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Τετάρτη 14 Ιουνίου 2017

Pre-operative assessment of residual disease in locally advanced breast cancer patients: A sequential study by quantitative diffusion weighted MRI as a function of therapy

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Publication date: Available online 13 June 2017
Source:Magnetic Resonance Imaging
Author(s): Khushbu Agarwal, Uma Sharma, Rani G. Sah, Sandeep Mathur, Smriti Hari, Vurthaluru Seenu, Rajinder Parshad, Naranamangalam R. Jagannathan
PurposeThe potential of diffusion weighted imaging (DWI) in assessing pathologic response and surgical margins in locally advanced breast cancer patients (n=38) undergoing neoadjuvant chemotherapy was investigated.MethodsDWI was performed at pre-therapy (Tp0), after I (Tp1) and III (Tp3) NACT at 1.5T. Apparent diffusion coefficient (ADC) of whole tumor (ADCWT), solid tumor (ADCST), intra-tumoral necrosis (ADCNec) was determined. Further, ADC of 6 consecutive shells (5mm thickness each) including tumor margin to outside tumor margins (OM1 to OM5) was calculated and the data analyzed to define surgical margins.ResultsOf 38 patients, 6 were pathological complete (pCR), 19 partial responders (pPR) and 13 were non-responders (pNR). Significant increase was observed in ADCST and ADCWT in pCR and pPR following therapy. Pre-therapy ADC was significantly lower in pCR compared to pPR and pNR indicating heterogeneous nature of tumor which may affect drug perfusion and consequently the response. ADC of outside margins (OM1, OM2, and OM3) was significantly different among pCR, pPR and pNR at Tp3 which may serve as response predictive parameter. Further, at Tp3, ADC of the outside margins (OM1, OM2, and OM3) was significantly lower compared to that seen at Tp0 in pCR indicating the presence of residual disease in these shells.ConclusionThis pre-surgery information may serve as a guide to define cancer free margins and extent of residual disease which may be useful in planning breast conservation surgery.



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