A three-sequence dynamic contrast enhanced abbreviated MRI protocol to evaluate response to breast cancer neoadjuvant chemotherapy

Breast cancer is the most lethal neoplasia in women, with invasive carcinoma of no special type (NST) accounting for approximately 75% of breast carcinomas [1]. Systemic therapy performed before local surgical treatment, or neoadjuvant chemotherapy (NAC), may be indicated for breast cancer patients with large or locally advanced tumors, triple-negative or HER2-positive breast cancer, inflammatory breast cancer, or to assess response to treatment before surgery [[2], [3], [4], [5], [6]]. NAC is as effective as adjuvant (postoperative) therapy, with the advantage of reducing tumor size before surgery, thus allowing a more conservative procedure [7,8]. NAC can result in a complete pathological response (pCR), which refers to the absence of any residual invasive or in situ cancer cells in the breast tissue; achieving pCR after NAC has been associated with better long-term outcomes, such as a lower risk of cancer recurrence and improved survival, compared to patients who do not achieve pCR, especially in triple-negative and HER2 subtypes [[9], [10], [11]].

Breast magnetic resonance imaging (MRI) is the most accurate tool for assessing NAC response, with a range sensitivity of 63–88% and a range specificity of 54–91% in detecting residual tumor tissue. The radiologic-complete response (rCR) is a term used to describe an absence of post-contrast pathological enhancement [12]. However, it's important to note that rCR in imaging studies does not always correlate with pCR on surgical resection, as imaging studies may not be able to detect low-enhancement hypovascular residual lesions after NAC [12].

MRI full protocols (FP-MRIs) can last approximately 40 min, during which time multiple sequences for multiparametric breast evaluation are applied, thus generating hundreds of images [13]. Abbreviated breast MRI protocols (ABP-MRIs), focused mainly on the pre- and post-dynamic contrast-enhanced sequences, with subsequent evaluation of subtractions and MIP images, have been proposed to reduce examination time and thereby patient discomfort and imaging-associated costs [14,15]. In the past decade, studies with ABP-MRI for breast cancer have been performed primarily for screening [16] or breast lesion characterization [17,18]. However, an ABP-MRI for assessing NAC response still needs to be explored [19,20]. The present study aimed to develop an ABP-MRI to evaluate the response to NAC for invasive breast cancer with a diagnostic performance comparable to the FP-MRI.

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