Comparison of MRI With PET / CT in the Evaluation of Response to Neoadjuvant Therapy Based on the Molecular Subtypes of Breast Cancer

NCT ID: NCT04882371

Last Updated: 2021-05-11

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 88 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2018-01-01
• Study Completion Date: 2020-08-01

Brief Summary

The current study aims to determine the diagnostic accuracy of Magnetic Resonance Imaging (MRI) and Positron Emission Tomography- Computed Tomography (PET-CT) in predicting a pathological response of molecular subtypes of breast cancer to neoadjuvant chemotherapy (NAC).

Detailed Description

Eighty-eight patients with breast cancer who had undergone surgery after NAC were retrospectively analyzed between January 2018 and May 2020, at the general surgery clinic of Istanbul Medeniyet University Göztepe Training and Research Hospital. Demographic data, clinical findings, tumor markers, radiologic findings and pathology data were documented. With the use of MRI and / or PET-CT obtained before and after NAC, tumor staging was performed, and tumor size and the presence of metastatic lymph nodes and radiological response to NAC were evaluated. The response to NAC was evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST) and contrast enhancement patterns described by Tozaki et al. on MRI, and the classification PET Response Criteria in Solid Tumors (PERCIST) on PET-CT. The postoperative pathology study reported the followings: the size and histopathologic type of the tumor, its hormone receptor status, staining intensities (Allred score), HER-2 positivity, Ki-67 proliferation percentages, and the molecular subtypes; the presence and number of metastatic lymph nodes, the response of the tumor and, the metastatic lymph node, if any, to NAC according to the Sataloff classification. Patients with a Sataloff score of "A" were considered to have a pCR, those with the scores of "B" or "C" were considered to have a partial response. When examining the Sataloff scores, the presence of pCR in both the primary tumor and axilla was evaluated and compared with the presence of radiological complete response on MRI and / or PET-CT. In addition, the sensitivities of MRI and PET-CT in predicting pCR in patients undergoing NAC were statistically compared based on the molecular subtypes. Patients whose MRI and PET-CT findings were consistent with histopathologic data were included in the "Radiology-Pathology agreement " group. The sensitivity of imaging methods was determined by examining the rates of agreement in the molecular subgroups. The Statistical Package for Social Sciences software for Windows version 20 (SPSS Inc.; Chicago, IL, USA) was used for all analyses. Normality was assessed by the Shapiro-Wilk test. Categorical variables were compared using chi-square or, where appropriate, Fisher's exact test. The Mc-Nemar test was used for paired categorical data. Trends in tables larger than 2x2 were examined with the linear-by-linear association test. Kruskal-Wallis test was used to compare non-normal distributed variables in three groups. Cohen's kappa (κ) was calculated to test the agreement between the classifications of radiology and pathology.

Conditions

Breast Cancer; Chemotherapy Effect

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: RETROSPECTIVE

Study Groups

MRI RECIST

Radiological responses were evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST) and changes in contrast enhancement patterns on MRI

Chemotherapy

Intervention Type: DRUG

Neoadjuvant Chemotherapy for Breast Cancer

Magnetic Resonance Imaging (MRI)

Intervention Type: DIAGNOSTIC_TEST

Performed contrasted MRI for evaluate response of neoadjuvant chemotherapy

PET-CT PERCIST

Radiological responses were evaluated according to the classification of PET Response Criteria in Solid Tumors (PERCIST) on PET-CT.

Chemotherapy

Intervention Type: DRUG

Neoadjuvant Chemotherapy for Breast Cancer

Positron emission tomography - Copmputer Tomography (PET-CT)

Intervention Type: DIAGNOSTIC_TEST

Performed contrasted PET-CT for evaluate response of neoadjuvant chemotherapy

Interventions

Chemotherapy

Neoadjuvant Chemotherapy for Breast Cancer

Intervention Type: DRUG

Magnetic Resonance Imaging (MRI)

Performed contrasted MRI for evaluate response of neoadjuvant chemotherapy

Intervention Type: DIAGNOSTIC_TEST

Positron emission tomography - Copmputer Tomography (PET-CT)

Performed contrasted PET-CT for evaluate response of neoadjuvant chemotherapy

Intervention Type: DIAGNOSTIC_TEST

Eligibility Criteria

Inclusion Criteria

• Older than 18
• Breast cancer patients
• Had neoadjuvant chemotherapy before surgery
• Had undergone surgery after chemotherapy

Exclusion Criteria

• Younger than 18
• History of surgery for breast cancer

• Minimum Eligible Age: 18 Years
• Eligible Sex: FEMALE
• Accepts Healthy Volunteers: Yes

Sponsors

Cem Ilgin Erol

OTHER

Sponsor Role: lead

Responsible Party

Cem Ilgin Erol

MD

Responsibility Role: SPONSOR_INVESTIGATOR

Locations

Istanbul Medeniyet University Goztepe City Hospital

Istanbul, Kadikoy, Turkey (Türkiye)

Countries

Turkey (Türkiye)

References

World Health Organization, Fact Sheets, Detail, Cancer. https://www.who.int/news-room/fact-sheets/detail/cancer

Reference Type: BACKGROUND

International Agency for Research on Cancer, Globocan 2018 Report. https://www.uicc.org/news/global-cancer-data-globocan-2018

Reference Type: BACKGROUND

Gianni L, Eiermann W, Semiglazov V, Lluch A, Tjulandin S, Zambetti M, Moliterni A, Vazquez F, Byakhov MJ, Lichinitser M, Climent MA, Ciruelos E, Ojeda B, Mansutti M, Bozhok A, Magazzu D, Heinzmann D, Steinseifer J, Valagussa P, Baselga J. Neoadjuvant and adjuvant trastuzumab in patients with HER2-positive locally advanced breast cancer (NOAH): follow-up of a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet Oncol. 2014 May;15(6):640-7. doi: 10.1016/S1470-2045(14)70080-4. Epub 2014 Mar 20.

Reference Type: BACKGROUND

PMID: 24657003 (View on PubMed)

Cardoso F, Costa A, Norton L, Senkus E, Aapro M, Andre F, Barrios CH, Bergh J, Biganzoli L, Blackwell KL, Cardoso MJ, Cufer T, El Saghir N, Fallowfield L, Fenech D, Francis P, Gelmon K, Giordano SH, Gligorov J, Goldhirsch A, Harbeck N, Houssami N, Hudis C, Kaufman B, Krop I, Kyriakides S, Lin UN, Mayer M, Merjaver SD, Nordstrom EB, Pagani O, Partridge A, Penault-Llorca F, Piccart MJ, Rugo H, Sledge G, Thomssen C, Van't Veer L, Vorobiof D, Vrieling C, West N, Xu B, Winer E; European School of Oncology; European Society of Medical Oncology. ESO-ESMO 2nd international consensus guidelines for advanced breast cancer (ABC2). Breast. 2014 Oct;23(5):489-502. doi: 10.1016/j.breast.2014.08.009. Epub 2014 Sep 20. No abstract available.

Reference Type: BACKGROUND

PMID: 25244983 (View on PubMed)

Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, Bonnefoi H, Cameron D, Gianni L, Valagussa P, Swain SM, Prowell T, Loibl S, Wickerham DL, Bogaerts J, Baselga J, Perou C, Blumenthal G, Blohmer J, Mamounas EP, Bergh J, Semiglazov V, Justice R, Eidtmann H, Paik S, Piccart M, Sridhara R, Fasching PA, Slaets L, Tang S, Gerber B, Geyer CE Jr, Pazdur R, Ditsch N, Rastogi P, Eiermann W, von Minckwitz G. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014 Jul 12;384(9938):164-72. doi: 10.1016/S0140-6736(13)62422-8. Epub 2014 Feb 14.

Reference Type: BACKGROUND

PMID: 24529560 (View on PubMed)

Rastogi P, Anderson SJ, Bear HD, Geyer CE, Kahlenberg MS, Robidoux A, Margolese RG, Hoehn JL, Vogel VG, Dakhil SR, Tamkus D, King KM, Pajon ER, Wright MJ, Robert J, Paik S, Mamounas EP, Wolmark N. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol. 2008 Feb 10;26(5):778-85. doi: 10.1200/JCO.2007.15.0235.

Reference Type: BACKGROUND

PMID: 18258986 (View on PubMed)

Abedi M, Farrokh D, Shandiz Homaei F, Joulaee A, Anbiaee R, Zandi B, Gity M, Sayah HR, Abedi MS. The validity of MRI in evaluation of tumor response to neoadjuvant chemotherapy in locally advanced breast cancer. Iran J Cancer Prev. 2013 Winter;6(1):28-35.

Reference Type: BACKGROUND

PMID: 25250107 (View on PubMed)

Gonzalez-Angulo AM, Morales-Vasquez F, Hortobagyi GN. Overview of resistance to systemic therapy in patients with breast cancer. Adv Exp Med Biol. 2007;608:1-22. doi: 10.1007/978-0-387-74039-3_1.

Reference Type: BACKGROUND

PMID: 17993229 (View on PubMed)

Wang H, Mao X. Evaluation of the Efficacy of Neoadjuvant Chemotherapy for Breast Cancer. Drug Des Devel Ther. 2020 Jun 18;14:2423-2433. doi: 10.2147/DDDT.S253961. eCollection 2020.

Reference Type: BACKGROUND

PMID: 32606609 (View on PubMed)

Dhillon GS, Bell N, Ginat DT, Levit A, Destounis S, O'Connell A. Breast MR Imaging: What the Radiologist Needs to Know. J Clin Imaging Sci. 2011;1:48. doi: 10.4103/2156-7514.85655. Epub 2011 Oct 3.

Reference Type: BACKGROUND

PMID: 22059150 (View on PubMed)

Nunes LW, Schnall MD, Orel SG, Hochman MG, Langlotz CP, Reynolds CA, Torosian MH. Correlation of lesion appearance and histologic findings for the nodes of a breast MR imaging interpretation model. Radiographics. 1999 Jan-Feb;19(1):79-92. doi: 10.1148/radiographics.19.1.g99ja0379.

Reference Type: BACKGROUND

PMID: 9925393 (View on PubMed)

Rausch DR, Hendrick RE. How to optimize clinical breast MR imaging practices and techniques on Your 1.5-T system. Radiographics. 2006 Sep-Oct;26(5):1469-84. doi: 10.1148/rg.265055176.

Reference Type: BACKGROUND

PMID: 16973776 (View on PubMed)

Tozaki M, Kobayashi T, Uno S, Aiba K, Takeyama H, Shioya H, Tabei I, Toriumi Y, Suzuki M, Fukuda K. Breast-conserving surgery after chemotherapy: value of MDCT for determining tumor distribution and shrinkage pattern. AJR Am J Roentgenol. 2006 Feb;186(2):431-9. doi: 10.2214/ajr.04.1520.

Reference Type: BACKGROUND

PMID: 16423949 (View on PubMed)

Kim TH, Kang DK, Yim H, Jung YS, Kim KS, Kang SY. Magnetic resonance imaging patterns of tumor regression after neoadjuvant chemotherapy in breast cancer patients: correlation with pathological response grading system based on tumor cellularity. J Comput Assist Tomogr. 2012 Mar-Apr;36(2):200-6. doi: 10.1097/RCT.0b013e318246abf3.

Reference Type: BACKGROUND

PMID: 22446360 (View on PubMed)

Hegarty C, Collins CD. PET/CT and breast cancer. Cancer Imaging. 2010 Oct 4;10 Spec no A(1A):S59-62. doi: 10.1102/1470-7330.2010.9031.

Reference Type: BACKGROUND

PMID: 20880780 (View on PubMed)

Park SH, Moon WK, Cho N, Chang JM, Im SA, Park IA, Kang KW, Han W, Noh DY. Comparison of diffusion-weighted MR imaging and FDG PET/CT to predict pathological complete response to neoadjuvant chemotherapy in patients with breast cancer. Eur Radiol. 2012 Jan;22(1):18-25. doi: 10.1007/s00330-011-2236-x. Epub 2011 Aug 16.

Reference Type: BACKGROUND

PMID: 21845462 (View on PubMed)

Basu S, Chen W, Tchou J, Mavi A, Cermik T, Czerniecki B, Schnall M, Alavi A. Comparison of triple-negative and estrogen receptor-positive/progesterone receptor-positive/HER2-negative breast carcinoma using quantitative fluorine-18 fluorodeoxyglucose/positron emission tomography imaging parameters: a potentially useful method for disease characterization. Cancer. 2008 Mar 1;112(5):995-1000. doi: 10.1002/cncr.23226.

Reference Type: BACKGROUND

PMID: 18098228 (View on PubMed)

Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977 Mar;33(1):159-74.

Reference Type: BACKGROUND

PMID: 843571 (View on PubMed)

Mauri D, Pavlidis N, Ioannidis JP. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst. 2005 Feb 2;97(3):188-94. doi: 10.1093/jnci/dji021.

Reference Type: BACKGROUND

PMID: 15687361 (View on PubMed)

Spring LM, Fell G, Arfe A, Sharma C, Greenup R, Reynolds KL, Smith BL, Alexander B, Moy B, Isakoff SJ, Parmigiani G, Trippa L, Bardia A. Pathologic Complete Response after Neoadjuvant Chemotherapy and Impact on Breast Cancer Recurrence and Survival: A Comprehensive Meta-analysis. Clin Cancer Res. 2020 Jun 15;26(12):2838-2848. doi: 10.1158/1078-0432.CCR-19-3492. Epub 2020 Feb 11.

Reference Type: BACKGROUND

PMID: 32046998 (View on PubMed)

Boughey JC, McCall LM, Ballman KV, Mittendorf EA, Ahrendt GM, Wilke LG, Taback B, Leitch AM, Flippo-Morton T, Hunt KK. Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: findings from the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial. Ann Surg. 2014 Oct;260(4):608-14; discussion 614-6. doi: 10.1097/SLA.0000000000000924.

Reference Type: BACKGROUND

PMID: 25203877 (View on PubMed)

Resende U, Cabello C, Oliveira Botelho Ramalho S, Zeferino LC. Predictors of Pathological Complete Response in Women with Clinical Complete Response to Neoadjuvant Chemotherapy in Breast Carcinoma. Oncology. 2018;95(4):229-238. doi: 10.1159/000489785. Epub 2018 Jul 19.

Reference Type: BACKGROUND

PMID: 30025385 (View on PubMed)

Tang S, Xiang C, Yang Q. The diagnostic performance of CESM and CE-MRI in evaluating the pathological response to neoadjuvant therapy in breast cancer: a systematic review and meta-analysis. Br J Radiol. 2020 Aug;93(1112):20200301. doi: 10.1259/bjr.20200301. Epub 2020 Jul 2.

Reference Type: BACKGROUND

PMID: 32574075 (View on PubMed)

Tateishi U, Miyake M, Nagaoka T, Terauchi T, Kubota K, Kinoshita T, Daisaki H, Macapinlac HA. Neoadjuvant chemotherapy in breast cancer: prediction of pathologic response with PET/CT and dynamic contrast-enhanced MR imaging--prospective assessment. Radiology. 2012 Apr;263(1):53-63. doi: 10.1148/radiol.12111177.

Reference Type: BACKGROUND

PMID: 22438441 (View on PubMed)

Jones EF, Hathi DK, Freimanis R, Mukhtar RA, Chien AJ, Esserman LJ, Van't Veer LJ, Joe BN, Hylton NM. Current Landscape of Breast Cancer Imaging and Potential Quantitative Imaging Markers of Response in ER-Positive Breast Cancers Treated with Neoadjuvant Therapy. Cancers (Basel). 2020 Jun 9;12(6):1511. doi: 10.3390/cancers12061511.

Reference Type: BACKGROUND

PMID: 32527022 (View on PubMed)

Han S, Choi JY. Prognostic value of 18F-FDG PET and PET/CT for assessment of treatment response to neoadjuvant chemotherapy in breast cancer: a systematic review and meta-analysis. Breast Cancer Res. 2020 Oct 31;22(1):119. doi: 10.1186/s13058-020-01350-2.

Reference Type: BACKGROUND

PMID: 33129348 (View on PubMed)

Wang Y, Zhang C, Liu J, Huang G. Is 18F-FDG PET accurate to predict neoadjuvant therapy response in breast cancer? A meta-analysis. Breast Cancer Res Treat. 2012 Jan;131(2):357-69. doi: 10.1007/s10549-011-1780-z. Epub 2011 Sep 30.

Reference Type: BACKGROUND

PMID: 21960111 (View on PubMed)

An YY, Kim SH, Kang BJ, Lee AW. Treatment Response Evaluation of Breast Cancer after Neoadjuvant Chemotherapy and Usefulness of the Imaging Parameters of MRI and PET/CT. J Korean Med Sci. 2015 Jun;30(6):808-15. doi: 10.3346/jkms.2015.30.6.808. Epub 2015 May 13.

Reference Type: BACKGROUND

PMID: 26028936 (View on PubMed)

Rouzier R, Perou CM, Symmans WF, Ibrahim N, Cristofanilli M, Anderson K, Hess KR, Stec J, Ayers M, Wagner P, Morandi P, Fan C, Rabiul I, Ross JS, Hortobagyi GN, Pusztai L. Breast cancer molecular subtypes respond differently to preoperative chemotherapy. Clin Cancer Res. 2005 Aug 15;11(16):5678-85. doi: 10.1158/1078-0432.CCR-04-2421.

Reference Type: BACKGROUND

PMID: 16115903 (View on PubMed)

Other Identifiers

2020-0327

Identifier Type: -

Identifier Source: org_study_id