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Prediction of Pathologic Complete Response by Ultrasonography and Magnetic Resonance Imaging After Neoadjuvant Chemotherapy in Patients with Breast Cancer

Authors Zhang K, Li J, Zhu Q, Chang C

Received 25 January 2020

Accepted for publication 25 March 2020

Published 16 April 2020 Volume 2020:12 Pages 2603—2612


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Sanjeev Srivastava

Kai Zhang,* Jiawei Li,* Qian Zhu, Cai Chang

Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Cai Chang
Fudan University Shanghai Cancer Center, No. 270, Dong’an Road, Shanghai, Xuhui District 200032, People’s Republic of China
Tel +86 180 1731 2605
Fax +86 21 6417 4774

Purpose: To compare the diagnostic performance for pathologic complete response (pCR) in breast cancer after neoadjuvant chemotherapy (NAC) between ultrasound (US) and magnetic resonance imaging (MRI).
Patients and Methods: A total of 1,219 breast cancer patients with 1,232 tumors who accepted US and/or MRI examination after NAC and before breast surgery were included. The diagnostic performance of US, MRI, and US plus MRI in predicting pCR was compared.
Results: The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of US for pCR were 36.2%, 90.2%, 71.0%, 67.3%, and 71.9%, respectively, while for MRI they were 44.4%, 92.9%, 75.6%, 77.7%, and 75.0%, respectively. The combination of US and MRI had increased specificity (98.0%) and PPV (86.8%), decreased sensitivity (22.5%) and NPV (68.8%), but similar accuracy (70.5%) in comparison with US or MRI alone. The prediction of pCR by imaging differed in different histological, molecular subtypes and primary tumor size.
Conclusion: Neither US nor MRI could predict a pCR with sufficient accuracy. The combination of US and MRI could not predict a pCR reliably either. The explanation of imaging for pCR should take into account histological, molecular subtypes, and primary tumor size.

Keywords: breast neoplasms, neoadjuvant therapy, pathologic complete response, ultrasonography, magnetic resonance imaging

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