#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Role of the radiologist during neoadjuvant systemic therapy for breast cancer


Authors: D. Houserková 1,2;  N. Zlámalová 3;  K. Spáčilová 1,2;  K. Vomáčková 3;  B. Donociková 4;  M. Kolečková 5;  E. Buriánková 1,6
Authors‘ workplace: MAMMACENTRUM Olomouc, screeningové mamodiagnostické centrum 1;  Magnetická rezonance Medihope Olomouc 2;  Chirurgická klinika Fakultní nemocnice Olomouc 3;  Onkologická klinika Fakultní nemocnice Olomouc 4;  Ústav klinické a molekulární patologie Fakultní nemocnice Olomouc 5;  Klinika nukleární medicíny Fakultní nemocnice Olomouc 6
Published in: Rozhl. Chir., 2021, roč. 100, č. 6, s. 285-294.
Category: Case Report
doi: https://doi.org/10.33699/PIS.2021.100.6.285–294

Overview

Introduction: Neoadjuvant therapy (NT) is one of the possible oncological treatment strategies for breast cancer. Its aim is to achieve down-staging of the tumour in the breast and axilla and thus the possibility of converting mastectomy to a breast-conserving procedure, and also to allow for a less burdensome and more targeted operation of the axillary lymph nodes. The role of the radiologist is to utilise imaging procedures for precise local staging of the malignancy prior to NT, to evaluate the effect of treatment during its course and upon its completion, and to perform restaging of the cancer in the breast and axilla.

Case reports: The authors present three case reports of female patients with breast cancer who underwent neoadjuvant chemotherapy (NCT). They describe the diagnostic procedure and imaging methods used to establish local staging of the cancer prior to treatment, to monitor the disease during the course of treatment, and to perform restaging of the cancer after completing NCT. The radiological response after NCT completion was correlated with the pathological response.

Conclusion: Correct determination of the extent of the cancer in the breast and axilla by the radiologist before NT and precise histological analysis of the tumour by the pathologist are fundamental for selecting the appropriate treatment for patients at the multidisciplinary breast tumour board.

Keywords:

breast cancer − neoadjuvant therapy – Mammography – ultrasound − magnetic resonance imaging


Sources

1. Petrů V, Vážan P, Zábojníková M, et al. Chirurgická léčba karcinomu prsu po neoadjuvantní terapii. Rozhl Chir. 2020,99:172−177.

2. Coufal O, Zapletal O, Gabrielová L, et al. Cílená axilární disekce a sentinelová biopsie u pacientek s karcinomem prsu po neoadjuvantní chemoterapii – retrospektivní studie. Rozhl Chir. 2018,97:551−557.

3. Neumanová R, Petera J. Neoadjuvantní systémová léčba karcinomu prsu a její vliv na indikaci adjuvantní systémové terapie. 19. ročník sympozia Onkologie v gynekologii a mammologii 2014.

4. Masood S. Neoadjuvant chemotherapy in breast cancers. Womens Health (Lond). 2016 Sep; 12(5): 480–491. doi: 10.1177/1745505716677139.

5. Schneiderová M. Diagnostické zobrazovací metody ve sledovaném efektu neoadjuvantní chemoterapie karcinomu prsu. XXXVII. Brněnské onkologické dny a XXVII. Konference pro nelékařské zdravotnické pracovníky 2013.

6. Skarping I, Förnvik D, Sartor H, et al. Mammographic density is a potential predictive marker of pathological response after neoadjuvant chemotherapy in breast cancer. BMC Cancer 2019;19:1272. doi: 10.1186/s12885-019-6485-4.

7. Stavros T. Breast ultrasound. Lippincott Williams and Wilkins Philadelphia 2004.

8. Candelaria R, Bassett R, Symmans W, et al. Performance of mid‐treatment breast ultrasound and axillary ultrasound in predicting response to neoadjuvant chemotherapy by breast cancer subtype. Oncologist. 2017 Apr;22(4):394–401. doi: 10.1634/theoncologist.2016-0307.

9. Skovajsová M. Mamodiagnostika: Integrovaný přístup. Praha, Galén 2003.

10. Daneš J. Základy ultrasonografie prsu. Praha, Maxdorf 2001.

11. Veverková L, Dusíková R. The status of core-needle biopsy of axillary lymph nodes in the breast cancer diagnosis. Ces Radiol. 2016;70(2):100–4.

12. Veverková L, Vomáčková K. Ultrasound- guided axillary lymph node biopsy: a retrospective analysis. Research article, J Diagn Tech Biomed Anal. 2019;8:1.

13. Scheel J, Kim E, Partridge S,et al. Preoperative MRI, clinical examination, and mammography for residual disease and pathologic complete response after neoadjuvant chemotherapy for breast cancer. ACRIN 6657 Trial. AJR Am J Roentgenol. 2018 Jun; 210(6):1376–1385. doi: 10.2214/AJR.17.18323.

14. Gao W, Guo N, Dong T. Diffusion-weighted imaging in monitoring the pathological response to neoadjuvant chemotherapy in patients with breast cancer: a meta-analysis. World J Surg Oncol. 2018;16:145. doi: 10.1186/s12957-018- 1438-y.

15. Goorts B, Dreuning K, Houwers J, et al. MRI-based response patterns during neoadjuvant chemotherapy can predict pathological (complete) response in patients with breast cancer. Breast Cancer Res. 2018;20:34. doi: 10.1186/s13058- 018-0950-x.

16. Sener S, Sargent R, Lee C, et al. MRI does not predict pathologic complete response after neoadjuvant chemotherapy for breast cancer. J Surg Oncol. 2019 Nov;120(6):903–910. doi: 10.1002/ jso.25663.

17. Loo C, Rigter L, Pengel K, et al. Survival is associated with complete response on MRI after neoadjuvant chemotherapy in ER-positive HER2-negative breast cancer. Breast Cancer Res. 2016;18:82. doi: 10.1186/s13058-016-0742-0.

18. Gampenrieder S, Peer A, Weismann C, et al. Radiologic complete response (rCR) in contrast-enhanced magnetic resonance imaging (CE-MRI) after neoadjuvant chemotherapy for early breast cancer predicts recurrence-free survival but not pathologic complete response (pCR). Breast Cancer Res. 2019;21:19. doi: 10.1186/s13058-018-1091-y.

19. Lotti V, Ravaioli S, Vacondio R, et al. Contrast- enhanced spectral mammography in neoadjuvant chemotherapy monitoring: a comparison with breast magnetic resonance imaging. Breast Cancer Res. 2017;19:106. doi: 10.1186/s13058-017- 0899-1.

20. Schmitz A, Teixeira S, Pengel K, et al. Monitoring tumor response to neoadjuvant chemotherapy using MRI and F-FDG PET/CT in breast cancer subtypes. PLoS One 2017;12(5). doi: 10.1371/journal. pone.0176782.

21. Houserková D, Váša P. Bioptické metody v současné mamodiagnostice. Ces Radiol. 2014;68(3):183–190.

22. Houssami N, Turner R. Staging the axilla in women with breast cancer: the utility of preoperative ultrasound-guided needle biopsy. Cancer Bio Med. 2014;11(2):69–77.

23. Ye B, Zhao H, Yu Y, et al. Accuracy of axillary ultrasound after different neoadjuvant chemotherapy cycles in breast cancer patients. Oncotarget 2017 May 30;8(22):36696– 36706. doi: 10.18632/oncotarget.13313.

Labels
Surgery Orthopaedics Trauma surgery

Article was published in

Perspectives in Surgery

Issue 6

2021 Issue 6

Most read in this issue
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#