Higher underestimation of tumour size post-neoadjuvant chemotherapy with breast magnetic resonance imaging (MRI)—A concordance comparison cohort analysis

Autoři: Wen-Pei Wu aff001;  Hwa-Koon Wu aff001;  Chih-Jung Chen aff003;  Chih-Wie Lee aff001;  Shou-Tung Chen aff006;  Dar-Ren Chen aff006;  Chen-Te Chou aff001;  Chi Wei Mok aff008;  Hung-Wen Lai aff006
Působiště autorů: Department of Diagnostic Radiology, Changhua Christian Hospital, Changhua, Taiwan aff001;  School of Medicine, Kaohusiung Medical University, Kaohsiung, Taiwan aff002;  Department of Pathology, Taichung Veterans General Hospital, Taichung, Taiwan aff003;  School of Medicine, Chung Shan Medical University, Taichung, Taiwan aff004;  Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan aff005;  Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan aff006;  Comprehensive Breast Cancer Center, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan aff007;  Division of Breast Surgery, Department of Surgery, Changi General Hospital, Singapore aff008;  Endoscopic & Oncoplastic Breast Surgery Center, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan aff009;  School of Medicine, National Yang Ming University, Taipei, Taiwan aff010
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222917



The aim of this study was to evaluate the diagnostic accuracy of breast MRI for detecting residual tumor and the tumor size whether it would be affected after neoadjuvant chemotherapy.


Total 109 patients with NAC and 682 patients without NAC were included in this retrospective study. Measurement of the largest diameter of tumors at pathology was chosen as gold standard and compared with preoperative breast MRI. A concordance threshold of ±25% of maximal tumor size was used. The accuracy of MRI was graded as concordant, underestimation, or overestimation rate. Further subgroup analysis with tumor stages, histologic subgroups and intrinsic subtypes was performed.


The post-NAC MRI was associated with 92.5% sensitivity, 55.2% specificity, 85.1% positive predictive value, 72.7% negative predictive value, and overall 82.6% accuracy for detecting residual tumor. In determining tumor size, the overall concordance rates of the non-NAC group and the NAC group were 43.5% and 41.3%, respectively (p = 0.678). But the overestimation rate and underestimation rate were 26.6% and 32.1% for NAC group, and 52.9% and 3.5% for the non-NAC group (p<0.001). While in the subgroups analysis, the concordance rate of the NAC group (26.7%) was lower than that of the non-NAC group (82.1%) at T3 stage (p<0.001). There were no statistically significant differences between different tumor histologic subgroups and intrinsic subtypes.


The overall accuracy of MRI in predicting tumor size was not affected by NAC; however, it tends to underestimate tumor size after NAC, especially in patients with T3 lesions and above.

Klíčová slova:

Breast cancer – Breast tumors – Cancer detection and diagnosis – Cancer chemotherapy – Carcinomas – Histology – Magnetic resonance imaging – Surgical and invasive medical procedures


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