This study aimed to evaluate the influence of hormonal receptor and Ki-67 proliferation marker in predicting MRI accuracy of measuring residual tumor size in HER2 negative breast cancer receiving neoadjuvant chemotherapy (NAC).
Fifty-four women were studied. Patients received AC and/or taxane-based regimens. The accuracy of MR determined clinical complete response (CCR) was compared to pathological complete response (pCR). The size of detectable residual tumor on MRI was correlated with pathology-diagnosed tumor size using Pearson’s correlation.
MRI correctly diagnosed 16 of the 17 pCR patients. There were 8 false negative diagnoses, 7 hormonal receptor (HR) positive and one HR negative. The overall sensitivity, specificity, and accuracy of MRI were 78%, 94%, and 83%, respectively. The positive predictive value was 97% and the negative predictive value was 67%. For MRI-pathology tumor size correlation, HR negative cancers showed a higher correlation (R=0.79) than HR positive cancers (R= 0.58). A worse MRI-pathology size discrepancy was found in HR positive cancer than in HR negative cancer (1.6±2.8 cm vs. 0.56±0.9 cm, p=0.05). Tumors with a low Ki-67 proliferation (<40%) showed a larger size discrepancy than those with a high Ki-67 proliferation (≥40%) (1.2±2.0 cm vs. 0.4±0.8 cm p=0.05).
The results showed that the diagnostic performance of MRI for breast cancer undergoing NAC is associated with molecular biomarker profile. Among HER2 negative tumors, the accuracy of MRI was worse in HR positive than negative cancers, and also worse in low proliferative than high proliferative tumors. These findings may help in surgical planning.