研究目的
To evaluate the performance of contrast-enhanced mammography (CEM) compared to magnetic resonance imaging (MRI) for estimating residual tumor size after neoadjuvant chemotherapy (NAC) in women with newly diagnosed breast cancer.
研究成果
CEM has good correlation and agreement with histopathology for measuring residual tumors after NAC. CEM is as reliable as MRI in assessing the presence of residual tumor. Our findings are encouraging since CEM might be useful for patients with contraindications to MRI and patients in regions with limited MRI availability or lack of reimbursement.
研究不足
It was a single institution trial, and the small study population and uncommon molecular subtype distribution may limit the applicability of our results to the general population. For better comparison to MRI, CEM analysis was based only on recombined images. There is the risk of losing calcifications without enhancement, which may underestimate residual tumor measurements. Although the radiologist was blinded to the results of other imaging modality when reviewing CEM and MRI, all studies were reviewed by the same radiologist, thereby introducing inherent bias. We were not able to evaluate the relationship of NAC agents, tumor histology, and molecular subtype with the performance of CEM.
1：Experimental Design and Method Selection:
This prospective study included women with newly diagnosed breast cancer who underwent breast CEM and MRI at the end of the last cycle of NAC and before definitive surgery. Size of residual malignancy on post-NAC CEM and MRI was compared with surgical pathology.
2：Sample Selection and Data Sources:
Thirty-three patients were included with a mean age of 45 years (range 22–76).
3：6). List of Experimental Equipment and Materials:
3. List of Experimental Equipment and Materials: Bilateral craniocaudal (CC) and mediolateral oblique (MLO) views were acquired using a commercially available FFDM system (GE Senographe DS, GE Healthcare, Milwaukee, WI). All breast MRI examinations were performed using a
4：5T MRI system (GE Signa HDxT, GE Healthcare) with a dedicated eight-channel breast coil. Experimental Procedures and Operational Workflow:
Before image acquisition,
5：5 ml/kg of non-ionic contrast medium (Iohexol, 300 mg/ml) was injected using an automated injector at a flow rate of 3 ml/s. The first image was obtained 5–2 min after injection initiation, and all images were obtained within 4–7 min. Data Analysis Methods:
Agreements and correlations of CEM and MRI measurements with histological size were assessed using Bland–Altman plots. Lin’s concordance and Pearson correlation coefficient were used to assess agreement between diagnostic imaging tools and pathology results.
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