Purpose
MRI is the most accurate technique for evaluating the extent of residual disease after neoadjuvant chemotherapy (NAC). Limitation in tumor localization may lead to a great incidence of positive resection margins and the need for repeated excision or mastectomy. However, in many cases, sonographic identification of MRI detected residual disease is difficult, because the patient’s body is positioned differently than it is during MRI. Recently, we have developed a real-time virtual sonography (RVS) that synchronizes breast sonography and MRI cutaway images of the same site,...
Methods and Materials
Materials Between April 2007 and May 2009, 96 breast conservation therapy were performed for invasive ductal carcinoma (IDC) at our hospital. Fourteen patients with stage IIA-IIIB palpable IDC were enrolled in a study investigating the effects of NAC on tumor imaging. All patients underwent MMG, US, MRI, andRVS before and after NAC. Nine patients received lumpectomy, and 5 received mastectomy.Methods MRI MRI was obtained on a Magnetom 1.5-T imager (Siemens, Germany) using a flexible body surface coil. All patients were examined in the supine position...
Results
All index tumors were detected by sonography and MRI before NAC. After NAC, a cCR was seen in 5 (5 of 14, 36%) patients. MRI correctly diagnosed pCR in 4 (4 of 5, 80%) patients. Detection rate for residual tumors was 9% (1 of 11) for mammography, 33% (3 of 9) for sonography alone, 78% (7 of 9) for MRI, and 89% (8 of 9) for RVS. It was noteworthy that 5 (5 of 5, 100%) cases with cCR were accurately localized onto the body...
Conclusion
By using RVS, two different forms of diagnostic imaging can be integrated in real time and thereby complement each other. The present results suggest thatRVS is a useful imaging technique for detecting residual tumors that have been associated with local recurrence after NAC.
References
1) Nakano S, et al. Detection of enhancing lesions on contrast-enhanced MRI of the breast using real-time virtual sonography; fusion of MRI and sonography data. Breast CancerRes Treat 106, S13 (abstract 43), 20072) Nakano S, et al. Fusion of MRI and sonography image for breast cancer evaluation using real-time virtual sonography with magnetic navigation: First Experience. Jpn J Clin Oncol 39, 552-9, 20093) Yoshida M, Nakano S, et al. Virtual MRI sonography using magnetic navigation improves sonographically identification of enhancing lesions on breast MRI. (manuscript...