Assessment of Residual Disease With Molecular Breast Imaging in Patients Undergoing Neoadjuvant Therapy: Association With Molecular Subtypes

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Abstract

Background:

Assessment of residual disease after neoadjuvant therapy for breast cancer is an ongoing challenge of breast imaging. This study evaluates the accuracy of a novel dedicated system for molecular breast imaging (MBI) composed of the new generation of cadmium zinc telluride detectors in assessing residual disease after neoadjuvant therapy in patients with breast cancer.

Patients and Methods:

Clinical data, imaging, surgical, and pathological findings of 51 women with breast cancer undergoing neoadjuvant therapy were recorded. MBI findings were correlated with surgical pathology results. Accuracy of MBI in predicting complete pathological response and size of residual disease was assessed according to molecular subtypes.

Results:

The size of the largest focus of uptake on MBI correlated with the largest dimension measured on pathology (r = 0.55; P < .001). This correlation was stronger for triple negative and HER2/neu positive subtypes (r = 0.92 and 0.62, respectively). Sixteen patients (31%) had complete pathological response. The sensitivity and specificity of MBI for detecting residual disease were 83% (95% confidence interval [CI], 66–93) and 69% (95% CI, 42–88), respectively. For triple negative or HER2/neu positive disease the sensitivity and specificity were 88% (95% CI, 62–98) and 75% (95% CI, 43–93), respectively.

Conclusion:

The accuracy of MBI in assessing residual disease after neoadjuvant treatment might be related to the molecular subtype. Accuracy is highest in the triple negative and HER2/neu positive subtypes.

Micro-Abstract:

With the increased use of neoadjuvant treatment there is a growing need for accurate assessment of residual disease before surgery. The accuracy of molecular breast imaging (MBI) in assessing residual disease was assessed in this retrospective study. MBI appears to be more accurate in identifying residual cancer in triple negative and HER2/neu-positive disease.

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