Kirsten Gaarder MD, Presenter: Nothing to Disclose

Kirti Manohar Kulkarni MD, Abstract Co-Author: Nothing to Disclose

Jeffrey Mueller MD, Abstract Co-Author: Nothing to Disclose

Hiroyuki Abe MD, Abstract Co-Author: Nothing to Disclose

Charlene A. Sennett MD, Abstract Co-Author: Nothing to Disclose

David Victor Schacht MD, Abstract Co-Author: Nothing to Disclose

Akiko Shimauchi MD, Abstract Co-Author: Nothing to Disclose

Gillian Maclaine Newstead MD, Abstract Co-Author: Medical Advisory Board, Bayer AG Consultant, Three Palm Software LLC

To review the influence of receptor profile and residual cellularity on MRI findings in breast cancer patients undergoing neoadjuvant chemotherapy (NAC). To better identify patients showing residual invasive cancer post-NAC despite no or minimal enhancement on MRI and to understand factors influencing this rad-path discrepancy. To better delineate extent of residual disease and determine appropriate surgical treatment post NAC. 

10 cases of breast cancer will be shown with pre- and post-NAC MRI and histopathologic images. Differences in imaging response associated with different receptor profiles and patterns of pathologic response to therapy will be reviewed. Pathologic staging of post-NAC breast cancers will be discussed.

Major teaching points: Some breast cancers become less cellular post NAC without significantly decreasing in size. These cancers may have no or minimal contrast enhancement on MRI. Evaluation of non-subtracted contrast and delayed images is of increased importance in order to evaluate the extent of residual tumor. ER+Her2- cancers more often have subtle imaging findings after treatment as compared to triple negative and Her2+ cancers. Evaluation of different tumor morphologies and patterns of response to NAC can be helpful in surgical planning. 

Gaarder, K, Kulkarni, K, Mueller, J, Abe, H, Sennett, C, Schacht, D, Shimauchi, A, Newstead, G, MRI Appearance of Breast Cancer Treated with Neoadjuvant Chemotherapy (NAC): Influence of Receptor Status and Pathologic Residual Cellularity.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13011336.html