Evaluation of pathological complete response after neoadjuvant systemic treatment of invasive breast cancer using diffusion-weighted imaging compared with dynamic contrast-enhanced based kinetic analysis. Issue 154 (September 2022)

• Record Type: Journal Article
• Authors: Ota, Rie; Kataoka, Masako; Iima, Mami; Honda, Maya; Ohashi, Akane; Ohno Kishimoto, Ayami; Miyake, Kanae Kawai; Yamada, Yosuke; Takeuchi, Yasuhide; Toi, Masakazu; Nakamoto, Yuji
• Is Part Of: European journal of radiology. Issue 154(2022)
• Publication Date: 2022-09
• Subjects: Neoadjuvant systemic treatment -- Pathological complete response -- Magnetic resonance imaging -- Diffusion-weighted image -- Kinetic assessment -- Breast cancer; NST neoadjuvant systemic treatment -- pCR pathological complete response -- DWI diffusion-weighted imaging -- DCE-MRI dynamic contrast-enhanced magnetic resonance imaging -- ADC apparent diffusion coefficient -- BI-RADS Breast Imaging Report and Data System -- ROC receiver operating characteristic -- CI confidence interval -- AUC area under the ROC curve -- ER estrogen receptor -- PgR progesterone receptor -- HER2 human epidermal growth factor receptor 2 -- RECIST response evaluation criteria in solid tumors -- CR complete response -- PR partial response -- SD stable disease -- PD progressive disease; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2022.110372
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Our proposed DWI score based on visual assessment is feasible for evaluating lesions after neoadjuvant systemic treatment. Our DWI-based visual score and kinetic score had similar diagnostic performances when evaluating pCR. DWI and kinetic scores tended to perform better in predicting pCR for the triple-negative subtype. Abstract: Purpose: This study compared the performance of diffusion-weighted imaging (DWI) to dynamic contrast-enhanced (DCE)-MRI for diagnosing pathological complete response (pCR) before surgery. Method: Overall, 133 lesions from 133 patients who underwent pre-surgical MRI evaluation after neoadjuvant systemic treatment were included. Two readers blinded to the pathological diagnosis evaluated the images. MR images were obtained using a routine protocol sequence that included DWI and DCE-MRI. DWI of the target lesion was scored using a three-point scale. Kinetic patterns of lesions on DCE-MRI were scored using a four-point scale. The capacities of DWI and kinetic parameters for discriminating pCR and non-pCR were assessed via receiver operating characteristic (ROC) analysis. Results: For DWI scores, ROC analysis showed areas under the ROC curve (AUCs) of 0.84 (95% confidence interval: 0.77–0.90) and 0.85 (0.77–0.90) for readers 1 and 2, respectively; corresponding AUCs of kinetic scores were 0.89 (0.82–0.94) and 0.88 (0.81–0.93). Among the triple-negative subtype, the AUCs of DWI scores were 0.84 (0.70–0.93) and 0.88 (0.75–0.96) for readers 1 and 2, respectively; corresponding AUCs of kinetic scores were 0.94 (0.83–0.99) and 0.93 (0.82–0.99). Among the luminal subtype, the AUCs of DWI scores were 0.85 (0.71–0.94) and 0.82 (0.68–0.92) for readers 1 and 2, respectively; corresponding AUCs of kinetic scores were 0.82 (0.68–0.92) and 0.72 (0.56–0.85). Conclusions: Our DWI-based visual score and kinetic score showed similar diagnostic performances. Both DWI and kinetic scores tended to perform better in predicting pCR for the triple-negative subtype.