Evaluation of neoadjuvant chemotherapeutic response of breast cancer using dynamic MRI with high temporal resolution

Abstract. The aim of this study was to evaluate changes in both size and contrast enhancement of breast tumors during neoadjuvant chemotherapy, using dynamic MRI with high temporal resolution. Patients with advanced breast cancer (n=21) underwent a 1.5-T MRI scan prior to and following neoadjuvant chemotherapy with four cycles. Dynamic contrast enhancement was measured using a fast turbo-FLASH sequence and quantified using a two-compartment model with the parameters kep and amplitude. Image analysis was done on images overlayed with a color map of parameters. The correlation between tumor diameter measured by histopathology and MRI was 0.7 (p<0.003). A reduction of tumor size after chemotherapy of more than 25% was associated with a decrease of both analyzed contrast enhancement parameters (kep: p<0.002; amplitude: p<0.006), where kep began to drop already after the first cycle of chemotherapy (p<0.008). A clear reduction of tumor size was only noted after the third cycle (p<0.008). In patients without tumor regression there was also a trend towards an early reduction of contrast enhancement.We assume that MRI with high temporal resolution and color mapping is a novel tool to assess therapeutic effects of neoadjuvant chemotherapy in breast tumors, which deserves further prospective evaluation.

[1]  H. Junkermann,et al.  [Histologic regression of breast cancer after primary (neoadjuvant) chemotherapy]. , 1994, Geburtshilfe und Frauenheilkunde.

[2]  G. Gasparini,et al.  Metronomic scheduling: the future of chemotherapy? , 2001, The Lancet. Oncology.

[3]  J E Husband,et al.  Primary breast cancer: mammographic changes after neoadjuvant chemotherapy, with pathologic correlation. , 1996, Radiology.

[4]  M V Knopp,et al.  Angiogenic activity of cervical carcinoma: assessment by functional magnetic resonance imaging-based parameters and a histomorphological approach in correlation with disease outcome. , 1998, Clinical cancer research : an official journal of the American Association for Cancer Research.

[5]  S E Harms,et al.  Evaluation of neoadjuvant chemotherapeutic response of locally advanced breast cancer by magnetic resonance imaging , 1996, Cancer.

[6]  G Brix,et al.  Recurrent rectal cancer: diagnosis with dynamic MR imaging. , 1993, Radiology.

[7]  S. Delorme,et al.  Locally advanced breast carcinoma: evaluation of mammography in the prediction of residual disease after induction chemotherapy. , 2000, Anticancer research.

[8]  R. Gilles,et al.  Locally advanced breast cancer: contrast-enhanced subtraction MR imaging of response to preoperative chemotherapy. , 1994, Radiology.

[9]  H Mumtaz,et al.  Staging of symptomatic primary breast cancer with MR imaging. , 1997, AJR. American journal of roentgenology.

[10]  A. Luini,et al.  Primary chemotherapy to avoid mastectomy in tumors with diameters of three centimeters or more. , 1990, Journal of the National Cancer Institute.

[11]  G. Schwartz,et al.  Induction chemotherapy followed by breast conservation for locally advanced carcinoma of the breast , 1994, Cancer.

[12]  G J Metzger,et al.  MRI vs. histologic measurement of breast cancer following chemotherapy: Comparison with x‐ray mammography and palpation , 2001, Journal of magnetic resonance imaging : JMRI.

[13]  G. Brix,et al.  Methods for quantitative assessment of tissue microcirculation using dynamic contrast-enhanced MR imaging , 1997, Der Radiologe.

[14]  H Zeitler,et al.  MRI of breast cancer: influence of chemotherapy on sensitivity. , 1997, The British journal of radiology.

[15]  M. Knopp,et al.  Estimating kinetic parameters from dynamic contrast‐enhanced t1‐weighted MRI of a diffusable tracer: Standardized quantities and symbols , 1999, Journal of magnetic resonance imaging : JMRI.

[16]  I. Zuna,et al.  Multi-reader-analysis to assess functional MR-Mammography , 1998, Der Radiologe.

[17]  H. Junkermann,et al.  Pharmakokinetische Analyse der Gd-DTPA-Anreicherung in der MRT beim Mammakarzinom , 1994 .

[18]  W. J. Lorenz,et al.  Pharmacokinetic Mapping of the Breast: A New Method for Dynamic MR Mammography , 1995, Magnetic resonance in medicine.

[19]  M. Knopp,et al.  [Methodological approaches to quantitative evaluation of microcirculation in tissues with dynamic magnetic resonance tomography]. , 1997, Der Radiologe.

[20]  G. Hortobagyi,et al.  Feasibility of breast‐conservation surgery after induction chemotherapy for locally advanced breast carcinoma , 1992, Cancer.

[21]  A. Rieber,et al.  Breast MRI for monitoring response of primary breast cancer to neo-adjuvant chemotherapy , 2002, European Radiology.

[22]  G Brix,et al.  MR mammography with pharmacokinetic mapping for monitoring of breast cancer treatment during neoadjuvant therapy. , 1994, Magnetic resonance imaging clinics of North America.

[23]  G. Hortobagyi,et al.  Management of stage III primary breast cancer with primary chemotherapy, surgery, and radiation therapy , 1988, Cancer.

[24]  L. Mauriac,et al.  Effects of primary chemotherapy in conservative treatment of breast cancer patients with operable tumors larger than 3 cm. Results of a randomized trial in a single centre. , 1991, Annals of oncology : official journal of the European Society for Medical Oncology.

[25]  M. Kaufmann,et al.  Histologische Regression des Mammakarzinoms nach primärer (neoadjuvanter) Chemotherapie , 1994 .

[26]  S. Steinberg,et al.  Neoadjuvant chemotherapy in the combined modality approach of locally advanced nonmetastatic breast cancer. , 1987, Cancer research.

[27]  G Brix,et al.  Pathophysiologic basis of contrast enhancement in breast tumors , 1999, Journal of magnetic resonance imaging : JMRI.

[28]  A. Miller,et al.  Reporting results of cancer treatment , 1981, Cancer.