Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.
Medical Radiation Physics, Department of Translational Medicine, Lund University, Skåne University Hospital, Malmö, Sweden.
Breast. 2020 Oct;53:33-41. doi: 10.1016/j.breast.2020.05.013. Epub 2020 Jun 4.
To assess if mammographic density (MD) changes during neoadjuvant breast cancer treatment and is predictive of a pathological complete response (pCR).
We prospectively included 200 breast cancer patients assigned to neoadjuvant chemotherapy (NACT) in the NeoDense study (2014-2019). Raw data mammograms were used to assess MD with a fully automated volumetric method and radiologists categorized MD using the Breast Imaging-Reporting and Data System (BI-RADS), 5th Edition. Logistic regression was used to calculate odds ratios (OR) for pCR comparing BI-RADS categories c vs. a, b, and d as well as with a 0.5% change in percent dense volume adjusting for baseline characteristics.
The overall median age was 53.1 years, and 48% of study participants were premenopausal pre-NACT. A total of 23% (N = 45) of the patients accomplished pCR following NACT. Patients with very dense breasts (BI-RADS d) were more likely to have a positive axillary lymph node status at diagnosis: 89% of the patients with very dense breasts compared to 72% in the entire cohort. A total of 74% of patients decreased their absolute dense volume during NACT. The likelihood of accomplishing pCR following NACT was independent of volumetric MD at diagnosis and change in volumetric MD during treatment. No trend was observed between decreasing density according to BI-RADS and the likelihood of accomplishing pCR following NACT.
The majority of patients decreased their MD during NACT. We found no evidence of MD as a predictive marker of pCR in the neoadjuvant setting.
评估新辅助乳腺癌治疗过程中乳腺密度（MD）的变化及其对病理完全缓解（pCR）的预测价值。
我们前瞻性纳入了 200 例新辅助化疗（NACT）的乳腺癌患者，这些患者均来自 NeoDense 研究（2014-2019 年）。采用全自动容积法评估原始数据乳腺 X 线摄影的 MD，放射科医生使用乳腺影像报告和数据系统（BI-RADS）第 5 版对 MD 进行分类。采用逻辑回归计算 BI-RADS 类别 c 与 a、b 和 d 以及调整基线特征后 MD 容积百分比变化 0.5%的 pCR 比值比（OR）。
研究人群的总体中位年龄为 53.1 岁，48%的患者在新辅助治疗前处于绝经前状态。NACT 后共有 23%（N=45）的患者达到了 pCR。乳腺致密（BI-RADS d）的患者在诊断时更有可能出现阳性腋窝淋巴结状态：致密乳腺患者的阳性淋巴结比例为 89%，而整个队列的阳性淋巴结比例为 72%。NACT 期间，共有 74%的患者减少了绝对致密体积。NACT 后达到 pCR 的可能性与诊断时的容积 MD 及治疗期间容积 MD 的变化无关。根据 BI-RADS 减少密度与 NACT 后达到 pCR 的可能性之间未观察到趋势。
大多数患者在 NACT 期间降低了 MD。我们没有发现 MD 作为新辅助治疗中 pCR 预测标志物的证据。
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