TY - JOUR
T1 - Comparison of 99mTc-sestamibi molecular breast imaging and breast MRI in patients with invasive breast cancer receiving neoadjuvant chemotherapy
AU - Hunt, Katie N.
AU - Conners, Amy Lynn
AU - Goetz, Matthew P.
AU - O’Connor, Michael K.
AU - Suman, Vera
AU - Kalari, Krishna
AU - Weinshilboum, Richard
AU - Wang, Liewei
AU - Carter, Jodi
AU - McLaughlin, Sarah
AU - Aspitia, Alvaro Moreno
AU - Gray, Richard
AU - Northfelt, Don
AU - Boughey, Judy C.
N1 - Funding Information:
Supported in part by funding to the BEAUTY study from the Mayo Clinic Center for Individualized Medicine, Nadia’s Gift Foundation, John P. Guider, the Eveleigh family, George M. Eisenberg Foundation for Charities, Afaf Al-Bahar, and the Pharmacogenomics Research Network, and other contributing groups including the Mayo Clinic Cancer Center and the Mayo Clinic Breast Specialized Program of Research Excellence.
Funding Information:
Supported in part by funding to the BEAUTY study from the Mayo Clinic Center for Individualized Medicine, Nadia?s Gift Foundation, John P. Guider, the Eveleigh family, George M. Eisenberg Foundation for Charities, Afaf Al-Bahar, and the Pharmacogenomics Research Network, and other contributing groups including the Mayo Clinic Cancer Center and the Mayo Clinic Breast Specialized Program of Research Excellence.
Publisher Copyright:
© 2019 American Roentgen Ray Society. All rights reserved.
PY - 2019
Y1 - 2019
N2 - OBJECTIVE. The purpose of this study is to prospectively compare the size of invasive breast cancer before and after neoadjuvant chemotherapy (NAC) at breast MRI and molecular breast imaging (MBI) and to assess the accuracy of post-NAC MBI and MRI relative to pathologic analysis. SUBJECTS AND METHODS. Women with invasive breast cancer greater than or equal to 1.5 cm were enrolled to compare the longest dimension before and after NAC at MRI and MBI. MBI was performed on a dual-detector cadmium zinc telluride system after administration of 6.5 mCi (240 MBq) 99mTc-sestamibi. The accuracy of MRI and MBI in assessing residual disease (invasive disease or ductal carcinoma in situ) was determined relative to pathologic examination. RESULTS. The longest dimension at MRI was within 1.0 cm of that at MBI in 72.3% of cases before NAC and 70.1% of cases after NAC. The difference between the longest dimension at imaging after NAC and pathologic tumor size was within 1 cm for 58.7% of breast MRI cases and 59.6% of MBI cases. Ninety patients underwent both MRI and MBI after NAC. In the 56 patients with invasive residual disease, 10 (17.9%) cases were negative at MRI and 23 (41.1%) cases were negative at MBI. In the 34 patients with breast pathologic complete response, there was enhancement in 10 cases (29.4%) at MRI and uptake in six cases (17.6%) at MBI. Sensitivity, specificity, positive predictive value, and negative predictive value after NAC were 82.8%, 69.4%, 81.4%, and 71.4%, respectively, for MRI and 58.9%, 82.4%, 84.6%, and 54.9%, respectively, for MBI. CONCLUSION. Breast MRI and MBI showed similar disease extent before NAC. MBI may be an alternative to breast MRI in patients with a contraindication to breast MRI. Neither modality showed sufficient accuracy after NAC in predicting breast pathologic complete response to obviate tissue diagnosis to assess for residual invasive disease. Defining the extent of residual disease compared with pathologic evaluation was also limited after NAC for both breast MRI and MBI.
AB - OBJECTIVE. The purpose of this study is to prospectively compare the size of invasive breast cancer before and after neoadjuvant chemotherapy (NAC) at breast MRI and molecular breast imaging (MBI) and to assess the accuracy of post-NAC MBI and MRI relative to pathologic analysis. SUBJECTS AND METHODS. Women with invasive breast cancer greater than or equal to 1.5 cm were enrolled to compare the longest dimension before and after NAC at MRI and MBI. MBI was performed on a dual-detector cadmium zinc telluride system after administration of 6.5 mCi (240 MBq) 99mTc-sestamibi. The accuracy of MRI and MBI in assessing residual disease (invasive disease or ductal carcinoma in situ) was determined relative to pathologic examination. RESULTS. The longest dimension at MRI was within 1.0 cm of that at MBI in 72.3% of cases before NAC and 70.1% of cases after NAC. The difference between the longest dimension at imaging after NAC and pathologic tumor size was within 1 cm for 58.7% of breast MRI cases and 59.6% of MBI cases. Ninety patients underwent both MRI and MBI after NAC. In the 56 patients with invasive residual disease, 10 (17.9%) cases were negative at MRI and 23 (41.1%) cases were negative at MBI. In the 34 patients with breast pathologic complete response, there was enhancement in 10 cases (29.4%) at MRI and uptake in six cases (17.6%) at MBI. Sensitivity, specificity, positive predictive value, and negative predictive value after NAC were 82.8%, 69.4%, 81.4%, and 71.4%, respectively, for MRI and 58.9%, 82.4%, 84.6%, and 54.9%, respectively, for MBI. CONCLUSION. Breast MRI and MBI showed similar disease extent before NAC. MBI may be an alternative to breast MRI in patients with a contraindication to breast MRI. Neither modality showed sufficient accuracy after NAC in predicting breast pathologic complete response to obviate tissue diagnosis to assess for residual invasive disease. Defining the extent of residual disease compared with pathologic evaluation was also limited after NAC for both breast MRI and MBI.
KW - Breast cancer
KW - MRI
KW - Molecular breast imaging
KW - Neoadjuvant chemotherapy
KW - Tc-sestamibi
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U2 - 10.2214/AJR.18.20628
DO - 10.2214/AJR.18.20628
M3 - Article
C2 - 31166752
AN - SCOPUS:85070313942
SN - 0361-803X
VL - 213
SP - 932
EP - 943
JO - The American journal of roentgenology and radium therapy
JF - The American journal of roentgenology and radium therapy
IS - 4
ER -