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Keywords:
Breast, Oncology, MR, Diagnostic procedure, Cancer
Authors:
M. Nadrljanski, R. Maksimovic, V. Plesinac-Karapandzic, M. Nikitovic, Z. C. Milosevich; Belgrade/RS
DOI:
10.1594/ecr2015/B-0016
Conclusion
In the two subgroups: R and NR – the initial tumor size was not considered statistically significant (p>0.05),
therefore the comparison of the morphologic criteria,
was performed in the two subgroups of patients with the tumors of similar size.
The initial ADC value differed significantly between the two subgroups: R vs.
NR (p=0.0001).
It was noted that the ADC value changed in R after the 2nd cycle of NACT and the change was slightly higher than the predefined cut-off value of 27% for R,
based on the previously published limited number of trials (p=0.05; +27.89%),
while the tumor response was categorized as SD according to RECIST (-15.44%).
The predefined parameter of functional imaging – ADC based on DWI,
changed as early as after 2nd cycle,
before the morphologic tumor change eventually became apparent in R.
However,
only modest correlation in parameters (RECIST,
ADC) was noted in R,
which was not considered significant.
In NR,
neither parameter changed significantly.
Our results confirmed the previously published cut-off value of 27% increase in ADC value upon the completion of 2nd cycle of NACT in R.
It is worth mentioning that the DWI and ADC value change in NACT have not been standardized and recommended in the guidelines for standardized breast MRI.
Should larger trials confirm these results,
ADC may have predictive value in early tumor response assessment to NACT,
before the apparent morphologic changes based on the recommended standardized measuring tools,
which could contribute to the standardization of the method.
The practical aspects of the early identification of R and NR – after the completion of 2nd cycle – may contribute to the adequate selection of patients and the avoidance of toxic effects of the otherwise inefficient treatment in NR and the selection of the appropriate regimen.