Korean J Radiol.  2011 Feb;12(1):34-43. 10.3348/kjr.2011.12.1.34.

Computer-Aided Evaluation of Breast MRI for the Residual Tumor Extent and Response Monitoring in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy

• Lyou CY
• Cho N
• Kim SM
• Jang M
• Park JS
• Baek SY
• Moon WK

• KMID: 991680
• DOI: http://doi.org/10.3348/kjr.2011.12.1.34

Abstract

OBJECTIVE
To evaluate the accuracy of a computer-aided evaluation program (CAE) of breast MRI for the assessment of residual tumor extent and response monitoring in breast cancer patients receiving neoadjuvant chemotherapy.
MATERIALS AND METHODS
Fifty-seven patients with breast cancers who underwent neoadjuvant chemotherapy before surgery and dynamic contrast enhanced MRI before and after chemotherapy were included as part of this study. For the assessment of residual tumor extent after completion of chemotherapy, the mean tumor diameters measured by radiologists and CAE were compared to those on histopathology using a paired student t-test. Moreover, the agreement between unidimensional (1D) measurement by radiologist and histopathological size or 1D measurement by CAE and histopathological size was assessed using the Bland-Altman method. For chemotherapy monitoring, we evaluated tumor response through the change in the 1D diameter by a radiologist and CAE and three-dimensional (3D) volumetric change by CAE based on Response Evaluation Criteria in Solid Tumors (RECIST). Agreement between the 1D response by the radiologist versus the 1D response by CAE as well as by the 3D response by CAE were evaluated using weighted kappa (k) statistics.
RESULTS
For the assessment of residual tumor extent after chemotherapy, the mean tumor diameter measured by radiologists (2.0 +/- 1.7 cm) was significantly smaller than the mean histological diameter (2.6 +/- 2.3 cm) (p = 0.01), whereas, no significant difference was found between the CAE measurements (mean = 2.2 +/- 2.0 cm) and histological diameter (p = 0.19). The mean difference between the 1D measurement by the radiologist and histopathology was 0.6 cm (95% confidence interval: -3.0, 4.3), whereas the difference between CAE and histopathology was 0.4 cm (95% confidence interval: -3.9, 4.7). For the monitoring of response to chemotherapy, the 1D measurement by the radiologist and CAE showed a fair agreement (k = 0.358), while the 1D measurement by the radiologist and 3D measurement by CAE showed poor agreement (k = 0.106).
CONCLUSION
CAE for breast MRI is sufficiently accurate for the assessment of residual tumor extent in breast cancer patients receiving neoadjuvant chemotherapy. However, for the assessment of response to chemotherapy, the assessment by the radiologist and CAE showed a fair to poor agreement.

Keyword

Breast neoplasm; Chemotherapy; MR imaging; Computer-aided

MeSH Terms

Adult
Antineoplastic Combined Chemotherapy Protocols/*therapeutic use
Breast Neoplasms/*diagnosis/drug therapy/surgery
*Diagnosis, Computer-Assisted
Humans
*Magnetic Resonance Imaging
Middle Aged
*Neoadjuvant Therapy
Neoplasm, Residual
Young Adult

Figure

• 

  Fig. 1 Bland-Altman plots of manual measurements by radiologists (RAD), computer-assisted evaluation program (CAE), and histopathologic unidimensional measurements of residual tumor extent after neoadjuvant chemotherapy. Solid line (center) represents mean of differences. Top dashed line represents upper limit of agreement (mean difference plus two times standard deviation); bottom line represents lower limit of agreement (mean difference minus two times standard deviation). A is for agreement between RAD and histopathology (mean difference = 0.6 cm, 95% limits of agreement: -3.0 to 4.3 cm) and B is for agreement between CAE and histopathology (mean difference = 0.4 cm, 95% limits of agreement: -3.9 to 4.7 cm).

• 

  Fig. 2 Concordant case between unidimensional and three dimensional measurements is presented. Imaging measurements are presented for 52-year-old woman diagnosed with infiltrating duct carcinoma upon initial examination (indicator in A) and follow-up examination (indicators in B). After chemotherapy, 1D measurement shows 57% diameter reduction from 6.7 cm (A) to 2.9 cm (B). According to RECIST, this tumor is categorized as responder. Computer-aided volumetry shows 94% volume reduction from 61.8 cc (C) to 3.5 cc (D). According to volumetric criteria; this tumor is also categorized as responder.

• 

  Fig. 3 Discordant case between unidimensional and three dimensional measurements is presented. Imaging measurements are presented for 36-year-old woman diagnosed with infiltrating duct carcinoma upon initial examination (indicator in A) and follow-up examination (indicator in B). After chemotherapy, 1D measurement shows 21% diameter reduction from 5.3 cm (A) to 4.2 cm (B). According to RECIST, this tumor is categorized as non-responder. Computer-aided volumetry shows 90% volume reduction from 6.4 cc (C) to 0.64 cc (D). According to volumetric criteria, this tumor is categorized as responder.

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