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Magnetic Resonance Imaging after Completion of Neoadjuvant Chemotherapy Can Accurately Discriminate between No Residual Carcinoma and Residual Ductal Carcinoma In Situ in Patients with Triple-Negative Breast Cancer

 Seho Park  ;  Jung Hyun Yoon  ;  Joohyuk Sohn  ;  Hyung Seok Park  ;  Hee Jung Moon  ;  Min Jung Kim  ;  Eun-Kyung Kim  ;  Seung Il Kim  ;  Byeong-Woo Park 
 PLOS ONE, Vol.11(2) : e0149347, 2016 
Journal Title
Issue Date
Adult ; Antineoplastic Agents/therapeutic use ; Breast/pathology ; Carcinoma/diagnosis* ; Carcinoma/drug therapy ; Carcinoma/pathology ; Carcinoma, Intraductal, Noninfiltrating/diagnosis* ; Carcinoma, Intraductal, Noninfiltrating/drug therapy ; Carcinoma, Intraductal, Noninfiltrating/pathology ; Chemotherapy, Adjuvant ; Diagnosis, Computer-Assisted ; False Positive Reactions ; Female ; Humans ; Image Processing, Computer-Assisted ; Magnetic Resonance Imaging* ; Mammography ; Middle Aged ; Multivariate Analysis ; Neoadjuvant Therapy ; ROC Curve ; Retrospective Studies ; Treatment Outcome ; Triple Negative Breast Neoplasms/diagnosis* ; Triple Negative Breast Neoplasms/drug therapy ; Triple Negative Breast Neoplasms/pathology ; Ultrasonography, Mammary
BACKGROUND: The accurate evaluation of favorable response to neoadjuvant chemotherapy (NCT) is critical to determine the extent of surgery. We investigated independent clinicopathological and radiological predictors to discriminate no residual carcinoma (ypT0) from residual ductal carcinoma in situ (ypTis) in breast cancer patients who received NCT.
PATIENTS AND METHODS: Parameters of 117 patients attaining pathological complete response (CR) in the breast after NCT between January 2010 and December 2013 were retrospectively evaluated by univariate and multivariate analyses. All patients underwent mammography, ultrasound, and magnetic resonance imaging (MRI) before and after NCT.
RESULTS: There were 67 (57.3%) patients with ypT0. These patients were associated with hormone receptor-negative status, human epidermal growth factor receptor-2 (HER2)-negative tumors, and a higher likelihood of breast-conservation surgery. Baseline mammographic and MRI presentation of the main lesion, absence of associated microcalcifications, shape, posterior features, and absence of calcifications on ultrasound were significantly associated with ypT0. CR in mammography, ultrasound, or MRI after NCT was also related to ypT0. By multivariate analysis, independent predictors of ypT0 were the triple-negative subtype [Odds ratio (OR), 4.23; 95% confidence interval (CI), 1.11-16.09] and CR in MRI after NCT (OR, 5.23; 95% CI, 1.53-17.85). Stratified analysis by breast cancer subtype demonstrated that MRI well predicted ypT0 in all subtypes except the HER2-positive subtype. In particular, of 40 triple-negative subtypes, 22 showed CR in MRI and 21 (95.5%) were ypT0 after NCT.
CONCLUSION: Among imaging modalities, breast MRI can potentially distinguish between ypT0 and ypTis after NCT, especially in patients with triple-negative breast cancer. This information can help clinicians evaluate tumor response to NCT and plan surgery for breast cancer patients of all subtypes except for those with HER2-enriched tumors after NCT.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Min Jung(김민정) ORCID logo https://orcid.org/0000-0003-4949-1237
Kim, Seung Il(김승일)
Kim, Eun-Kyung(김은경) ORCID logo https://orcid.org/0000-0002-3368-5013
Moon, Hee Jung(문희정) ORCID logo https://orcid.org/0000-0002-5643-5885
Park, Byeong Woo(박병우) ORCID logo https://orcid.org/0000-0003-1353-2607
Park, Se Ho(박세호) ORCID logo https://orcid.org/0000-0001-8089-2755
Park, Hyung Seok(박형석) ORCID logo https://orcid.org/0000-0001-5322-6036
Sohn, Joo Hyuk(손주혁) ORCID logo https://orcid.org/0000-0002-2303-2764
Yoon, Jung Hyun(윤정현) ORCID logo https://orcid.org/0000-0002-2100-3513
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