Monitoring the size and response of locally advanced breast cancers to neoadjuvant chemotherapy (weekly paclitaxel and epirubicin) with serial enhanced MRI

Purpose. To determine if early cancer size reduction seen on enhanced magnetic resonance imaging (MRI) can serve as a response predictor and to correlate final tumor sizes on MRI and excised gross tumor size to microscopic findings in patients with locally advanced breast cancers treated with preoperative neoadjuvant chemotherapy. Methods and materials. Thirty-three patients with advanced breast cancer entered this prospective chemotherapeutic study. Serial, dynamic, enhanced MRI was performed before chemotherapy induction, after the first course of chemotherapy and after the third course of chemotherapy prior to surgery. Responses were measured by image subtraction of tumor size on subsequent axial MRIs using the response evaluation criteria in solid tumors (RECIST). Early tumor size reduction, percentage of relative early tumor size reduction and final tumor size response were calculated and analyzed statistically. Sizes of residual tumors measured on MRI and gross tumors in excised breasts were correlated with microscopic findings. Results. Based on tumor sizes measured with enhanced MRI, four complete responders (CR), 19 partial responders (PR) and 10 non-responder were documented. Twelve (52%) of the 23 responders (CR and PR) had reached the criteria for PR (≥30% size reduction) after the first course of chemotherapy. All CR had a marked early size reduction (ESR) of more than 45%. Using the receiver operating characteristic (ROC) curve, a good cutoff point for early tumor size reduction was 7.4 cm, with a false positive rate of 0.1 and a false negative rate of 0.13. The percentage of ESR was 8.8%, with a false positive rate of 0.1 and a false negative rate of 0.09. Residual tumor size on MRI correlated well with microscopic findings (r = 0.982, p < 0.001) and gross tumor size in excised breasts correlated moderately with microscopic findings (r = 0.640, p < 0.001). Conclusion. Serial, dynamic, enhanced MRI monitoring of chemotherapeutic response in patients with locally advanced breast cancer can be used to assess early response to chemotherapy and post-chemotherapy tumor size change. Although the residual tumor size on MRI correlated well with the microscopic findings, surgical determination of residual cancer load is still recommended to avoid underestimation.