Pathologic Response of Breast Cancer

Published Date: 19th July 2016

Publication Authors: , Jois RHS, Harris O, Pennick M

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Background:  Neo-adjuvant chemotherapy is being increasingly used for breast cancer. MRI is used for assessing tumour response. Literature on correlation of pathologic response and MRI response is scanty.

Aim:  Can a pre-operative MRI predict pathologic response of breast cancer to neo-adjuvant chemotherapy?

Methods:  A consecutive series of patients with invasive breast cancer underwent neo-adjuvant chemotherapy (2008-2012). All patients had breast MRI prior to commencing chemotherapy and before definitive surgery. In this study radiological response is correlated with pathological response.

Results:  60 women had neo-adjuvant chemotherapy after MRI breast; median age 48 yrs. The tumour characteristics were; median tumour size 35mm, 34 (57%) Grade 3, 20 (33%) LVI +^ve, 22 (36%) ER eve, 37 (62%) PR -ve, 40 (66%) HER2 -^ve. Taxotere based chemotherapy administered to 37 (61%) and Docitaxol to 16 (26%) pts. Good / complete response reported on MRI for 30 (50%). 27 (45%) women had breast conservation. 32 (53%) had axillary dissection. No invasive cancer was found in specimen of 10 (17%) pts. Primary tumour was down- staged in 29 (48%). MRI correctly predicted down-stage in pathology size of tumour p < 0.049 Pearson Chi square test (CI; 0.072 - 0.089). Good / complete response to neo-adjuvant chemotherapy on MRI was significantly associated with compete pathological response p <= 0.002 (95% CI; 0.001 - 0.003 Monte Carlo test).

Conclusions:  In our experience good or complete response on MRI is associated with complete pathological response (absence of invasive cancer). MRI is useful to plan surgery after neo-adjuvant chemotherapy.

Jois, R; Harris, O; Pennick, M; Audisio, R. (2013).  Can a pre-operative MRI predict the pathologic response of breast cancer to neo-adjuvant chemotherapy?  European Journal of Surgical Oncology. 39 (5), 462

 

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