J Korean Soc Radiol.  2014 Aug;71(2):89-96. 10.3348/jksr.2014.71.2.89.

Response Evaluation to Neoadjuvant Chemotherapy in Advanced Breast Cancer: Comparison of MRI and Positron Emission Tomography/CT (RECIST 1.1 versus PERCIST 1.0)

• An YY
• Kim SH
• Park YH

• KMID: 1819786
• DOI: http://doi.org/10.3348/jksr.2014.71.2.89

Abstract

PURPOSE
The aim of this study was to compare the diagnostic performances between the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1) criteria on dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) and positron emission tomography Response Evaluation Criteria in Solid Tumors version 1.0 (PERCIST 1.0) criteria on positron emission tomography/CT (PET/CT) in evaluating the treatment response of neoadjuvant chemotherapy (NAC) in breast cancer patients.
MATERIALS AND METHODS
We compared MRI and PET/CT in the assessment of tumor response after NAC with the pathological response as the standard reference in 54 breast cancer patients. The tumor response was assessed by using the RECIST 1.1 criteria on DCE-MRI and PERCIST 1.0 criteria on PET/CT. The diagnostic performance of RECIST 1.1 and PERCIST 1.0 criteria was statistically analyzed and compared by receiver operating characteristic (ROC) analysis.
RESULTS
There were 21 responders and 33 non-responders according to the pathology. The discordant rate with pathological response was 37.0% for RECIST 1.1 and 55.6% for PERCIST 1.0. Twenty six patients (48.1%) were classified as responders in both MRI and PET/CT, but the final pathology showed non-response. In the ROC curve, the area under the curves (AUC) was 0.89 for RECIST 1.1 and 0.79 for PERCIST 1.0 (p < 0.001).
CONCLUSION
The RECIST 1.1 criteria on MRI showed the better diagnostic performance than PERCIST 1.0 criteria on PET/CT for the response assessment of breast cancer after NAC, although there was no statistically significant difference between both (p = 0.15).

MeSH Terms

Breast Neoplasms*
Drug Therapy*
Electrons*
Humans
Magnetic Resonance Imaging*
Pathology
Positron-Emission Tomography
Positron-Emission Tomography and Computed Tomography
ROC Curve

Figure

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  Fig. 1 The scatter-plot shows the relationship between changes in the maximal diameters with the use of breast MRI and standard uptake values (SUVs) with the use of PET after neoadjuvant chemotherapy. Note.-PET = positron emission tomography

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  Fig. 2 A 47-year-old woman was diagnosed with invasive lobular carcinoma in the right breast and underwent neoadjuvant chemotherapy. Pre-chemotherapy (A) and post-chemotherapy (B) maximal intensity projection images of DCE-MRI and PET/CT. Applying RECIST 1.1 and PERCIST 1.0 criteria, this case was classified into responder on both, DCE-MRI and PET/CT examinations. But there was an about 1.9 cm sized residual invasive cancer at the surgical specimen. Note.-DCE-MRI = dynamic contrast enhanced magnetic resonance imaging, PERCIST = PET Response Evaluation Criteria in Solid Tumors, PET/CT = positron emission tomography/CT, RECIST = Response Evaluation Criteria in Solid Tumors

• 

  Fig. 3 The ROC curves used to evaluate the pathological response of NAC with DCE-MRI and PET/CT. The AUC value of DCE-MRI (0.89, p < 0.001) was higher than that of PET/CT (0.79, p < 0.001). There was no statistical difference in AUCs between RECIST 1.1 criteria and PERCIST 1.0 criteria (p = 0.15). Note.-AUC = area under the curves, DCE-MRI = dynamic contrast enhanced magnetic resonance imaging, dmax = the maximal diameter, NAC = neoadjuvant chemotherapy, PERCIST = PET Response Evaluation Criteria in Solid Tumors, PET/CT = positron emission tomography/CT, RECIST = Response Evaluation Criteria in Solid Tumors, ROC = receiver operating characteristic, SUVmax = maximum standardized uptake value

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