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British Journal of Cancer (2006) 94, 427-435.
doi:10.1038/sj.bjc.6602948
Neoadjuvant chemotherapy in breast cancer: early response prediction with quantitative MR imaging and spectroscopy
D J Manton1, A Chaturvedi2, A Hubbard3, M J Lind1, M Lowry1, A Maraveyas1, M D Pickles1, D J Tozer4 and L W Turnbull1
1The Postgraduate Medical Institute of the University of Hull Division of Cancer in association with the Hull York Medical School, The University of Hull, Hull, East Yorkshire HU6 7RX, UK
2The Department of Clinical Oncology, Hull and East Yorkshire Hospitals NHS Trust, The Princess Royal Hospital, Saltshouse Road, Hull, East Yorkshire HU8 9HE, UK
3The Breast Screening Unit, Hull and East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire HU16 5JQ, UK
4NMR Research Unit, Institute of Neurology, Queen Square, London WC1N 3BG, UK
Correspondence to: Dr DJ Manton, MRI Centre, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ, UK. E-mail: d.j.manton@.hull.ac.uk
Received 10 June 2005; revised 17 October 2005; accepted 7 December 2005
A prospective study was undertaken in women undergoing neoadjuvant chemotherapy for locally advanced breast cancer in order to determine the ability of quantitative magnetic resonance imaging (MRI) and proton spectroscopy (MRS) to predict ultimate tumour response (percentage decrease in volume) or to detect early response. Magnetic resonance imaging and MRS were carried out before treatment and after the second of six treatment cycles. Pharmacokinetic parameters were derived from T1-weighted dynamic contrast-enhanced MRI, water apparent diffusion coefficient (ADC) was measured, and tissue water : fat peak area ratios and water T2 were measured using unsuppressed one-dimensional proton spectroscopic imaging (30 and 135 ms echo times). Pharmacokinetic parameters and ADC did not detect early response; however, early changes in water : fat ratios and water T2 (after cycle two) demonstrated substantial prognostic efficacy. Larger decreases in water T2 accurately predicted final volume response in 69% of cases (11/16) while maintaining 100% specificity and positive predictive value. Small/absent decreases in water : fat ratios accurately predicted final volume non-response in 50% of cases (3/6) while maintaining 100% sensitivity and negative predictive value. This level of accuracy might permit clinical application where early, accurate prediction of non-response would permit an early change to second-line treatment, thus sparing patients unnecessary toxicity, psychological morbidity and delay of initiation of effective treatment.
Keywords: breast neoplasms; chemotherapy; magnetic resonance; MR; spectroscopy; contrast enhancement; diffusion study
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