DCE MRI and DW Imaging for response prediction and measurement of locally advanced mamma carcinoma treated by neoadjuvant chemotherapy; results of patients treated in Deventer Hospital from 2006 to 2012.

Knapen, D.G. (Daan Geert) (2013) DCE MRI and DW Imaging for response prediction and measurement of locally advanced mamma carcinoma treated by neoadjuvant chemotherapy; results of patients treated in Deventer Hospital from 2006 to 2012. thesis, Medicine.

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Abstract

Introduction: Neoadjuvant chemotherapy (NAC) is being used in increased extent for treatment of breast carcinoma. The success of NAC is highly dependent on reliable assessment of tumor response to NAC. The current method for response assessment using Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1 criteria) has limitations. Diffusion-Weighted Imaging (DW Imaging), a very promising new magnetic resonance imaging (MRI) modality, is not considered in the criteria. Also, phase of imaging for dynamic contrast enhanced magnetic resonance imaging (DCE MRI) is not specified. Purpose: The study’s purpose was to find solutions for the shortcoming the RECIST 1.1 criteria still have. Parameters provided by DCE MRI and DW Imaging have been studied to find the best MRI method for all three MRI’s made during the course of NAC. Methods: In this retrospective study, 89 patients (90 tumors) with invasive breast cancer were included. DCE MRI and DW Imaging were performed before NAC, after 3 cycles of NAC and before surgery. If possible, tumor diameter was measured using RECIST 1.1 criteria of the early and late enhancement area as well as the washout area. The apparent diffusion coefficient (ADC) was derived as well. These parameters were correlated with the golden standard; final histopathology. Final histopathology was categorized in 2 ways. It was divided in pathologic complete response (pCR) and non-pathologic complete response (non-pCR). Secondly, it was categorized in the Miller and Payne grading system. Results: Pretreatment ADC values significantly differed for the pCR and non-pCR groups (mean ± SD, 15.46 ± 0.71 x 10-2 mm2/s versus, 12.72 ± 0.30 x 10-2 mm2/s, p = 0.002). Best cut-off value of ADC for the prediction of pCR was 11.95 x 10-2 mm2/s yielding a sensitivity of 100% and specificity of 43%. The aggressive HER2 enriched and triple negative subtype had higher pretreatment ADC values than the hormone positive tumors; (mean ± SD, 14.522 ± 2.534 x 10-2 mm2/s, 14.143 ± 2.862 x 10-2 mm2/s versus 12.357 ± 2.332 x 10-2 mm2/s). For early response measurements, the change of largest diameter of the late enhancement area was best in predicting pathologic outcome. An odds ratio of 1,038 (CI 95% 1.013-1.063), p = 0.003 to predict pCR and 1.028 (CI 95% 1.008-1.048) , p = 0.005 to predict Miller and Payne grades per per cent tumor diameter decrease was found. Percentage increase of ADC was not suitable for prediction of pCR or Miller and Payne grades (p = 0.465 and 0.676). DCE MRI at preoperative MRI had a sensitivity of 97% and a specificity of 100% for prediction of pCR if measurements at late enhancement and washout were combined. Residual tumor diameter measurements by measuring washout area had highest correlation with pathological tumor size with Pearson’s correlation of 0.644 and regression coefficient of 0.784 (CI 95% 0.271-1.297). Conclusion: Best MRI method is different for the three MRI’s made during the course of NAC for breast cancer. For the pretreatment MRI, DW imaging’s parameter ADC proves to be a surrogate marker for detection of aggressive breast tumors and prediction of pCR. For early response measurements, DCE MRI is superior to DW Imaging. Measurement of percentage change of late enhancement area is best for response measurement and prediction of reaching pCR. At preoperative MRI, DCE MRI was very accurate, with a sensitivity of 100% and a specificity of 97%, for prediction of pCR if measurements at late enhancement and washout were combined. If residual tumor is present, diameter measurements of washout area is best in estimation of size.

Item Type:	Thesis (Thesis)
Supervisor name:	Imholz, Dr. A.L.T.
Supervisor name:	Dijk, Dr. R.A.J.M. van and Hage, Dr. M. and Tran, Dr. V.H.P. and Deventer Ziekenhuis
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:56
Last Modified:	25 Jun 2020 10:56
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1665

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