Quantitative DCE-MRI for prediction of pathological complete response prior to neoadjuvant systemic therapy

Abstract Purpose To explore the correlation between quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)-derived tumour characteristics prior to neoadjuvant systemic therapy (NST) and pathological complete response (pCR) in patients with breast cancer patients. Methods Among 120 randomly selected patients with breast neoplasms, 28 diagnosed with invasive ductal carcinoma underwent NST. All patients underwent at least three MRI examinations: preoperative and before and after NST. Spearman correlation analysis was used to assess the correlation between pCR and Miller–Payne (MP) scores with pharmacokinetic parameters (K trans , K ep , V e , V p ) in the regions of interest (ROI) in the tumour (ROI1), tumoural junction with the normal gland (ROI2), peritumoural region (ROI3), and background parenchymal enhancement; tumour morphological characteristics (type, location, quantity, margin, and maximum diameter); enhancement or shrinkage mode; and residual condition following preoperative MRI. Results A positive correlation was observed between pCR and tumour HER2 expression (r = 0.546); and K ep (r = 0.427) and V e of ROI3 (r = 0.564) (P < 0.05). A negative correlation between pCR, tumour shrinkage pattern (r=-0.506) and residual tumours (r=-0.551) was observed by preoperative MRI (r=-0.551) (P < 0.05). MP associated with progesterone receptor (r=-0.37), HER2 (r = 0.608), and Ki-67 (r = 0.393) expression; tumour shrinkage pattern (r=-0.625); and preoperative MRI residual tumour (r=-0.715) (P < 0.05). Preoperative MRI tumour residual status associated with Ki-67 (r=-0.465) and tumour shrinkage pattern (r = 0.677) (P < 0.05). Conclusions A correlation was observed between DCE-MRI of the peritumoural region prior to NST and pCR. Early MRI evaluation of tumour shrinkage patterns following NST and preoperative tumour residual status showed predictive value for pCR and tumour burden.