Abstract
The response to primary chemotherapy is an important prognostic factor in patients with non metastatic breast cancer. In this study we compared the assessment of response performed by clinical palpation to that performed by echography and mammography in 141 out of 157 consecutive breast cancer patients (T2-4, N0-1, M0) submitted to primary chemotherapy. A low relationship was recorded between tumor size assessed clinically and that evaluated by either mammography: Spearman R = 0.38 or echography: R = 0.24, while a greater correlation was found between the tumor dimension obtained by the two imaging techniques (R = 0.62). According to the WHO criteria, the grade of response of breast cancer to primary chemotherapy, showed by mammography and echography, was less marked than the grade of response seen at clinical examination. Residual tumor size assessed clinically depicted a stronger correlation with pathological findings (R = 0.68) than the residual disease assessed by echography (R = 0.29) and mammography (R = 0.33). Post-chemotherapy histology evaluation revealed pathological complete response in three cases (2.1%). Two of these cases were judged as complete responders by clinical palpation but only one was recognized by mammography, and none by echography. Clinical response, but not the response obtained by the two imaging techniques, was a significant predictor for longer disease free survival (p = 0.04). To conclude, physical examination measurements remain the method of choice in evaluating preoperatively the disease response in trials of primary chemotherapy. Prediction of pathological outcome is not improved by echography and mammography.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Fisher B, Bryant J, Wolmark N, Mamounas E, Brown A, Fisher ER, Wickerham DL, Begovic M, DeCillis A, Robidoux A, Margolese RG, Cruz AB, Jr, Hoehn JL, Lees AW, Dimitrov NV, Bear HD: Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol 16: 2672-2685, 1998
Bonadonna G, Valagussa P, Brambilla C, Ferrari L, Molinterni A, Terenziani M, Zambetti M: Primary chemotherapy in operable breast cancer: eight-years experience at the Milan Cancer Institute. J Clin Oncol 16: 93-100, 1998
Feldman LD, Hortobagyi GN, Buzdar AU, Ames FC, Blumenschein GR: Pathological assessment of response to induction chemotherapy in breast cancer. Cancer Res 46: 2578-2581, 1986
Nistrom L: Breast cancer screening with mammography: overview of Swedish randomized trials. Lancet 341: 973-978, 1993
Bassa P, Kim EE, Inoue T, Wong FCL, Korkmaz M, Yang DJ, Wong WH, Hicks KW, Buzdar AU, Podoloff DA: Evaluation of preoperative chemotherapy using PET with fluorine-18-fluorodeoxyglucose in breast Cancer. J Nucl Med 37: 931-938, 1996
Skaane P, Olsen JB, Sager EM, Abdelnoor M, Berger A, Kullmann G, Wolff PA: Variability in the interpretation of ultrasonography in patients with palpable noncalcified breast tumors. Acta Radiol 40(2): 163-168, 1999
Bonadonna G, Veronesi U, Brambilla C, Ferrari L, Luini A, Greco M, Bartoli C, Coopmans de Y, Zucali R, Rilke F, Andreola S, Silvestrini R, Di Fronzo G, Valagussa P: Primary chemotherapy to avoid mastectomy in tumors with diameters of 3 cm or more. J Natl Cancer Inst 82: 1539-1545, 1990
Helvie MA, Joynt LK, Cody RL, Pierce LJ, Adler DD, Merajver SD: Locally advanced breast carcinoma: accuracy of mammography versus clinical examination in the prediction of residual disease after chemotherapy. Radiology 198: 327-332, 1996
Fornage BD, Toubas O, Morel M: Clinical, mammographic, and sonographic determination of preoperative breast cancer size. Cancer 60: 765-771, 1987
Serrano-Migallon JA, Sandoval-Guerrero FJ, Miranda-Hernandez H, Martinez-Macias R: Estudio comparativo entre clinica, mastografia y ultrasonido, para determinar el tamano de las lesiones mamarias. Rev Inst Nal Cancerol (Mex) 39: 1931-1936, 1993
Gawne-Cain ML, Smith E, Darby M, Given-Wilson R: The use of ultrasound for monitoring breast tumour response to pro-adjuvant therapy. Clin Radiol 50(10): 681-686, 1995
Kurtz B, Achten C, Audretsch W, Rezai M, Urban P, Zocholl G: MR-mammography assessment of tumor response after neoadjuvant radiochemotherapy of locally advanced breast carcinoma. Rofo Fortscher Geb Rontgenstr Neuen Bildgeb Verfahr 164(6): 469-474, 1996
Cocconi G, di Blasio B, Alberti G, Bisagni G, Botti E, Peracchia G: Problems in evaluating response of primary breast cancer to systemic therapy. Breast Cancer Res Treat 4: 309-313, 1984
Segel MC, Paulus DD, Hortobagyi GN: Advanced primary breast cancer: assessment at mammography of response to induction chemotherapy. Radiology 169: 49-54, 1988
Dershaw DD, Drossman S, Liberman L, Abramson A: Assessment of response to therapy of primary breast cancer by mammography and physical examination. Cancer 75: 2093-2098, 1995
Lluch A, Cervantes A, Pardo JD, Cervera V, Pallardo Y, Ferrando F, Juan O, Martinez-Agullo A, Azagra P, Lledo S, Garcia-Conde J: Assessment of primary tumor and axillary (AX) involvement in breast cancer after neoadjuvant chemotherapy (NC). A comparison of clinical examination (CE), mammography (M), ultrasonography (US) and CT-scan (CT). Proc Am Soc Clin Oncol 14: 135, 1995
Herrada J, Revathy BI, Atkinson EN, Sneige N, Buzdar AU, Hortobagyi GN: Relative value of physical examination, mammography, and breast sonography in evaluating the size of the primary tumor and regional lymph node metastases in women receiving neoadjuvant chemotherapy for locally advanced breast carcinoma. Clin Cancer Res 3: 1565-1569, 1997
Bottini A, Berruti A, Bersiga A, Brunelli A, Brizzi MP, Di Marco B, Cirillo F, Tampellini M, Bolsi G, Aguggini S, Betri E, Filippini L, Bertoli A, Alquati P, Dogliotti L: Cytotoxic and antiproliferative activity of the CMF regimen administered in association with tamoxifen as primary chemotherapy in breast cancer patients. Int J Oncol 13: 385-390, 1998
Bottini A, Berruti A, Bersiga A, Brizzi MP, Brunelli A, Gorzegno G, DiMarco B, Aguggini S, Bolsi G, Cirillo F, Filippini L, Betri E, Bertoli G, Alquati P, Dogliotti L: p53 but not bcl2 immunostaining is predictive of poor clinical complete response to primary chemotherapy in breast cancer patients. Clin Cancer Res 6: 2751-2758, 2000
Miller AB, Hoogstroten B, Staquet M, Winkler A: Reporting results of cancer treatment. Cancer 47: 207-214, 1981
Kaplan EL, Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53: 457-481, 1958
Norusis MJ: SPSS/PC+ Base Manual for the IBM PC/XT/AT and PS/2. SPSS, Chicago, 1988
Fisher B, Brown A, Mamounas E, Wieand S, Robidoux A, Margolese RG, Cruz AB, jr, Fisher ER, Wickerham DL, Wolmark N, DeCillis A, Hoehn JL, Lees AW, Dimitrov NV: The effect of preoperative therapy on local-regional disease in women with operable breast cancer: findings from NSABP B-18. J Clin Oncol 15: 2483-2493, 1997
Vinnicombe SJ, MacVicar AD, Guy RL, Sloane JP, Powles TJ, Knee G, Husband JE: Primary breast cancer: mammographic changes after neoadjuvant chemotherapy, with pathologic correlation. Radiology 198: 333-340, 1996
Libshitz HI, Montague ED, Paulus DD: Calcifications and the therapeutically irradiated breast. AJR 128: 1021-1025, 1977
Moskovic EC, Mansi JL, Kind DM, Murch CR, Smith IE: Mammography in the assessment of response to medical treatment of large primary breast cancers. Clin Radiol 47: 339-344, 1993
Paulus DD, Libshitz HI: Breast. In: Libshitz HI (ed) Diagnostic Roentgenology of Radiotherapy Change. Williams & Wilkins, Baltimore, 1979
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Fiorentino, C., Berruti, A., Bottini, A. et al. Accuracy of mammography and echography versus clinical palpation in the assessment of response to primary chemotherapy in breast cancer patients with operable disease. Breast Cancer Res Treat 69, 143–151 (2001). https://doi.org/10.1023/A:1012277325168
Issue Date:
DOI: https://doi.org/10.1023/A:1012277325168