Breast MRI predicts effectiveness of chemo better

Magnetic resonance imaging (MRI) provides an indication of a breast tumour’s response to pre-surgical chemotherapy considerably earlier than possible through clinical examination, according to a new study. Women with breast cancer often undergo chemotherapy before the surgery. Research has revealed that women who receive this treatment, known as ‘neoadjuvant chemotherapy’, are more likely to achieve breast conservation than those receiving chemotherapy after surgery. Clinicians have tracked a patient`s response to ‘neoadjuvant chemotherapy’ through clinical measurements of the tumour’s size and location. Contrast-enhanced MRI, also known as Magnetic resonance imaging, offers a promising alternative to the clinical approach through its ability to detect blood vessel formation in tumours, known as angiogenesis. Angiogenesis is an earlier and more exact marker of tumour response. "MRI was better than the clinical approach for predicting which patients would go on to have complete tumour response," said Nola M. Hylton, Ph.D., professor of radiology and biomedical imaging at the University of California in San Francisco. "It gave us great information on early response to treatment," she said. For the study, researchers analyzed data from ‘ACRIN 6657’, the imaging component of the multicenter I-SPY TRIAL (Investigation of Serial Studies to Predict Your Therapeutic Response with Imaging and moLecular Analysis) breast cancer trial. They compared MRI and clinical assessment of 216 female patients ranging between the age from 26 to 68 years undergoing ‘neoadjuvant chemotherapy’ for stage II or III breast cancer. MRI sessions were performed before, during and after administration of a chemotherapy treatment. The researchers then correlated imaging results with subsequent laboratory analysis of surgical samples. Researchers discovered that MRI size measurements were superior to clinical examination at all time points, with tumour volume change showing the greatest relative benefit at the second MRI exam. Moreover, MRI was better than the clinical assessment in predicting both complete tumour response and residual cancer burden. The study reveals that how imaging can play a vital role in characterizing a tumour and monitoring treatment response. "What we see on imaging helps us define not just the size of the tumour but its biological activity," Hylton said. "We can observe if the signal increases after contrast injection, and interpret that increase as angiogenic activity. We can also use water diffusion measurements with MRI to provide an indirect reflection of the density of the cells," she added. Besides this, Hylton and colleagues are currently assessing I-SPY data to see if MRI is better for predicting the likelihood of breast cancer recurrence. This study has been published online in the journal Radiology.