Institute of Radiology, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil.
Fleury Group, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP, 01333-010, Brazil.
Eur Radiol. 2022 Mar;32(3):1663-1675. doi: 10.1007/s00330-021-08290-1. Epub 2021 Oct 30.
Radiologic complete response (rCR) in breast cancer patients after neoadjuvant chemotherapy (NAC) does not necessarily correlate with pathologic complete response (pCR), a marker traditionally associated with better outcomes. We sought to verify if data extracted from two important steps of the imaging workup (tumor features at pre-treatment MRI and post-treatment mammographic findings) might assist in refining the prediction of pCR in post-NAC patients showing rCR.
A total of 115 post-NAC women with rCR on MRI (2010-2016) were retrospectively assessed. Pre-treatment MRI (lesion morphology, size, and distribution) and post-treatment mammographic findings (calcification, asymmetry, mass, architectural distortion) were assessed, as well as clinical and molecular variables. Bivariate and multivariate analyses evaluated correlation between such variables and pCR. Post-NAC mammographic findings and their correlation with ductal in situ carcinoma (DCIS) were evaluated using Pearson's correlation.
Tumor distribution at pre-treatment MRI was the only significant predictive imaging feature on multivariate analysis, with multicentric lesions having lower odds of pCR (p = 0.035). There was no significant association between tumor size and morphology with pCR. Mammographic residual calcifications were associated with DCIS (p = 0.009). The receptor subtype remained as a significant predictor, with HR-HER2 + and triple-negative status demonstrating higher odds of pCR on multivariate analyses.
Multicentric lesions on pre-NAC MRI were associated with a lower chance of pCR in post-NAC rCR patients. The receptor subtype remained a reliable predictor of pCR. Residual mammographic calcifications correlated with higher odds of malignancy, making the correlation between mammography and MRI essential for surgical planning. Key Points • The presence of a multicentric lesion on pre-NAC MRI, even though the patient reaches a radiologic complete response on MRI, is associated with a lower chance of pCR. • Molecular status of the tumor remained the only significant predictor of pathologic complete response in such patients in the present study. • Post-neoadjuvant residual calcifications found on mammography were related to higher odds of residual malignancy, making the correlation between mammography and MRI essential for surgical planning.
新辅助化疗（NAC）后乳腺癌患者的放射学完全缓解（rCR）不一定与病理完全缓解（pCR）相关，pCR 是传统上与更好的预后相关的标志物。我们试图验证从影像学检查的两个重要步骤中提取的数据（治疗前 MRI 的肿瘤特征和治疗后乳腺 X 线摄影发现）是否可以帮助预测 NAC 后显示 rCR 的患者的 pCR。
回顾性评估了 2010 年至 2016 年间共 115 例 NAC 后 MRI 显示 rCR 的女性患者。评估了治疗前 MRI（病变形态、大小和分布）和治疗后乳腺 X 线摄影发现（钙化、不对称、肿块、结构扭曲）以及临床和分子变量。使用二变量和多变量分析评估了这些变量与 pCR 之间的相关性。使用 Pearson 相关系数评估了 NAC 后乳腺 X 线摄影发现及其与导管原位癌（DCIS）的相关性。
治疗前 MRI 的肿瘤分布是多变量分析中唯一具有显著预测意义的影像学特征，多中心病变的 pCR 可能性较低（p=0.035）。肿瘤大小和形态与 pCR 无显著相关性。乳腺 X 线摄影残余钙化与 DCIS 相关（p=0.009）。受体亚型仍然是一个显著的预测因子，HR-HER2+和三阴性状态在多变量分析中显示出更高的 pCR 可能性。
NAC 前 MRI 上的多中心病变与 NAC 后 rCR 患者的 pCR 机会较低相关。肿瘤受体亚型仍然是 pCR 的可靠预测因子。乳腺 X 线摄影残余钙化与更高的恶性肿瘤几率相关，因此乳腺 X 线摄影和 MRI 之间的相关性对手术计划至关重要。
NAC 前 MRI 上存在多中心病变，即使患者在 MRI 上达到放射学完全缓解，也与 pCR 的可能性较低相关。
在本研究中，肿瘤的分子状态仍然是此类患者病理完全缓解的唯一显著预测因子。
乳腺 X 线摄影检查中发现的 NAC 后残余钙化与残余恶性肿瘤的几率较高相关，因此乳腺 X 线摄影和 MRI 之间的相关性对手术计划至关重要。
