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Role of scintimammography in assessing the response of neoadjuvant chemotherapy in locally advanced breast cancer.

Trehan R, Seam RK, Gupta MK, Sood A, Dimri K, Mahajan R - World J Nucl Med (2014)

Bottom Line: The prechemotherapy Tc-99m sestamibi study predicted chemoresistance (WOR >45%) in 6 out of 20 patients and no chemoresistance (WOR <45%) in 14 out of 20 patients.When the WOR cut-off was set at >45%, the predictivity of the test was indicated by sensitivity of 91.7%, specificity of 62.5%, positive predictive value of 78.6%, and negative predictive value of 82.3% with a likelihood ratio of 0.1.WOR >45% is highly predictive of chemoresistance with likelihood ratio of 0.1 than WOR <45% being predictive of chemoresponsiveness.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiotherapy, Government Medical College and Hospital, Chandigarh, India.

ABSTRACT
Locally advanced breast cancer (LABC) is a common cancer in the developing countries. Neoadjuvant chemotherapy (NACT) is a very important step in the treatment of such tumors and hence that the disease can be down staged and made amenable for surgery. All the tumors do not respond to the therapy equally. Hence, it becomes very important to predict the response of chemotherapy in such cases. This study evaluated the role of scintimammography in assessing the response to NACT in 23 patients with LABC. Histologically proven 23 patients of LABC were recruited in this study. Prechemotherapy tumor size was measured clinically in all patients and technitium (Tc)-99m sestamibi test was performed before NACT for each patient. Early (10 min) and delayed (2 h) image of the breast were acquired in anterior and lateral views after Tc-99m sestamibi intravenous injections and wash out rate (WOR) was computed. After 3-4 cycles of chemotherapy, surgery in the form of modified radical mastectomy was performed in 20 out of 23 patients (3 patients lost to follow-up) with pathologic evaluation of the residual tumor size. The pretherapy Tc-99m sestamibi WOR ranged from 8.3% to 68% with mean ± SD of 34.5% ±16.5%. The prechemotherapy Tc-99m sestamibi study predicted chemoresistance (WOR >45%) in 6 out of 20 patients and no chemoresistance (WOR <45%) in 14 out of 20 patients. When the WOR cut-off was set at >45%, the predictivity of the test was indicated by sensitivity of 91.7%, specificity of 62.5%, positive predictive value of 78.6%, and negative predictive value of 82.3% with a likelihood ratio of 0.1. Tc-99m sestamibi WOR is a reliable test for predicting tumor response to NACT. WOR >45% is highly predictive of chemoresistance with likelihood ratio of 0.1 than WOR <45% being predictive of chemoresponsiveness.

No MeSH data available.


Related in: MedlinePlus

Patient no. 17 (responder case) - shows early and delayed images of scintigraphy studies of breast, who showed good response to chemotherapy on pathological examination. It evidenced intense tracer uptake in tumor in early image and low wash out rate in delayed image predicting good response to chemotherapy
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Figure 1: Patient no. 17 (responder case) - shows early and delayed images of scintigraphy studies of breast, who showed good response to chemotherapy on pathological examination. It evidenced intense tracer uptake in tumor in early image and low wash out rate in delayed image predicting good response to chemotherapy

Mentions: Clinical response was compared with scintigraphic prediction in 23 patients. It was observed that WOR correctly identified 10 patients as responders [Figures 1 and 2-case no. 17] and falsely identified 6 patients as responders when compared with clinical response. WOR correctly identified 4 patients as nonresponders out of 7 patients [Figures 3 and 4-case no. 21]. Pathological response was measured in 20 patients and was compared with scintigraphic prediction. It was observed that WOR correctly identified 11 patients as responders and falsely identified 3 patients as responders when compared with pathological response. WOR correctly identified 5 patients as nonresponders out of 6 patients. When clinical response was compared with pathological response, it was observed that, out of 20 patients, 9 clinical responders and 7 clinical nonresponders were correctly identified pathologically. Total 16 out of 20 patients matched clinically and pathologically. When level of agreement between clinical response and pathological response was seen, the findings were statistically different (P = 0.009). The level of agreement as seen by kappa coefficient was moderate. So, likelihood ratios are more relevant for pathological response that to the clinical response.


Role of scintimammography in assessing the response of neoadjuvant chemotherapy in locally advanced breast cancer.

Trehan R, Seam RK, Gupta MK, Sood A, Dimri K, Mahajan R - World J Nucl Med (2014)

Patient no. 17 (responder case) - shows early and delayed images of scintigraphy studies of breast, who showed good response to chemotherapy on pathological examination. It evidenced intense tracer uptake in tumor in early image and low wash out rate in delayed image predicting good response to chemotherapy
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4262874&req=5

Figure 1: Patient no. 17 (responder case) - shows early and delayed images of scintigraphy studies of breast, who showed good response to chemotherapy on pathological examination. It evidenced intense tracer uptake in tumor in early image and low wash out rate in delayed image predicting good response to chemotherapy
Mentions: Clinical response was compared with scintigraphic prediction in 23 patients. It was observed that WOR correctly identified 10 patients as responders [Figures 1 and 2-case no. 17] and falsely identified 6 patients as responders when compared with clinical response. WOR correctly identified 4 patients as nonresponders out of 7 patients [Figures 3 and 4-case no. 21]. Pathological response was measured in 20 patients and was compared with scintigraphic prediction. It was observed that WOR correctly identified 11 patients as responders and falsely identified 3 patients as responders when compared with pathological response. WOR correctly identified 5 patients as nonresponders out of 6 patients. When clinical response was compared with pathological response, it was observed that, out of 20 patients, 9 clinical responders and 7 clinical nonresponders were correctly identified pathologically. Total 16 out of 20 patients matched clinically and pathologically. When level of agreement between clinical response and pathological response was seen, the findings were statistically different (P = 0.009). The level of agreement as seen by kappa coefficient was moderate. So, likelihood ratios are more relevant for pathological response that to the clinical response.

Bottom Line: The prechemotherapy Tc-99m sestamibi study predicted chemoresistance (WOR >45%) in 6 out of 20 patients and no chemoresistance (WOR <45%) in 14 out of 20 patients.When the WOR cut-off was set at >45%, the predictivity of the test was indicated by sensitivity of 91.7%, specificity of 62.5%, positive predictive value of 78.6%, and negative predictive value of 82.3% with a likelihood ratio of 0.1.WOR >45% is highly predictive of chemoresistance with likelihood ratio of 0.1 than WOR <45% being predictive of chemoresponsiveness.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiotherapy, Government Medical College and Hospital, Chandigarh, India.

ABSTRACT
Locally advanced breast cancer (LABC) is a common cancer in the developing countries. Neoadjuvant chemotherapy (NACT) is a very important step in the treatment of such tumors and hence that the disease can be down staged and made amenable for surgery. All the tumors do not respond to the therapy equally. Hence, it becomes very important to predict the response of chemotherapy in such cases. This study evaluated the role of scintimammography in assessing the response to NACT in 23 patients with LABC. Histologically proven 23 patients of LABC were recruited in this study. Prechemotherapy tumor size was measured clinically in all patients and technitium (Tc)-99m sestamibi test was performed before NACT for each patient. Early (10 min) and delayed (2 h) image of the breast were acquired in anterior and lateral views after Tc-99m sestamibi intravenous injections and wash out rate (WOR) was computed. After 3-4 cycles of chemotherapy, surgery in the form of modified radical mastectomy was performed in 20 out of 23 patients (3 patients lost to follow-up) with pathologic evaluation of the residual tumor size. The pretherapy Tc-99m sestamibi WOR ranged from 8.3% to 68% with mean ± SD of 34.5% ±16.5%. The prechemotherapy Tc-99m sestamibi study predicted chemoresistance (WOR >45%) in 6 out of 20 patients and no chemoresistance (WOR <45%) in 14 out of 20 patients. When the WOR cut-off was set at >45%, the predictivity of the test was indicated by sensitivity of 91.7%, specificity of 62.5%, positive predictive value of 78.6%, and negative predictive value of 82.3% with a likelihood ratio of 0.1. Tc-99m sestamibi WOR is a reliable test for predicting tumor response to NACT. WOR >45% is highly predictive of chemoresistance with likelihood ratio of 0.1 than WOR <45% being predictive of chemoresponsiveness.

No MeSH data available.


Related in: MedlinePlus