Clinical Science Comparison of breast magnetic resonance imaging clinical tumor size with pathologic tumor size in patients status post-neoadjuvant chemotherapy Mindy Williams, M.D. a , Jennifer Eatrides, B.S. a , Jongphil Kim, Ph.D. b , Harpreet Talwar, M.D. a , Nicole Esposito, M.D. a , Margaret Szabunio, M.D. a , Roohi Ismail-Khan, M.D. a , John Kiluk, M.D. a , Marie Lee, M.D. a , Christine Laronga, M.D. a , Nazanin Khakpour, M.D. a, * a Department of Women’s Oncology, Comprehensive Breast Program, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA; b Department of Biostatistics, Moffitt Cancer Center, Tampa, FL, USA KEYWORDS: Breast cancer; Magnetic resonance imaging; Neoadjuvant chemotherapy Abstract BACKGROUND: Neoadjuvant chemotherapy (NACT) is used in breast cancer to evaluate the re- sponse to treatment. We examined the usefulness of breast magnetic resonance imaging (MRI) in the evaluation of tumor response after NACT. METHODS: Breast MRIs of 87 women with MRI after NACT were reviewed. The Spearman coef- ficient was used for estimating the correlation between MRI and pathologic tumor sizes (ypTs). RESULTS: The median age was 50 years (range 25 to 83 years). The median MRI size was 1.25 cm (range 0 to 10 cm). The median ypT was 1.20 cm (range 0 to 10.4 cm). The Spearman coefficient be- tween MRI and ypT was .78 (95% confidence interval, .67 to .85; P , .0001). MRI was found to have a positive predictive value of 92% and a negative predictive value of 64% for residual in-breast disease. The sensitivity and specificity of MRI were 86% and 77%, respectively. CONCLUSIONS: MRI correlates well with the final pathology and can be a useful modality to predict residual disease after NACT and aid in surgical planning. Ó 2013 Elsevier Inc. All rights reserved. Historically, neoadjuvant chemotherapy (NACT) was used to convert inoperable and locally advanced breast cancers into operable cancers. Currently, NACT is used to shrink the size of the cancer, making breast conservation an option. Regardless of surgical choice, tumor response after NACT is measured by residual in-breast and nodal disease. The amount of response (none, partial, or complete) can subsequently be used as an indicator of survival and recurrence risk because the remaining disease is considered an ‘‘in vivo’’ marker of chemotherapeutic efficacy. 1,2 Although the National Breast and Bowel Project B-18 Trial showed no difference in disease-free or overall sur- vival between the study arms (administration of che- motherapy before or after surgery), it did show that a complete pathologic response after NACT was correlated There is no industry support or conflict of interest to prepare this manuscript Presented at the 63rd Annual Cancer Symposium, Society of Surgical Oncology. March 3–7, 2010. St. Louis. * Corresponding author. Tel.: 11-813-745-8480; fax: 11-813-745- 7287. E-mail address: nazanin.khakpour@moffitt.org Manuscript received February 22, 2012; revised manuscript December 6, 2012 0002-9610/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.amjsurg.2013.02.006 The American Journal of Surgery (2013) 206, 567-573