Pre-operative assessment of residual disease in locally advanced breast cancer patients: A sequential study by quantitative diffusion weighted MRI as a function of therapy

• Published in: Magnetic resonance imaging 2017-10, Vol.42, p.88-94
• Main Authors: Agarwal, Khushbu, Sharma, Uma, Sah, Rani G, Mathur, Sandeep, Hari, Smriti, Seenu, Vurthaluru, Parshad, Rajinder, Jagannathan, Naranamangalam R
• Format: Article
• Language: English
• Subjects: Adult; Aged; Apparent diffusion coefficient; Area Under Curve; Breast conservation surgery; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - pathology; Breast Neoplasms - therapy; Chemotherapy, Adjuvant; Cohort Studies; Diffusion Magnetic Resonance Imaging; Diffusion weighted imaging; Female; Humans; Image Processing, Computer-Assisted; Locally advanced breast cancer; Mastectomy; Middle Aged; Necrosis; Neoadjuvant chemotherapy; Neoadjuvant Therapy; Neoplasm, Residual - therapy; Radiology; Remission Induction; ROC Curve; Treatment Outcome; Young Adult
• ISSN: 0730-725X; 1873-5894
• DOI: 10.1016/j.mri.2017.06.002

Abstract Purpose The potential of diffusion weighted imaging (DWI) in assessing pathologic response and surgical margins in locally advanced breast cancer patients (n = 38) undergoing neoadjuvant chemotherapy was investigated. Methods DWI was performed at pre-therapy (Tp0), after I (Tp1) and III (Tp3) NACT at 1.5 T. Apparent diffusion coefficient (ADC) of whole tumor (ADCWT ), solid tumor (ADCST ), intra-tumoral necrosis (ADCNec ) was determined. Further, ADC of 6 consecutive shells (5 mm thickness each) including tumor margin to outside tumor margins (OM1 to OM5) was calculated and the data analyzed to define surgical margins. Results Of 38 patients, 6 were pathological complete (pCR), 19 partial responders (pPR) and 13 were non-responders (pNR). Significant increase was observed in ADCST and ADCWT in pCR and pPR following therapy. Pre-therapy ADC was significantly lower in pCR compared to pPR and pNR indicating heterogeneous nature of tumor which may affect drug perfusion and consequently the response. ADC of outside margins (OM1, OM2, and OM3) was significantly different among pCR, pPR and pNR at Tp3 which may serve as response predictive parameter. Further, at Tp3, ADC of the outside margins (OM1, OM2, and OM3) was significantly lower compared to that seen at Tp0 in pCR indicating the presence of residual disease in these shells. Conclusion This pre-surgery information may serve as a guide to define cancer free margins and extent of residual disease which may be useful in planning breast conservation surgery.