. Two-tailed paired T and Fisher's exact tests and Cohen's kappa coefficient were applied for analysis. Results: There was no significant difference between the two sub-groups regarding demographics. Tumors demonstrated equivalent features regarding size, lymph node involvement, and DCIS component. ER-negative/HER2-positive tumors more commonly exhibited calcifications (33% n = 17 calcified vs 13% n = 8 non-calcified; p < 0.05); triple negative pathology rarely calcified (6% n = 3 calcified vs 33% n = 20 non-calcified; p < 0.05). NME was more common with calcifications (62% n = 32 calcified vs 29% n = 18 non-calcified; p < 0.05) and mass enhancement without (90% n = 56 non-calcified vs 81% n = 42 calcified; p < 0.05). Both groups responded similarly to NAC (pCR = 37% non-calcified vs 38% calcified); response on MRI equally correlated with pathology (69% both subgroups; p = 0.988). Conclusion: We propose utilizing post-NAC MRI findings rather than mammography in planning surgery, as MRI prediction is independent of the presence or absence of calcifications. Prospective studies to evaluate this approach are warranted. Key Points: • No difference was found in demographic, clinical, pathology, or imaging characteristics between patients with or without tumoral calcifications on mammography prior to neoadjuvant chemotherapy. • Residual mammographic calcifications are inadequate predictors of residual invasive disease. MRI accurately recognized complete response and correctly correlated with post-treatment surgical pathology in 69% of patients, regardless of the presence or absence of mammographic calcifications. • We propose utilizing post-NAC MRI findings rather than mammography in planning post-NAC surgery, as MRI prediction of response is independent of the presence or absence of calcifications. [ABSTRACT FROM AUTHOR] |
| Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
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| Header | DbId: egs DbLabel: Engineering Source An: 172041147 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: MRI prediction of neoadjuvant chemotherapy response is equivalent in patients with or without mammographic calcifications: a step towards adapting surgical approach? – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Sella%2C+Tamar%22">Sella, Tamar</searchLink><relatesTo>1,2</relatesTo> (AUTHOR)<i> tamarse@hadassah.org.il</i><br /><searchLink fieldCode="AR" term="%22Simor%2C+Bar%22">Simor, Bar</searchLink><relatesTo>1,2,3,4</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Adler+-+Levy%2C+Yael%22">Adler - Levy, Yael</searchLink><relatesTo>1,2</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Maly%2C+Bella%22">Maly, Bella</searchLink><relatesTo>2,5</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kadouri%2C+Luna%22">Kadouri, Luna</searchLink><relatesTo>2,6</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Carmon%2C+Einat%22">Carmon, Einat</searchLink><relatesTo>7,8</relatesTo> (AUTHOR) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22European+Radiology%22">European Radiology</searchLink>. Oct2023, Vol. 33 Issue 10, p7168-7177. 10p. 1 Black and White Photograph, 1 Diagram, 4 Charts. – Name: Subject Label: Subjects Group: Su Data: <searchLink fieldCode="DE" term="%22Neoadjuvant+chemotherapy%22">Neoadjuvant chemotherapy</searchLink><br /><searchLink fieldCode="DE" term="%22Calcifications+of+the+breast%22">Calcifications of the breast</searchLink><br /><searchLink fieldCode="DE" term="%22Magnetic+resonance+mammography%22">Magnetic resonance mammography</searchLink><br /><searchLink fieldCode="DE" term="%22Calcification%22">Calcification</searchLink><br /><searchLink fieldCode="DE" term="%22Magnetic+resonance+imaging%22">Magnetic resonance imaging</searchLink><br /><searchLink fieldCode="DE" term="%22Digital+mammography%22">Digital mammography</searchLink><br /><searchLink fieldCode="DE" term="%22Fisher+exact+test%22">Fisher exact test</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Objectives: Current surgical policy recommends comprehensive excision of tumorous calcifications in breast cancer patients following neoadjuvant chemotherapy (NAC) regardless of MRI outcomes, despite MRI defining tumor response superior to mammography. The current study examines MRI prediction of response in tumors with vs without calcifications, using post-NAC surgical pathology as the standard of reference. Methods: Retrospective analysis of 114 NAC patients between 2011 and 2018 including demographics, mammography, 3 T-MRI, and pathology compared two sub-groups: without (n = 62) or with (n = 52) mammographic calcifications. In the calcification cohort, the mammographic extent of calcifications and MRI enhancement overlapped. MRI prediction of response to NAC was correlated with pathology. Two-tailed paired T and Fisher's exact tests and Cohen's kappa coefficient were applied for analysis. Results: There was no significant difference between the two sub-groups regarding demographics. Tumors demonstrated equivalent features regarding size, lymph node involvement, and DCIS component. ER-negative/HER2-positive tumors more commonly exhibited calcifications (33% n = 17 calcified vs 13% n = 8 non-calcified; p < 0.05); triple negative pathology rarely calcified (6% n = 3 calcified vs 33% n = 20 non-calcified; p < 0.05). NME was more common with calcifications (62% n = 32 calcified vs 29% n = 18 non-calcified; p < 0.05) and mass enhancement without (90% n = 56 non-calcified vs 81% n = 42 calcified; p < 0.05). Both groups responded similarly to NAC (pCR = 37% non-calcified vs 38% calcified); response on MRI equally correlated with pathology (69% both subgroups; p = 0.988). Conclusion: We propose utilizing post-NAC MRI findings rather than mammography in planning surgery, as MRI prediction is independent of the presence or absence of calcifications. Prospective studies to evaluate this approach are warranted. Key Points: • No difference was found in demographic, clinical, pathology, or imaging characteristics between patients with or without tumoral calcifications on mammography prior to neoadjuvant chemotherapy. • Residual mammographic calcifications are inadequate predictors of residual invasive disease. MRI accurately recognized complete response and correctly correlated with post-treatment surgical pathology in 69% of patients, regardless of the presence or absence of mammographic calcifications. • We propose utilizing post-NAC MRI findings rather than mammography in planning post-NAC surgery, as MRI prediction of response is independent of the presence or absence of calcifications. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1007/s00330-023-09640-x Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 10 StartPage: 7168 Subjects: – SubjectFull: Neoadjuvant chemotherapy Type: general – SubjectFull: Calcifications of the breast Type: general – SubjectFull: Magnetic resonance mammography Type: general – SubjectFull: Calcification Type: general – SubjectFull: Magnetic resonance imaging Type: general – SubjectFull: Digital mammography Type: general – SubjectFull: Fisher exact test Type: general Titles: – TitleFull: MRI prediction of neoadjuvant chemotherapy response is equivalent in patients with or without mammographic calcifications: a step towards adapting surgical approach? Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Sella, Tamar – PersonEntity: Name: NameFull: Simor, Bar – PersonEntity: Name: NameFull: Adler - Levy, Yael – PersonEntity: Name: NameFull: Maly, Bella – PersonEntity: Name: NameFull: Kadouri, Luna – PersonEntity: Name: NameFull: Carmon, Einat IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 10 Text: Oct2023 Type: published Y: 2023 Identifiers: – Type: issn-print Value: 09387994 Numbering: – Type: volume Value: 33 – Type: issue Value: 10 Titles: – TitleFull: European Radiology Type: main |
| ResultId | 1 |
