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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2015; 3(7): 607-613
Published online Jul 16, 2015. doi: 10.12998/wjcc.v3.i7.607
How to use magnetic resonance imaging following neoadjuvant chemotherapy in locally advanced breast cancer
Elissa R Price, Jasmine Wong, Rita Mukhtar, Nola Hylton, Laura J Esserman
Elissa R Price, Nola Hylton, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94115, United States
Jasmine Wong, Laura J Esserman, Carol Franc Buck Breast Care Center, Department of Surgery, University of California, San Francisco, CA 94143, United States
Rita Mukhtar, Department of Surgery, Kaiser San Francisco, San Francisco, CA 94115, United States
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest statement: Authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Elissa R Price, Assistant Professor, Department of Radiology and Biomedical Imaging, University of California, 1600 Divisadero Street, Room C-250, San Francisco, CA 94115, United States. elissa.price@ucsf.edu
Telephone: +1-415-8857758 Fax: +1-415-8857876
Received: March 8, 2015
Peer-review started: March 8, 2015
First decision: March 20, 2015
Revised: April 17, 2015
Accepted: May 16, 2015
Article in press: May 18, 2015
Published online: July 16, 2015
Processing time: 141 Days and 14.8 Hours
Abstract

Magnetic resonance imaging (MRI) is highly sensitive in identifying residual breast cancer following neoadjuvant chemotherapy (NAC), and consequently is a commonly used imaging modality in locally advanced breast cancer patients. In these patients, tumor response is an important prognostic indicator. However, discrepancies between MRI findings and surgical pathology are well documented. Overestimation of residual disease by MRI may result in greater surgery than is actually required while underestimation may result in insufficient surgery. Thus, it is important to understand when MRI findings are reliable and when they are less accurate. MRI most accurately predicts pathology in triple negative, Her2 positive and hormone receptor negative tumors, especially if they are of a solid imaging phenotype. In these cases, post-NAC MRI is highly reliable for surgical planning. Hormone receptor positive cancers and those demonstrating non mass enhancement show lower concordance with surgical pathology, making surgical guidance more nebulous in these cases. Radiologists and surgeons must assess MRI response to NAC in the context of tumor subtype. Indiscriminate interpretations will prevent MRI from achieving its maximum potential in the pre-operative setting.

Keywords: Breast; Magnetic resonance imaging; Neoadjuvant chemotherapy; Biomarkers; Phenotypes

Core tip: Following neoadjuvant chemotherapy, breast magnetic resonance imaging (MRI) most accurately predicts surgical pathology in triple negative, Her2 positive and hormone receptor negative tumors, especially if they are of a solid imaging phenotype. In these cases, post-neoadjuvant chemotherapy (NAC) MRI is highly reliable for surgical planning. Hormone receptor positive cancers and those demonstrating non mass enhancement show lower concordance with surgical pathology, making surgical guidance more nebulous in these cases. Radiologists and surgeons must assess MRI response to NAC in the context of tumor subtype.