Role of MRI diffusion as an adjunct to contrast enhanced MRI of the breast for the evaluation of breast cancer patients receiving neoadjuvent chemotherapy

Abstract

Purpose: To assess the role of diffusion weighted MRI in predicting future responders and non-responders in breast cancer patients receiving neoadjuvant chemotherapy. Materials and methods: Thirty-eight breast cancer patients scheduled for NAC between January 2014 and January 2015 were enrolled in this study. Contrast enhanced MRI and DWI were performed, where the lesions size and ADC values, were recorded before the start of NAC, after the first and second cycles and after completion of therapy. The diagnostic performance of morphological (size) and functional (ADC) MRI in predicting early response and assessing residual disease was then compared to the histopathology. Results: The percentage change in the ADC values measured before and after the 1st cycle of NAC was significant, with 79% sensitivity and 95% specificity in predicting tumor response. The sensitivity and specificity for depicting residual tumor was 94% and 92% respectively for DWI. Conclusion: DWI is a valuable tool in early identification of responders to NAC in breast cancer patients, hence selecting patients that will benefit from NAC, avoiding any unnecessary toxicity. The accuracy of DWI in detecting residual disease is almost similar to that of CEMRI, acting as a substitute in patients where contrast is contraindicated.

Keywords

• Breast cancer
• Neoadjuvant chemotherapy
• Prediction
• Response evaluation
• MRI techniques