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Radiological follow up of breast cancer after neoadjuvant therapy.pptx

  2. presurgical neoadjuvant chemotherapy is becoming the standard of care in the treatment of locally advanced breast cancer (BC) and is a treatment option for patients with early stage BC
  3.  The most commonly recognized definition of pathologic complete response pCR is the absence of invasive disease, with or without in situ disease, in the breast and axillary lymph nodes
  4.  Noninvasive imaging monitoring of treatment response during neoadjuvant chemotherapy may help predict which patients will achieve a pathologic complete response earlyin treatment to provide alternate options for treatment and avoid unnecessary toxicity in patients who do not experience a response  accurate imaging for close monitoring of neoadjuvant chemotherapy in patients with BC is essential
  5. CONVENTIONAL IMAGING  Mammography and breast ultrasound are the most commonly used imaging modalities for tumor diagnosis and neoadjuvant chemotherapy follow-up. However, they have variable accuracy for assessing residual tumors after neoadjuvant chemotherapy because of posttreatment changes, such as the development of fragmentation or fibrosis.
  6.  The initial mammographic appearance of the tumor influences the accuracy of mammography in predicting residual tumor size
  7. ultrasound is more accurate than mammography in estimating residual tumor utrasound was more accurate than mammography in measuring residual disease after neoadjuvant chemotherapy; ultrasound was able to size the residual disease in 91.3% of cases compared with only 51.9% by mammography
  8.  When both mammography and ultrasound found no residual disease, the likelihood of pathologic complete response was 80% [ . The use of both imaging modalities improved the accuracy of predicting a pathologic complete response to neoadjuvant chemotherapy to a greater degree than did the use of either modality alone [
  9. FUNCTIONAL IMAGING  Dynamic contrast-enhanced..DCE-MRI …is superior for predicting treatment response and evaluating residual disease. Newer MRI sequences, such as DWI with ADC analysis, as well as advanced imaging software using texture analysis and quantitative dynamic contrast measurements, are promising tools for predicting response
  10. FDG PET Imaging  The major limitation of FDG PET/CT is its inability to reliably detect subcentimeter breast lesions because of its lower spatial resolution, resulting in a high false-negative rate.
  11. Novel Ultrasound-Based Imaging Breast elastography tumors with low elastography had statistically significantly higher pathologic complete response rates than did those with high elastography Contrast-enhanced ultrasound has show
  12.  Axillary Nodal Imaging An axillary pathologic complete response is seen in 40–75% of patients with biopsy-proven positive nodal disease receiving neoadjuvant chemotherapy [Therefore, imaging the axilla before and after neoadjuvant chemotherapy may affect disease management. Ultrasound is a fast noninvasive inexpensive modality for axillary nodal imaging. A metanalysis of nine studies by Alvarez et al. showed that the overall sensitivity and specificity of ultrasound for the detection of axillary nodal metastasis were 82% (range, 68–92%) and 96% (range, 80–97%), respectively. Ultrasound-guided biopsy increased the specificity to 100%. A retrospective multimodality analysis of the detection of node-positive disease after neoadjuvant chemotherapy showed that ultrasound had the highest sensitivity (70%), followed by FDG PET/CT (63%) and MRI (61%)