Journal
MAGNETIC RESONANCE IMAGING
Volume 42, Issue -, Pages 88-94Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.mri.2017.06.002
Keywords
Diffusion weighted imaging; Apparent diffusion coefficient; Neoadjuvant chemotherapy; Breast conservation surgery; Locally advanced breast cancer
Funding
- Science and Engineering Research Board (SERB), Government of India [SP/SO/HS-80/2006, SR/SO/HS/213/2012]
- SERB, Government of India
- Indian Council of Medical Research, New Delhi [3/2/2/241/2014/NCD-III(OPA-31710)]
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Purpose: The 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. Methods: DWI was performed at pre-therapy (Tp0), after I (Tpl) and III (Tp3) NACT at 1.5 T. Apparent diffusion coefficient (ADC) of whole tumor (ADC(WT)), solid tumor (ADC(ST)), intra-tumoral necrosis (ADC(Nec)) was determined. Further, ADC of 6 consecutive shells (5 mm thickness each) including tumor margin to outside tumor margins (OM1 to OM5) was calculated and the data analyzed to define surgical margins. Results: Of 38 patients, 6 were pathological complete responders (pCR), 19 partial responders (pPR) and 13 were non-responders (pNR). Significant increase was observed in ADC(ST) and ADC(wr) in pCR and pPR following therapy. Pre-therapy ADC was significantly lower in pCR compared to pPR and pNR indicating the 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 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. Conclusion: Pre-surgery information may serve as a guide to define cancer free margins and the extent of residual disease which may be useful in planning breast conservation surgery. (C) 2017 Elsevier Inc. All rights reserved.
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