Multiparametric magnetic resonance imaging, spectroscopy and multinuclear ((2)(3)Na) imaging monitoring of preoperative chemotherapy for locally advanced breast cancer.

摘要

RATIONALE AND OBJECTIVES: The aim of this prospective study was to investigate using multiparametric and multinuclear magnetic resonance imaging during preoperative systemic therapy for locally advanced breast cancer. MATERIALS AND METHODS: Women with operable stage 2 or 3 breast cancer who received preoperative systemic therapy were studied using dynamic contrast-enhanced magnetic resonance imaging, magnetic resonance spectroscopy, and (2)(3)Na magnetic resonance. Quantitative metrics of choline peak signal-to-noise ratio, total tissue sodium concentration, tumor volumes, and Response Evaluation Criteria in Solid Tumors were determined and compared to final pathologic results using receiver-operating characteristic analysis. Hormonal markers were investigated. Statistical significance was set at P < .05. RESULTS: Eighteen eligible women were studied. Fifteen responded to therapy, four (22%) with pathologic complete response and 11 (61%) with pathologic partial response. Three patients (17%) had no response. Among estrogen receptor-positive, HER2-positive, and triple-negative phenotypes, observed frequencies of pathologic complete response, pathologic partial response, and no response were 2, 5, and 0; 1, 4, and 0; and 1, 1, and 3, respectively. Responders (pathologic complete response and pathologic partial response) had the largest reductions in choline signal-to-noise ratio (35%, from 7.2 +/- 2.3 to 4.6 +/- 2; P < .01) compared to nonresponders (11%, from 8.4 +/- 2.7 to 7.5 +/- 3.6; P = .13) after the first cycle. Total tissue sodium concentration significantly decreased in responders (27%, from 66 +/- 18 to 48.4 +/- 8 mmol/L; P = .01), while there was little change in nonresponders (51.7 +/- 7.6 to 56.5 +/- 1.6 mmol/L; P = .50). Lesion volume decreased in responders (40%, from 78 +/- 78 to 46 +/- 51 mm(3); P = .01) and nonresponders (21%, from 100 +/- 104 to 79.2 +/- 87 mm(3); P = .23) after the first cycle. The largest reduction in Response Evaluation Criteria in Solid Tumors occurred after the first treatment in responders (18%, from 24.5 +/- 20 to 20.2 +/- 18 mm; P = .01), with a slight decrease in tumor diameter noted in nonresponders (17%, from 23 +/- 19 to 19.2 +/- 19.1 mm; P = .80). CONCLUSIONS: Multiparametric and multinuclear imaging parameters were significantly reduced after the first cycle of preoperative systemic therapy in responders, specifically, choline signal-to-noise ratio and sodium. These new surrogate radiologic biomarkers maybe able to predict and provide a platform for potential adaptive therapy in patients.