Comparison of mammography, digital breast tomosynthesis, automated breast ultrasound, magnetic resonance imaging in evaluation of residual tumor after neoadjuvant chemotherapy

Publication date: Available online 2 October 2018

Source: European Journal of Radiology

Author(s): Jiyoon Park, Eun Young Chae, Joo Hee Cha, Hee Jung Shin, Woo Jung Choi, Young-Wook Choi, Hak Hee Kim

Abstract

Background

To compare the accuracy of mammography (MG), digital breast tomosynthesis (DBT), automated breast ultrasound (ABUS) and magnetic resonance imaging (MRI) for the assessment of residual tumor extent in breast cancer after neoadjuvant chemotherapy (NAC).

Methods

Fifty-one stage II-III breast cancer undergoing NAC were enrolled from March 2015 to December 2016. The longest diameter of residual tumor measured with MG, DBT, ABUS and MRI was compared with the pathologic tumor size. Statistical analysis was performed using intraclass correlation coefficients (ICC) and marginal homogeneity test. Receiver operating characteristics (ROC) analysis was used to evaluate the diagnostic performance for predicting pathologic complete response (pCR).

Results

MRI size correlated well with pathology (ICC = 0.83), significantly better than MG, DBT and ABUS size (ICC = 0.56, ICC = 0.63 and ICC = 0.55, respectively). The discrepancy between MRI and pathology was statistical different from that of MG and ABUS (p = 0.0231 and 0.0039, respectively), but not different from that of DBT (p = 0.5727). For predicting pCR, MRI and DBT had a better performance compared to MG and US (area under the ROC curve: 0.92, 0.84, 0.72, 0.75, respectively; p = 0.3749 for DBT, p = 0.0972 for MG and p = 0.0596 for ABUS, when MRI being reference).

Conclusions

MRI and DBT allow more accurate assessment of tumor size compared to pathology compared with MG and ABUS. MRI and DBT outperform MG and ABUS in the prediction of pathologic complete response.

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