Contrast-enhanced spectral mammography in neoadjuvant chemotherapy monitoring: a comparison with breast magnetic resonance imaging
Abstract Background Neoadjuvant-chemotherapy (NAC) is considered the standard treatment for locally advanced breast carcinomas. Accurate assessment of disease response is fundamental to increase the chances of successful breast-conserving surgery and to avoid local recurrence. The purpose of this st...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-09-01
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| Series: | Breast Cancer Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13058-017-0899-1 |
| _version_ | 1830138585231130624 |
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| author | Valentina Iotti Sara Ravaioli Rita Vacondio Chiara Coriani Sabrina Caffarri Roberto Sghedoni Andrea Nitrosi Moira Ragazzi Elisa Gasparini Cristina Masini Giancarlo Bisagni Giuseppe Falco Guglielmo Ferrari Luca Braglia Alberto Del Prato Ivana Malavolti Vladimiro Ginocchi Pierpaolo Pattacini |
| author_facet | Valentina Iotti Sara Ravaioli Rita Vacondio Chiara Coriani Sabrina Caffarri Roberto Sghedoni Andrea Nitrosi Moira Ragazzi Elisa Gasparini Cristina Masini Giancarlo Bisagni Giuseppe Falco Guglielmo Ferrari Luca Braglia Alberto Del Prato Ivana Malavolti Vladimiro Ginocchi Pierpaolo Pattacini |
| author_sort | Valentina Iotti |
| collection | DOAJ |
| description | Abstract Background Neoadjuvant-chemotherapy (NAC) is considered the standard treatment for locally advanced breast carcinomas. Accurate assessment of disease response is fundamental to increase the chances of successful breast-conserving surgery and to avoid local recurrence. The purpose of this study was to compare contrast-enhanced spectral mammography (CESM) and contrast-enhanced-MRI (MRI) in the evaluation of tumor response to NAC. Methods This prospective study was approved by the institutional review board and written informed consent was obtained. Fifty-four consenting women with breast cancer and indication of NAC were consecutively enrolled between October 2012 and December 2014. Patients underwent both CESM and MRI before, during and after NAC. MRI was performed first, followed by CESM within 3 days. Response to therapy was evaluated for each patient, comparing the size of the residual lesion measured on CESM and MRI performed after NAC to the pathological response on surgical specimens (gold standard), independently of and blinded to the results of the other test. The agreement between measurements was evaluated using Lin’s coefficient. The agreement between measurements using CESM and MRI was tested at each step of the study, before, during and after NAC. And last of all, the variation in the largest dimension of the tumor on CESM and MRI was assessed according to the parameters set in RECIST 1.1 criteria, focusing on pathological complete response (pCR). Results A total of 46 patients (85%) completed the study. CESM predicted pCR better than MRI (Lin’s coefficient 0.81 and 0.59, respectively). Both methods tend to underestimate the real extent of residual tumor (mean 4.1mm in CESM, 7.5mm in MRI). The agreement between measurements using CESM and MRI was 0.96, 0.94 and 0.76 before, during and after NAC respectively. The distinction between responders and non-responders with CESM and MRI was identical for 45/46 patients. In the assessment of CR, sensitivity and specificity were 100% and 84%, respectively, for CESM, and 87% and 60% for MRI. Conclusion CESM and MRI lesion size measurements were highly correlated. CESM seems at least as reliable as MRI in assessing the response to NAC, and may be an alternative if MRI is contraindicated or its availability is limited. |
| first_indexed | 2024-12-17T08:27:47Z |
| format | Article |
| id | doaj.art-e7ae5e9ec9754447a545a4550d8d453e |
| institution | Directory Open Access Journal |
| issn | 1465-542X |
| language | English |
| last_indexed | 2024-12-17T08:27:47Z |
| publishDate | 2017-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Breast Cancer Research |
| spelling | doaj.art-e7ae5e9ec9754447a545a4550d8d453e2022-12-21T21:56:41ZengBMCBreast Cancer Research1465-542X2017-09-0119111310.1186/s13058-017-0899-1Contrast-enhanced spectral mammography in neoadjuvant chemotherapy monitoring: a comparison with breast magnetic resonance imagingValentina Iotti0Sara Ravaioli1Rita Vacondio2Chiara Coriani3Sabrina Caffarri4Roberto Sghedoni5Andrea Nitrosi6Moira Ragazzi7Elisa Gasparini8Cristina Masini9Giancarlo Bisagni10Giuseppe Falco11Guglielmo Ferrari12Luca Braglia13Alberto Del Prato14Ivana Malavolti15Vladimiro Ginocchi16Pierpaolo Pattacini17Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Arcispedale Santa Maria Nuova - IRCCSRadiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Arcispedale Santa Maria Nuova - IRCCSRadiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Arcispedale Santa Maria Nuova - IRCCSRadiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Arcispedale Santa Maria Nuova - IRCCSRadiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, AUSL Reggio EmiliaMedical Physics Unit, Department of Oncology and Advanced Technologies, Arcispedale Santa Maria Nuova - IRCCSMedical Physics Unit, Department of Oncology and Advanced Technologies, Arcispedale Santa Maria Nuova - IRCCSPathology Unit, Department of Oncology and Advanced Technologies, Arcispedale Santa Maria Nuova - IRCCSOncology Unit, Hospital C. Magati, AUSL Reggio EmiliaOncology Unit, Department of Oncology and Advanced Technologies, Arcispedale Santa Maria Nuova - IRCCSOncology Unit, Department of Oncology and Advanced Technologies, Arcispedale Santa Maria Nuova - IRCCSBreast Surgery Unit, Department of Surgery, Arcispedale Santa Maria Nuova - IRCCSBreast Surgery Unit, Department of Surgery, Arcispedale Santa Maria Nuova - IRCCSScientific Directorate, Arcispedale Santa Maria Nuova - IRCCSRadiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Arcispedale Santa Maria Nuova - IRCCSRadiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, AUSL Reggio EmiliaRadiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, AUSL Reggio EmiliaRadiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Arcispedale Santa Maria Nuova - IRCCSAbstract Background Neoadjuvant-chemotherapy (NAC) is considered the standard treatment for locally advanced breast carcinomas. Accurate assessment of disease response is fundamental to increase the chances of successful breast-conserving surgery and to avoid local recurrence. The purpose of this study was to compare contrast-enhanced spectral mammography (CESM) and contrast-enhanced-MRI (MRI) in the evaluation of tumor response to NAC. Methods This prospective study was approved by the institutional review board and written informed consent was obtained. Fifty-four consenting women with breast cancer and indication of NAC were consecutively enrolled between October 2012 and December 2014. Patients underwent both CESM and MRI before, during and after NAC. MRI was performed first, followed by CESM within 3 days. Response to therapy was evaluated for each patient, comparing the size of the residual lesion measured on CESM and MRI performed after NAC to the pathological response on surgical specimens (gold standard), independently of and blinded to the results of the other test. The agreement between measurements was evaluated using Lin’s coefficient. The agreement between measurements using CESM and MRI was tested at each step of the study, before, during and after NAC. And last of all, the variation in the largest dimension of the tumor on CESM and MRI was assessed according to the parameters set in RECIST 1.1 criteria, focusing on pathological complete response (pCR). Results A total of 46 patients (85%) completed the study. CESM predicted pCR better than MRI (Lin’s coefficient 0.81 and 0.59, respectively). Both methods tend to underestimate the real extent of residual tumor (mean 4.1mm in CESM, 7.5mm in MRI). The agreement between measurements using CESM and MRI was 0.96, 0.94 and 0.76 before, during and after NAC respectively. The distinction between responders and non-responders with CESM and MRI was identical for 45/46 patients. In the assessment of CR, sensitivity and specificity were 100% and 84%, respectively, for CESM, and 87% and 60% for MRI. Conclusion CESM and MRI lesion size measurements were highly correlated. CESM seems at least as reliable as MRI in assessing the response to NAC, and may be an alternative if MRI is contraindicated or its availability is limited.http://link.springer.com/article/10.1186/s13058-017-0899-1Breast CancerNeoadjuvant chemotherapyTreatment monitoringCESM (contrast enhanced spectral mammography)Dual-energyContrast media |
| spellingShingle | Valentina Iotti Sara Ravaioli Rita Vacondio Chiara Coriani Sabrina Caffarri Roberto Sghedoni Andrea Nitrosi Moira Ragazzi Elisa Gasparini Cristina Masini Giancarlo Bisagni Giuseppe Falco Guglielmo Ferrari Luca Braglia Alberto Del Prato Ivana Malavolti Vladimiro Ginocchi Pierpaolo Pattacini Contrast-enhanced spectral mammography in neoadjuvant chemotherapy monitoring: a comparison with breast magnetic resonance imaging Breast Cancer Research Breast Cancer Neoadjuvant chemotherapy Treatment monitoring CESM (contrast enhanced spectral mammography) Dual-energy Contrast media |
| title | Contrast-enhanced spectral mammography in neoadjuvant chemotherapy monitoring: a comparison with breast magnetic resonance imaging |
| title_full | Contrast-enhanced spectral mammography in neoadjuvant chemotherapy monitoring: a comparison with breast magnetic resonance imaging |
| title_fullStr | Contrast-enhanced spectral mammography in neoadjuvant chemotherapy monitoring: a comparison with breast magnetic resonance imaging |
| title_full_unstemmed | Contrast-enhanced spectral mammography in neoadjuvant chemotherapy monitoring: a comparison with breast magnetic resonance imaging |
| title_short | Contrast-enhanced spectral mammography in neoadjuvant chemotherapy monitoring: a comparison with breast magnetic resonance imaging |
| title_sort | contrast enhanced spectral mammography in neoadjuvant chemotherapy monitoring a comparison with breast magnetic resonance imaging |
| topic | Breast Cancer Neoadjuvant chemotherapy Treatment monitoring CESM (contrast enhanced spectral mammography) Dual-energy Contrast media |
| url | http://link.springer.com/article/10.1186/s13058-017-0899-1 |
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