In:
The British Journal of Radiology, British Institute of Radiology, Vol. 96, No. 1148 ( 2023-08)
Kurzfassung:
Image monitoring is essential to monitor response to neoadjuvant chemotherapy (NACT). Whilst breast MRI is the gold-standard technique, evidence suggests contrast-enhanced spectral mammography (CESM) is comparable. We investigate whether the addition of digital breast tomosynthesis (DBT) to CESM increases the accuracy of response prediction. Methods Women receiving NACT for breast cancer were included. Imaging with CESM+DBT and MRI was performed post-NACT. Imaging appearance was compared with pathological specimens. Accuracy for predicting pathological complete response (pCR) and concordance with size of residual disease was calculated. Results Sixteen cancers in 14 patients were included, 10 demonstrated pCR. Greatest accuracy for predicting pCR was with CESM enhancement (accuracy: 81.3%, sensitivity: 100%, specificity: 57.1%), followed by MRI (accuracy: 62.5%, sensitivity: 44.4%, specificity: 85.7%). Concordance with invasive tumour size was greater for CESM enhancement than MRI, concordance-coefficients 0.70 vs 0.66 respectively. MRI demonstrated greatest concordance with whole tumour size followed by CESM+microcalcification, concordance coefficients 0.86 vs 0.69. DBT did not improve accuracy for prediction of pCR or residual disease size. CESM+DBT underestimated size of residual disease, MRI overestimated but no significant differences were seen (p 〉 0.05). Conclusions CESM is similar to MRI for predicting residual disease post-NACT. Size of enhancement alone demonstrates best concordance with invasive disease. Inclusion of residual microcalcification improves concordance with ductal carcinoma in situ. The addition of DBT to CESM does not improve accuracy. Advances in knowledge The addition ofDBT to CESM does not improve NACT response prediction. CESM enhancement has greatest accuracy for residual invasive disease, CESM+calcification has greater accuracy for residual in situ disease.
Materialart:
Online-Ressource
ISSN:
0007-1285
,
1748-880X
DOI:
10.1259/bjr.20220921
Sprache:
Englisch
Verlag:
British Institute of Radiology
Publikationsdatum:
2023
ZDB Id:
1468548-6
