RADIOLOGICAL FOLLOW
UP OF BREAST CANCER
AFTER NEOADJUVANT
THERAPY
Assistant prof.
KIRMANJ I.BAKER

presurgical neoadjuvant chemotherapy is becoming the standard
of care in the treatment of locally advanced breast cancer (BC) and
is a treatment option for patients with early stage BC

 The most commonly recognized definition of pathologic
complete response pCR is the absence of invasive disease, with or
without in situ disease, in the breast and axillary lymph nodes

 Noninvasive imaging monitoring of treatment response during
neoadjuvant chemotherapy may help predict which patients will
achieve a pathologic complete response earlyin treatment to provide
alternate options for treatment and avoid unnecessary toxicity in
patients who do not experience a response
 accurate imaging for close monitoring of neoadjuvant
chemotherapy in patients with BC is essential

CONVENTIONAL IMAGING
 Mammography and breast ultrasound are the most commonly
used imaging modalities for tumor diagnosis and neoadjuvant
chemotherapy follow-up. However, they have variable accuracy for
assessing residual tumors after neoadjuvant chemotherapy because of
posttreatment changes, such as the development of fragmentation or
fibrosis.

 The initial mammographic appearance of the tumor influences the
accuracy of mammography in predicting residual tumor size

ultrasound is more accurate than mammography in
estimating residual tumor utrasound was more accurate than
mammography in measuring residual disease after neoadjuvant
chemotherapy; ultrasound was able to size the residual disease in
91.3% of cases compared with only 51.9% by mammography

 When both mammography and ultrasound found no residual
disease, the likelihood of pathologic complete response was 80% [ .
The use of both imaging modalities improved the accuracy of
predicting a pathologic complete response to neoadjuvant
chemotherapy to a greater degree than did the use of either modality
alone [

FUNCTIONAL IMAGING
 Dynamic contrast-enhanced..DCE-MRI …is superior for
predicting treatment response and evaluating residual disease. Newer
MRI sequences, such as DWI with ADC analysis, as well as
advanced imaging software using texture analysis and quantitative
dynamic contrast measurements, are promising tools for predicting
response

FDG PET Imaging
 The major limitation of FDG PET/CT is its inability to reliably
detect subcentimeter breast lesions because of its lower spatial
resolution, resulting in a high false-negative rate.

Novel Ultrasound-Based Imaging Breast
elastography tumors with low elastography had
statistically significantly higher pathologic complete
response rates than did those with high elastography
Contrast-enhanced ultrasound has show

 Axillary Nodal Imaging An axillary pathologic complete response
is seen in 40–75% of patients with biopsy-proven positive nodal disease
receiving neoadjuvant chemotherapy [Therefore, imaging the axilla
before and after neoadjuvant chemotherapy may affect disease
management. Ultrasound is a fast noninvasive inexpensive modality for
axillary nodal imaging. A metanalysis of nine studies by Alvarez et al.
showed that the overall sensitivity and specificity of ultrasound for the
detection of axillary nodal metastasis were 82% (range, 68–92%) and
96% (range, 80–97%), respectively. Ultrasound-guided biopsy increased
the specificity to 100%. A retrospective multimodality analysis of the
detection of node-positive disease after neoadjuvant chemotherapy
showed that ultrasound had the highest sensitivity (70%), followed by
FDG PET/CT (63%) and MRI (61%)