MRI in the Evaluation of Residual Disease
| Study | Type of Study | Study Population | N | Major Findings/Comments |
|---|---|---|---|---|
| Yeh et al.25 | Prospective | Patients with stage IIb/III breast cancer undergoing neoadjuvant chemotherapy (doxorubicin and paclitaxel) | 31 | Correlation with pathology |
| Equal to pathology/underestimate/overestimate | ||||
| MRI: 71%/23%/6% | ||||
| XRM: 26%/52%/23% | ||||
| US: 35%/52%/13% | ||||
| MRI was best correlated with pathology | ||||
| (P < .002) | ||||
| Chen et al.26 | Prospective | Patients with locally advanced breast cancer receiving neoadjuvant therapy (adriamycin, cytoxan, and paclitaxel) | 15 | MRI tended to overestimate tumor response; for partial non-responders MRI correlated with pathology 0% of the time compared with 17% for CBE and 83% for PET; however, for responders, MRI correlated with pathology 90% of the time, with 70% correlation for CBE and 90% for PET; MRI size measurements of residual tumors did correlate with pathology (coefficient 0.7 compared with −0.06 for CBE) |
| Denis et al.27 | Prospective | Patients with locally advanced breast cancer receiving neoadjuvant therapy with either 5–5-fluorouracil/epirubicin/ cyclophosphamide; docetaxel only, or docetaxel with epirubicin | 40 | Correlation coefficient of MRI measurements with pathology: 5-fluorouracil/E/C: 0.89, DXL: 0.64, DXL/E: 0.16 MRI overestimated tumor response in DXL-based groups, which was believed to be due to antiangiogenic effect of DXL, which would impair MRI contrast enhancement; this was supported by the fact that DXL-based groups had residual disease of microscopic nests of tumor cells on pathology as opposed to single nodular lesions |
| Tozaki et al.28 | Prospective | Patients with locally advanced breast cancer (IIb/III) undergoing neoadjuvant chemotherapy | 19 | Accuracy (deviation from pathology of less than 2 mm) of late phase CT and MRI scans (scan 4 minutes after contrast injection) compared with pathology was up to 90% for DCIS and replaced (diffuse pre-NAC contrast enhancement) lesions and 88% for nonreplaced (localized CE) lesions; early phase scans were 0% accurate for DCIS/replaced and 75% accurate for nonreplaced lesions |
| Bodini et al.29 | Prospective | Patients with T2 to 4, N0 M0 breast cancer treated with 3 to 4 cycles of epirubicin | 79 | Clinical response correlation with pathology correlation coefficients were 0.72 for MRI and 0.68 for CBE |
| Warren et al.30 | Retrospective | Patients undergoing neoadjuvant therapy | 67 | MRI was more sensitive and specific for assessment of complete or partial response (100% and 80%) than conventional assessment methods (CAM), including XRM, US, and CBE (98% and 50%); agreement with pathology was marginally higher in MRI compared with CAM (81% compared to 68%, P = .09); MRI increased diagnostic knowledge in 70% of patients, and increased diagnostic confidence in 52%; however, MRI did not change treatment plan, decreased confidence in 20% of patients, and decreased knowledge in 17%; MRI tended to overestimate response |
| Lee et al.31 | Retrospective | Patients who had excisional biopsy who required definitive surgery, eg, because of positive margins/residual disease and were candidates for breast conservation | 80 | MRI sensitivity and specificity for residual disease was 61.2% and 69.7%, respectively; additional lesions were detected by imaging of which 10 were only seen on MRI; of these, 5 were benign, 5 were malignant; MRI changed management of patients in 29% of the cases, because of additional lesions found; whether this led to improved patient outcomes is not known |
| Rosen et al.32 | Retrospective | Patients with locally advanced breast cancer treated with neoadjuvant therapy (paclitaxel, doxorubicin, and breast hyperthermia) | 21 | Correlation with pathology equal to pathology/underestimate/overestimate MRI: 57%/10%/33% correlation coefficients were 0.74 for MRI and 0.65 (statistically nonsignificant trend); in contrast to some of the other studies, MRI tended to overestimate the residual tumor (ie, underestimate response) |
| Hwang et al.33 | Retrospective | Patients with histologically confirmed diagnosis of DCIS | 51 | MRI was 97% sensitive and 58% specific for detecting residual disease compared with histology; the sensitivity was significantly better than the sensitivity of XRM for residual disease; in addition MRI had a significantly higher NPV compared to XRM |
| Belli et al.34 | Prospective | Patients with locally advanced breast cancer being treated with neoadjuvant chemotherapy | 45 | MRI had a 90.2% sensitivity and a 100% specificity for residual disease |
| Cheung et al.35 | Prospective | Patients with locally advanced breast cancer being treated with neoadjuvant chemotherapy | 33 | Residual tumor on MRI correlated with microscopic findings (correlation coefficient = 0.982, P < .001) |
| Partridge et al.36 | Prospective | Patients with invasive breast cancer undergoing neoadjuvant therapy with doxorubicin and cyclophosphamide | 52 | Decreased tumor enhancement prechemotherapy and postchemotherapy (210% vs 166%, P < .001); MRI had correlation coefficient of 0.89 compared with pathology whereas clinical examination had coefficient of 0.60 |
| Kawashima et al.37 | Prospective | Patients who underwent excisional biopsy of breast lesion | 50 | MRI in detection of residual disease: sensitivity 66%; specificity 81%; PPV 72%; NPV 83%; accuracy 63% |
| Drew et al.38 | Prospective | Patients with locally advanced breast cancer receiving neoadjuvant therapy | 17 | Dynamic CE MRI was 100% accurate in assessing residual disease; CBE and XRM were not sensitivity/specificity/PPV/NPV CBE: 50%/86%/83%/55% XRM: 90%/57%/75%/80% |
| Weatherall et al.39 | Retrospective | Patients with breast cancer with chemotherapy prior to surgery | 20 | MRI demonstrated a correlation with pathology (coefficient = 0.93); coefficients for CBE and XRM were 0.72 and 0.63, respectively |
| Frei et al.40 | Retrospective | Patients with excisional biopsy | 68 | MRI sensitivity/specificity/PPV/NPV >7 days postbiopsy: 89%/52%/81%/69% >14 days postbiopsy: 88%/58%/82%/69% >21 days postbiopsy: 91%/69%/88%/75% >28 days postbiopsy: 92%/75%/92%/75% >35 days postbiopsy: 95%/75%/91%/86% >42 days postbiopsy: 94%/75%/89%/86%The peak values for PPV and plateau for specificity occurs at >28 days, after which the improvement is not as much; therefore, this may be the best time to perform the MRI as the PPV of positive margins in this study was 69% compared to 92% for MRI at day 28, which may lead to breast-conserving surgery |
| Trecate et al.41 | Prospective | Patients with locally advanced breast cancer receiving chemotherapy | 30 | MRI: sensitivity: 96%; specificity: 75%; PPV: 92.5%; NPV 66%; accuracy 90% |
| Orel et al.42 | Prospective | Patients who underwent excisional biopsy | 47 | MRI had PPV of 82% and NPV of 61%; false negatives possibly secondary to postsurgical changes |
| Soderstrom et al.43) | Prospective | Patients who underwent excisional biopsies | 19 | MRI had an 84% accuracy in determining whether residual tumor was present in patients postexcisional biopsy |