Diffusion-weighted MRI findings predict pathologic response in neoadjuvant treatment of breast cancer

The ACRIN 6698 multicenter trial

Savannah C. Partridge, Zheng Zhang, David C. Newitt, Jessica E. Gibbs, Thomas L. Chenevert, Mark A. Rosen, Patrick J. Bolan, Helga S. Marques, Justin Romanoff, Lisa Cimino, Bonnie N. Joe, Heidi R. Umphrey, Haydee Ojeda-Fournier, Basak Dogan, Karen Oh, Hiroyuki Abe, Jennifer S. Drukteinis, Laura J. Esserman, Nola M. Hylton

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Purpose: To determine if the change in tumor apparent diffusion coefficient (ADC) at diffusion-weighted (DW) MRI is predictive of pathologic complete response (pCR) to neoadjuvant chemotherapy for breast cancer. Materials and Methods: In this prospective multicenter study, 272 consecutive women with breast cancer were enrolled at 10 institutions (from August 2012 to January 2015) and were randomized to treatment with 12 weekly doses of paclitaxel (with or without an experimental agent), followed by 12 weeks of treatment with four cycles of anthracycline. Each woman underwent breast DW MRI before treatment, at early treatment (3 weeks), at midtreatment (12 weeks), and after treatment. Percentage change in tumor ADC from that before treatment (ADC) was measured at each time point. Performance for predicting pCR was assessed by using the area under the receiver operating characteristic curve (AUC) for the overall cohort and according to tumor hormone receptor (HR)/human epidermal growth factor receptor 2 (HER2) disease subtype. Results: The final analysis included 242 patients with evaluable serial imaging data, with a mean age of 48 years 6 10 (standard deviation); 99 patients had HR-positive (hereafter, HR+)/HER2-negative (hereafter, HER2-) disease, 77 patients had HR-/HER2-disease, 42 patients had HR+/HER2+ disease, and 24 patients had HR-/HER2+ disease. Eighty (33%) of 242 patients experienced pCR. Overall, ADC was moderately predictive of pCR at midtreatment/12 weeks (AUC = 0.60; 95% confidence interval [CI]: 0.52, 0.68; P = .017) and after treatment (AUC = 0.61; 95% CI: 0.52, 0.69; P = .013). Across the four disease subtypes, midtreatment ADC was predictive only for HR+/HER2- tumors (AUC = 0.76; 95% CI: 0.62, 0.89; P , .001). In a test subset, a model combining tumor subtype and midtreatment ADC improved predictive performance (AUC = 0.72; 95% CI: 0.61, 0.83) over ADC alone (AUC = 0.57; 95% CI: 0.44, 0.70; P = .032.). Conclusion: After 12 weeks of therapy, change in breast tumor apparent diffusion coefficient at MRI predicts complete pathologic response to neoadjuvant chemotherapy.

Original languageEnglish (US)
Pages (from-to)618-627
Number of pages10
JournalRadiology
Volume289
Issue number3
DOIs
StatePublished - Dec 1 2018

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Diffusion Magnetic Resonance Imaging
Neoadjuvant Therapy
Multicenter Studies
Breast Neoplasms
Area Under Curve
Hormones
Confidence Intervals
Therapeutics
Neoplasms
Drug Therapy
Anthracyclines
Paclitaxel
human ERBB2 protein
ROC Curve
Breast
Prospective Studies

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Partridge, S. C., Zhang, Z., Newitt, D. C., Gibbs, J. E., Chenevert, T. L., Rosen, M. A., ... Hylton, N. M. (2018). Diffusion-weighted MRI findings predict pathologic response in neoadjuvant treatment of breast cancer: The ACRIN 6698 multicenter trial. Radiology, 289(3), 618-627. https://doi.org/10.1148/radiol.2018180273

Diffusion-weighted MRI findings predict pathologic response in neoadjuvant treatment of breast cancer : The ACRIN 6698 multicenter trial. / Partridge, Savannah C.; Zhang, Zheng; Newitt, David C.; Gibbs, Jessica E.; Chenevert, Thomas L.; Rosen, Mark A.; Bolan, Patrick J.; Marques, Helga S.; Romanoff, Justin; Cimino, Lisa; Joe, Bonnie N.; Umphrey, Heidi R.; Ojeda-Fournier, Haydee; Dogan, Basak; Oh, Karen; Abe, Hiroyuki; Drukteinis, Jennifer S.; Esserman, Laura J.; Hylton, Nola M.

In: Radiology, Vol. 289, No. 3, 01.12.2018, p. 618-627.

Research output: Contribution to journalArticle

Partridge, SC, Zhang, Z, Newitt, DC, Gibbs, JE, Chenevert, TL, Rosen, MA, Bolan, PJ, Marques, HS, Romanoff, J, Cimino, L, Joe, BN, Umphrey, HR, Ojeda-Fournier, H, Dogan, B, Oh, K, Abe, H, Drukteinis, JS, Esserman, LJ & Hylton, NM 2018, 'Diffusion-weighted MRI findings predict pathologic response in neoadjuvant treatment of breast cancer: The ACRIN 6698 multicenter trial', Radiology, vol. 289, no. 3, pp. 618-627. https://doi.org/10.1148/radiol.2018180273
Partridge, Savannah C. ; Zhang, Zheng ; Newitt, David C. ; Gibbs, Jessica E. ; Chenevert, Thomas L. ; Rosen, Mark A. ; Bolan, Patrick J. ; Marques, Helga S. ; Romanoff, Justin ; Cimino, Lisa ; Joe, Bonnie N. ; Umphrey, Heidi R. ; Ojeda-Fournier, Haydee ; Dogan, Basak ; Oh, Karen ; Abe, Hiroyuki ; Drukteinis, Jennifer S. ; Esserman, Laura J. ; Hylton, Nola M. / Diffusion-weighted MRI findings predict pathologic response in neoadjuvant treatment of breast cancer : The ACRIN 6698 multicenter trial. In: Radiology. 2018 ; Vol. 289, No. 3. pp. 618-627.
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title = "Diffusion-weighted MRI findings predict pathologic response in neoadjuvant treatment of breast cancer: The ACRIN 6698 multicenter trial",
abstract = "Purpose: To determine if the change in tumor apparent diffusion coefficient (ADC) at diffusion-weighted (DW) MRI is predictive of pathologic complete response (pCR) to neoadjuvant chemotherapy for breast cancer. Materials and Methods: In this prospective multicenter study, 272 consecutive women with breast cancer were enrolled at 10 institutions (from August 2012 to January 2015) and were randomized to treatment with 12 weekly doses of paclitaxel (with or without an experimental agent), followed by 12 weeks of treatment with four cycles of anthracycline. Each woman underwent breast DW MRI before treatment, at early treatment (3 weeks), at midtreatment (12 weeks), and after treatment. Percentage change in tumor ADC from that before treatment (ADC) was measured at each time point. Performance for predicting pCR was assessed by using the area under the receiver operating characteristic curve (AUC) for the overall cohort and according to tumor hormone receptor (HR)/human epidermal growth factor receptor 2 (HER2) disease subtype. Results: The final analysis included 242 patients with evaluable serial imaging data, with a mean age of 48 years 6 10 (standard deviation); 99 patients had HR-positive (hereafter, HR+)/HER2-negative (hereafter, HER2-) disease, 77 patients had HR-/HER2-disease, 42 patients had HR+/HER2+ disease, and 24 patients had HR-/HER2+ disease. Eighty (33{\%}) of 242 patients experienced pCR. Overall, ADC was moderately predictive of pCR at midtreatment/12 weeks (AUC = 0.60; 95{\%} confidence interval [CI]: 0.52, 0.68; P = .017) and after treatment (AUC = 0.61; 95{\%} CI: 0.52, 0.69; P = .013). Across the four disease subtypes, midtreatment ADC was predictive only for HR+/HER2- tumors (AUC = 0.76; 95{\%} CI: 0.62, 0.89; P , .001). In a test subset, a model combining tumor subtype and midtreatment ADC improved predictive performance (AUC = 0.72; 95{\%} CI: 0.61, 0.83) over ADC alone (AUC = 0.57; 95{\%} CI: 0.44, 0.70; P = .032.). Conclusion: After 12 weeks of therapy, change in breast tumor apparent diffusion coefficient at MRI predicts complete pathologic response to neoadjuvant chemotherapy.",
author = "Partridge, {Savannah C.} and Zheng Zhang and Newitt, {David C.} and Gibbs, {Jessica E.} and Chenevert, {Thomas L.} and Rosen, {Mark A.} and Bolan, {Patrick J.} and Marques, {Helga S.} and Justin Romanoff and Lisa Cimino and Joe, {Bonnie N.} and Umphrey, {Heidi R.} and Haydee Ojeda-Fournier and Basak Dogan and Karen Oh and Hiroyuki Abe and Drukteinis, {Jennifer S.} and Esserman, {Laura J.} and Hylton, {Nola M.}",
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TY - JOUR

T1 - Diffusion-weighted MRI findings predict pathologic response in neoadjuvant treatment of breast cancer

T2 - The ACRIN 6698 multicenter trial

AU - Partridge, Savannah C.

AU - Zhang, Zheng

AU - Newitt, David C.

AU - Gibbs, Jessica E.

AU - Chenevert, Thomas L.

AU - Rosen, Mark A.

AU - Bolan, Patrick J.

AU - Marques, Helga S.

AU - Romanoff, Justin

AU - Cimino, Lisa

AU - Joe, Bonnie N.

AU - Umphrey, Heidi R.

AU - Ojeda-Fournier, Haydee

AU - Dogan, Basak

AU - Oh, Karen

AU - Abe, Hiroyuki

AU - Drukteinis, Jennifer S.

AU - Esserman, Laura J.

AU - Hylton, Nola M.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Purpose: To determine if the change in tumor apparent diffusion coefficient (ADC) at diffusion-weighted (DW) MRI is predictive of pathologic complete response (pCR) to neoadjuvant chemotherapy for breast cancer. Materials and Methods: In this prospective multicenter study, 272 consecutive women with breast cancer were enrolled at 10 institutions (from August 2012 to January 2015) and were randomized to treatment with 12 weekly doses of paclitaxel (with or without an experimental agent), followed by 12 weeks of treatment with four cycles of anthracycline. Each woman underwent breast DW MRI before treatment, at early treatment (3 weeks), at midtreatment (12 weeks), and after treatment. Percentage change in tumor ADC from that before treatment (ADC) was measured at each time point. Performance for predicting pCR was assessed by using the area under the receiver operating characteristic curve (AUC) for the overall cohort and according to tumor hormone receptor (HR)/human epidermal growth factor receptor 2 (HER2) disease subtype. Results: The final analysis included 242 patients with evaluable serial imaging data, with a mean age of 48 years 6 10 (standard deviation); 99 patients had HR-positive (hereafter, HR+)/HER2-negative (hereafter, HER2-) disease, 77 patients had HR-/HER2-disease, 42 patients had HR+/HER2+ disease, and 24 patients had HR-/HER2+ disease. Eighty (33%) of 242 patients experienced pCR. Overall, ADC was moderately predictive of pCR at midtreatment/12 weeks (AUC = 0.60; 95% confidence interval [CI]: 0.52, 0.68; P = .017) and after treatment (AUC = 0.61; 95% CI: 0.52, 0.69; P = .013). Across the four disease subtypes, midtreatment ADC was predictive only for HR+/HER2- tumors (AUC = 0.76; 95% CI: 0.62, 0.89; P , .001). In a test subset, a model combining tumor subtype and midtreatment ADC improved predictive performance (AUC = 0.72; 95% CI: 0.61, 0.83) over ADC alone (AUC = 0.57; 95% CI: 0.44, 0.70; P = .032.). Conclusion: After 12 weeks of therapy, change in breast tumor apparent diffusion coefficient at MRI predicts complete pathologic response to neoadjuvant chemotherapy.

AB - Purpose: To determine if the change in tumor apparent diffusion coefficient (ADC) at diffusion-weighted (DW) MRI is predictive of pathologic complete response (pCR) to neoadjuvant chemotherapy for breast cancer. Materials and Methods: In this prospective multicenter study, 272 consecutive women with breast cancer were enrolled at 10 institutions (from August 2012 to January 2015) and were randomized to treatment with 12 weekly doses of paclitaxel (with or without an experimental agent), followed by 12 weeks of treatment with four cycles of anthracycline. Each woman underwent breast DW MRI before treatment, at early treatment (3 weeks), at midtreatment (12 weeks), and after treatment. Percentage change in tumor ADC from that before treatment (ADC) was measured at each time point. Performance for predicting pCR was assessed by using the area under the receiver operating characteristic curve (AUC) for the overall cohort and according to tumor hormone receptor (HR)/human epidermal growth factor receptor 2 (HER2) disease subtype. Results: The final analysis included 242 patients with evaluable serial imaging data, with a mean age of 48 years 6 10 (standard deviation); 99 patients had HR-positive (hereafter, HR+)/HER2-negative (hereafter, HER2-) disease, 77 patients had HR-/HER2-disease, 42 patients had HR+/HER2+ disease, and 24 patients had HR-/HER2+ disease. Eighty (33%) of 242 patients experienced pCR. Overall, ADC was moderately predictive of pCR at midtreatment/12 weeks (AUC = 0.60; 95% confidence interval [CI]: 0.52, 0.68; P = .017) and after treatment (AUC = 0.61; 95% CI: 0.52, 0.69; P = .013). Across the four disease subtypes, midtreatment ADC was predictive only for HR+/HER2- tumors (AUC = 0.76; 95% CI: 0.62, 0.89; P , .001). In a test subset, a model combining tumor subtype and midtreatment ADC improved predictive performance (AUC = 0.72; 95% CI: 0.61, 0.83) over ADC alone (AUC = 0.57; 95% CI: 0.44, 0.70; P = .032.). Conclusion: After 12 weeks of therapy, change in breast tumor apparent diffusion coefficient at MRI predicts complete pathologic response to neoadjuvant chemotherapy.

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U2 - 10.1148/radiol.2018180273

DO - 10.1148/radiol.2018180273

M3 - Article

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