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Early Changes in Functional Dynamic Magnetic Resonance Imaging Predict for Pathologic Response to Neoadjuvant Chemotherapy in Primary Breast Cancer

Authors' Affiliations: ¹ Academic Oncology Unit and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, Middlesex, United Kingdom; ² CRC Clinical MR Research Group, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; and ³ Breast Unit, Luton & Dunstable Hospital NHS Trust, Luton, United Kingdom

Requests for reprints: Mei-Lin W. Ah-See, Academic Oncology Unit, Mount Vernon Hospital, Northwood, Middlesex HA6 2RN, United Kingdom. Phone: 44-1923-844805; Fax: 44-1923-844167; E-mail: meilinahsee{at}hotmail.com.

Purpose: Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) allows noninvasive, in vivo measurements of tissue microvessel perfusion and permeability. We examined whether DCE-MRI done after two cycles of neoadjuvant chemotherapy could predict final clinical and pathologic response in primary breast cancers.

Experimental Design: Thirty-seven patients with primary breast cancer, due to receive six cycles of neoadjuvant 5-fluorouracil, epirubicin and cyclophosphamide chemotherapy, were examined using DCE-MRI before neoadjuvant chemotherapy and after two cycles of treatment. Changes in DCE-MRI kinetic parameters (K^trans, k_ep, v_e, MaxGd, rBV, rBF, MTT) were correlated with the final clinical and pathologic response to neoadjuvant chemotherapy. Test-retest variability was used to determine individual patient response.

Results: Twenty-eight patients were evaluable for response (19 clinical responders and 9 nonresponders; 11 pathologic responders and 17 nonresponders). Changes in the DCE-MRI kinetic parameters K^trans, k_ep, MaxGd, rBV, and rBF were significantly correlated with both final clinical and pathologic response (P < 0.01). Change in K^trans was the best predictor of pathologic nonresponse (area under the receiver operating characteristic curve, 0.93; sensitivity, 94%; specificity, 82%), correctly identifying 94% of nonresponders and 73% of responders. Change in MRI-derived tumor size did not predict for pathologic response.

Conclusion: Changes in breast tumor microvessel functionality as depicted by DCE-MRI early on after starting anthracycline-based neoadjuvant chemotherapy can predict final clinical and pathologic response. The ability to identify nonresponders early may allow the selection of patients who may benefit from a therapy change.