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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