Hebatalla H. Elkassas MD, Presenter: Nothing to Disclose

Maha Hussein Helal MD, Abstract Co-Author: Nothing to Disclose

Asmaa Abdelkhalek Abourabia MD, Abstract Co-Author: Nothing to Disclose

Naglaa Abdel Razek MD, Abstract Co-Author: Nothing to Disclose

Ola Khorshid MD, MSc, Abstract Co-Author: Nothing to Disclose

Ahmed Farahat MD, MSc, Abstract Co-Author: Nothing to Disclose

Mohamed Zedan MSc, MRCS, Abstract Co-Author: Nothing to Disclose

Ehab Mansour MD, Abstract Co-Author: Nothing to Disclose

To assess the role of MRI diffusion in predicting furture responders and non responders, early during the course of neoadjuvant chemotherapy given to patients with advanced breast cancer. Another objective was to depict the role of diffusion imaging in the evaluation of residual disease at the end of treatment.  

Thirty five patients with advanced breast cancer scheduled to recieve neoadjuvant chemotherapy (NAC), between January 2013 and January 2014, were enrolled in this prospective study.MRI with diffusion weighted (DW) and contrast enhanced images were performed and parameters including number, size and apparant diffusion coeffiecient (ADC) values of lesions were recorded at 4 stages: before starting NAC, during (after the 1st and 2nd cycles) and after completion of NAC. The percentage changes in ADC values and tumor size, before and after the 1st and 2nd cycles were then calculated. Diagnostic performance of MRI (morphological and functional imaging) in predicting early response and assessing residual disease was then compared to the hitopathological results.  

The percentage increase in the ADC values, measured before and after the first cycleof NAC in responder patients, was significant, while the change in tumor diamter found after the 2nd cycle was only of border line significance. Following the first cycle of therapy, DWI had a sensitivity of 79% and a specificity up to 95% in differentiating responders from non responders. The senstvity and specificty for depicting residual tumor was 94% and 92% respectively for DW MR imaging, with a 89% and 94% results for contrast enhanced MR imaging.

Diffusion weighted MRI is a valuable tool in identifying responders and non responders to NAC, in patients with advanced breast cancer early during their treatment course, hence selecting only patients that will benefit from NAC and avoiding non responders any unnecessary toxicity.The overall accuracy of DWI in detecting residual disease is almost simillar to that of contrast enhanced MRI and can act as a substitute in patients that cannot be given contrast.

Early prediction of non responder by DWI  to neoadjuvant chemotherapy could potentially spare them unnecessary toxicity. Accurate delineation of the residual tumor could enhance surgical outcomes

Elkassas, H, Helal, M, Abourabia, A, Abdel Razek, N, Khorshid, O, Farahat, A, Zedan, M, Mansour, E, Role of MRI Diffusion, as an Adjunct to Contrast Enhanced MRI of The Breast, for the Evaluation of Patients with Locally Advanced Breast Cancer Receiving Neoadjuvant Chemotherapy.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014996.html