EJSO 2001; 27: 617–620 doi:10.1053/ejso.2001.1194, available online at http://www.idealibrary.com on Evaluation of response to neoadjuvant chemoradiotherapy for locally advanced breast cancer with dynamic contrast-enhanced MRI of the breast P. J. Drew, M. J. Kerin, T. Mahapatra, C. Malone, J. R. T. Monson, L. W. Turnbull* and J. N. Fox The University of Hull Academic Surgical Unit, Castle Hill Hospital, Castle Road, Hull HU16 5JQ, *The Centre for MR Investigations, Hull Royal Infirmary, Hull HU3 2JZ, UK Aims: This study aimed to examine the feasibility of utilizing dynamic contrast-enhanced MRI (DCE-MRI) of the breast for the planning of surgical intervention following neoadjuvant therapy for locally advanced breast cancer (LABC). Methods: Following their neoadjuvant therapy, women with LABC were followed-up by DCE-MRI in addition to clinical examination and mammography. If any modality suggested residual disease, surgery was carried out – initially salvage mastectomy and then breast-conserving surgery where appropriate. Results: Seventeen women were recruited: stage III (n=16), stage IV (n=1) mean age 55 (range 34–74). Following neoadjuvant therapy, 10 mastectomies and two local excisions were performed for 10 histologically confirmed residual cancers. Median follow-up for those women not undergoing surgery is 3.24 (IQR 2.8–3.5) years. DCE-MRI proved 100% accurate for the delineation of residual disease and facilitated the planning of the local excisions. Clinical examination and mammography proved inaccurate (PPV 83% and 75% and NPV 55% and 80%, respectively). Conclusions: DCE-MRI is a potentially accurate method of delineating residual tumour following neoadjuvant therapy for LABC and may be used to plan appropriate operative intervention where required.  2001 Harcourt Publishers Ltd Key words: breast cancer; locally advanced; neoadjuvant; RMI. have a poor prognosis and might possibly be spared INTRODUCTION extensive surgery. Neoadjuvant therapy for locally advanced breast cancer Dynamic contrast-enhanced MRI (DCE-MRI) of the (LABC) has now become the standard of care for this breast is an emerging imaging modality that relies on disease. 1–4 However, the precise role and sequence of fundamentally different principles to traditional X-ray each of the available therapeutic modalities remains mammography. 9 It is dependent on the vascularity of controversial. 3–5 Furthermore, pathologic examination of breast tumours rather than their tissue density and has the resected specimens has shown that, in a proportion been shown to be a reliable method for the diagnosis of patients, there is either a dramatic partial response of primary breast cancer and for the delineation of or a complete response to the induction therapy. 6 residual disease from scarring following breast- Unfortunately, both physical examination and conserving therapy. 8,10,11 We therefore examined the conventional imaging methods are unable to reliably ability of DCE-MRI to predict the presence of residual predict the presence or extent of residual or recurrent disease following neoadjuvant therapy for LABC. disease 7,8 and therefore a ‘salvage’ mastectomy is still often recommended in this group of patients who often METHODS Neoadjuvant therapy is our standard of care for patients Correspondence to: Mr P. J. Drew, The University of Hull Academic with LABC. From 1994, patients presenting to our Surgical Unit, Castle Hill Hospital, Hull HU16 5JQ, UK. Fax: 01482 623274. symptomatic clinics with LABC confirmed on fine needle 0748–7983/01/070617+04 $35.00/0  2001 Harcourt Publishers Ltd