Pretreatment prediction of pathologic complete response to neoadjuvant chemotherapy in breast cancer: Perfusion metrics of dynamic contrast enhanced MRI

The purpose of this study was to investigate imaging parameters predicting pathologic complete response (pCR) in pretreatment dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) in breast cancer patients who were treated with neoadjuvant chemotherapy (NAC). A total of 74 patients who received NAC followed by surgery were retrospectively reviewed. All patients underwent breast MRI before NAC. Perfusion parameters including Ktrans, Kep and Ve of tumor were measured three-dimensionally. These perfusion parameters of background parenchyma of contralateral breasts were analyzed two-dimensionally. Receiver-operating characteristic (ROC) analysis and multivariable logistic regression analysis were performed to compare the ability of perfusion parameters to predict pCR. Of 74 patients, 13 achieved pCR in final pathology. The fiftieth percentile and skewness of each perfusion parameter – Ktrans, Kep, and Ve of tumor were associated with pCR. Perfusion parameters of contralateral breast parenchyma in 2D analysis also showed predictive ability for pCR. The model combining perfusion parameters of contralateral breast background parenchyma and those of the tumor had higher predictive value than each single parameter. Thus, perfusion parameters of tumor, background parenchyma of contralateral breast and their combinations in pretreatment breast MRI allow early prediction for pCR of breast cancer.