Download Contrast-enhanced spectral mammography in treatment monitoring

Contrast-enhanced spectral mammography in treatment
monitoring: an initial comparison to breast MRI
Poster No.:
B-0437
Congress:
ECR 2015
Type:
Scientific Paper
Authors:
S. Ravaioli , R. Sghedoni , A. Nitrosi , V. Iotti , C. Coriani , R.
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Vacondio , C. A. Mori , V. Ginocchi , P. Pattacini ; Reggio Emilia/
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IT, Guastalla/IT
Keywords:
Breast, Oncology, Mammography, MR, Chemotherapy, Cancer,
Neoplasia
DOI:
10.1594/ecr2015/B-0437
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Purpose
To compare Contrast-Enhanced Spectral Mammography (CESM) and ContrastEnhanced MRI (CE-MRI) in breast cancer response to chemotherapy.
Methods and materials
43 consenting women with in situ, lobular or ductal carcinoma and with indication of
neoadjuvant chemotherapy (NAC) were enrolled into this prospective study between
October 2012 and October 2014.
The patients underwent CESM and CE-MRI before, after the first NAC cycle and after
the end of NAC. 29 patients completed the therapy up to October 2014.
Response to therapy was evaluated for each patient using the variation of the largest
dimension of malignancies measured on CE-MRI and CESM image sets.
A CESM examination consisted in a pair of low and high energy exposures for each
mammographic view, combined to visualize lesions with contrast up-take.
CESM and CE-MRI size measurements were compared through correlation (Pearson)
and agreement (Paired t-test).
Clinical outcomes were also compared: patients were considered as responding to
therapy when size reduction after NAC was larger than 30%.
Results
Pearson correlation coefficients between CESM and CE-MRI measurements were 0.982,
0.946 and 0.894 and paired t-test p-values were 0.71, 0.20 and 0.43, respectively before,
during and after NAC.
P-values show that there was no statistical difference between measurement sets with
CESM and MRI at each stage.
Clinical outcomes (response or non-response to chemotherapy) with CESM and CE-MRI
were identical for 28 over 29 patients.
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Images for this section:
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Fig. 1: 44-year-old woman with 30-mm in situ and invasive ductal carcinoma in right
breast. Complete response to chemotherapy after 6-months. A: CESM subtracted image,
pre-treatment. B: CESM subtracted image, post-treatment. C: DCE-MRI processed by
CAD, pre-treatment. D: DCE-MRI processed by CAD, post-treatment.
Fig. 2: 53-year-old woman with 33-mm invasive lobular carcinoma in the left breast.
Complete response to chemotherapy after 6-months. A: CESM subtracted image, pretreatment. B: DCE-MRI processed by CAD, pre-treatment. C: CESM subtracted image,
post-treatment. D: DCE-MRI processed by CAD, post-treatment.
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Fig. 3: 40-year-old woman with 48-mm invasive ductal carcinoma with microcalcifications
in left breast. Not responding to chemotherapy: after 3-months no dimensional reduction
but appearance of a second lesion (circled in white). A: CESM subtracted image, pretreatment. B: CESM low-energy, pre-treatment. C: CESM subtracted image, duringtreatment. D: CESM low-energy, during treatment. E: DCE-MRI processed by CAD, pretreatment. F: DCE-MRI processed by CAD, during-treatment.
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Conclusion
CESM and MRI lesion size measurements were highly correlated and in strong
agreement.
CESM may be an alternative to CE-MRI in assessing response to chemotherapy in
patients with breast cancer.
Personal information
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