Aims and objectives
Neoadjuvant chemotherapy is the mainstay for treatment of locally advanced breast cancer as it reduces the size of the lesion prior to surgery; making it amenable to treatment by conservation.
Accurate prediction of response to neoadjuvant chemotherapy is critical in surgical planning of non-palpable cancers.
Mammography and ultrasound are the modalities used for this purpose.
We assessed the accuracy of both these techniques to predict complete pathological response and compared the two techniques as well.
Methods and materials
We retrospectively reviewed the data of 225 patients diagnosed with stage 2 or a locally advanced breast tumour.
These patients had no palpable lesion post-neoadjuvant chemotherapy and were selected for sono or stereo guided wire localization as a part of breast conservation treatment.
All the patients were evaluated by sonomammogram at diagnosis and at the time of procedure after chemotherapy.
Patients with complete mammographic (mCR) and sonographic (sCR) response were correlated with pathological complete response (pCR).
Agreement between predicted radiological and pathological response,
as well...
Results
81 out of 225 patients demonstrated pCR which is defined as no residual microscopic or macroscopic tumour foci.
mCR was achieved in 66% of patients and sCR in 60% of patients(Fig.2).
Kappa method was used to calculate the agreement between mammography and sonography in predicting pCR as well as to individually correlate mCR and sCR with pCR.
The sensitivity,
specificity,
PPV,
NPV of mammography in predicting pCR was 65%,
80%,
66% and 79% respectively.
The sensitivity,
specificity,
PPV and NPV of sonography in predicting pCR...
Conclusion
Both mammography and ultrasound are important in assessing tumour response post-neoadjuvant chemotherapy.
Mammography is more sensitive while sonography demonstrates better specificity.
However,
the combination of sonomammogram increased the specificity of the study.
The agreement of pCR with mCR and sCR was moderate.
Personal information
Waqas Ahmad MBBS,
FCPS,
EDiR
Former Registrar and Resident Radiology Shaukat Khanum Memorial Cancer Hospital and Research Centre Lahore,
Pakistan.
Eisha Tahir MBBS,
FCPS
Senior Registrar Radiology
Shalamar Hospital Lahore,
Pakistan.
Shahper Aqeel MBBS,
FCPS,
EDBI
Consultant Radiologist Bahria Hospital Lahore,
Pakistan.
Iram Zaheer MBBS,
FCPS,
FRCR,
EDiR
Radiologist Armed Forces Hospital King Abdul Aziz Naval Base Jubail,
Kingdom of Saudi Arabia.
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