Abstract
Purpose: To determine if the change in tumor apparent diffusion coefficient (ADC) at diffusion-weighted (DW) MRI is predictive of pathologic complete response (pCR) to neoadjuvant chemotherapy for breast cancer. Materials and Methods: In this prospective multicenter study, 272 consecutive women with breast cancer were enrolled at 10 institutions (from August 2012 to January 2015) and were randomized to treatment with 12 weekly doses of paclitaxel (with or without an experimental agent), followed by 12 weeks of treatment with four cycles of anthracycline. Each woman underwent breast DW MRI before treatment, at early treatment (3 weeks), at midtreatment (12 weeks), and after treatment. Percentage change in tumor ADC from that before treatment (ADC) was measured at each time point. Performance for predicting pCR was assessed by using the area under the receiver operating characteristic curve (AUC) for the overall cohort and according to tumor hormone receptor (HR)/human epidermal growth factor receptor 2 (HER2) disease subtype. Results: The final analysis included 242 patients with evaluable serial imaging data, with a mean age of 48 years 6 10 (standard deviation); 99 patients had HR-positive (hereafter, HR+)/HER2-negative (hereafter, HER2-) disease, 77 patients had HR-/HER2-disease, 42 patients had HR+/HER2+ disease, and 24 patients had HR-/HER2+ disease. Eighty (33%) of 242 patients experienced pCR. Overall, ADC was moderately predictive of pCR at midtreatment/12 weeks (AUC = 0.60; 95% confidence interval [CI]: 0.52, 0.68; P = .017) and after treatment (AUC = 0.61; 95% CI: 0.52, 0.69; P = .013). Across the four disease subtypes, midtreatment ADC was predictive only for HR+/HER2- tumors (AUC = 0.76; 95% CI: 0.62, 0.89; P , .001). In a test subset, a model combining tumor subtype and midtreatment ADC improved predictive performance (AUC = 0.72; 95% CI: 0.61, 0.83) over ADC alone (AUC = 0.57; 95% CI: 0.44, 0.70; P = .032.). Conclusion: After 12 weeks of therapy, change in breast tumor apparent diffusion coefficient at MRI predicts complete pathologic response to neoadjuvant chemotherapy.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 618-627 |
| Number of pages | 10 |
| Journal | Radiology |
| Volume | 289 |
| Issue number | 3 |
| DOIs | |
| State | Published - Dec 2018 |
Bibliographical note
Funding Information:Supported by the National Cancer Institute through grants U01 CA079778 and U01 CA080098 (to the American College of Radiology Imaging Network), grant R01 CA151326 (to S.C.P.), grant U01 CA166104 (to T.L.C.), grant P41 EB015894 (to P.J.B.), and grants U01 CA151235 and R01 CA132870 (to N.M.H.).
Funding Information:
article: disclosed no relevant relationships. Activities not related to the present article: institution has received funding from GE Healthcare and Philips Healthcare; institution has received in-kind research support for an advanced MRI study. Other relationships: disclosed no relevant relationships. Z.Z. disclosed no relevant relationships. D.C.N. disclosed no relevant relationships. J.E.G. disclosed no relevant relationships.
Funding Information:
T.L.C. disclosed no relevant relationships. M.A.R. disclosed no relevant relationships. P.J.B. disclosed no relevant relationships. H.S.M. disclosed no relevant relationships. J.R. disclosed no relevant relationships. L.C. disclosed no relevant relationships. B.N.J. disclosed no relevant relationships. H.R.U. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: institution has received grants from AUR and GE Healthcare and from Philips Healthcare; receives royalties from Wolters Kluwer. Other relationships: disclosed no relevant relationships. H.O. disclosed no relevant relationships. B.D. disclosed no relevant relationships. K.O. disclosed no relevant relationships. H.A. disclosed no relevant relationships. J.S.D. disclosed no relevant relationships. L.J.E. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: institution has travel reimbursement grants from the Breast Cancer Research Foundation, the National Cancer Institute, and the Quantum Leap Healthcare Collaborative; has received travel reimbursement and honoraria from WIN 2018, the Einstein/Montefiore Visiting Professor Program, Cancer Progress 2018, the Bridging Clinical Collaborative Meeting, the Sanford H. Cole Memorial Symposium, and the UK Interdisciplinary Breast Cancer Symposium; has received travel expenses and an honorarium from the Blue Cross Blue Shield Association Medical Advisory Panel. Other relationships: disclosed no relevant relationships. N.M.H. disclosed no relevant relationships.
Publisher Copyright:
© RSNA, 2018.
