***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: PURPOSE To evaluate the accuracy of clinical examination and of three imaging modalities ( ultrasound [ US ] scan , mammography , and magnetic resonance imaging [ MRI ] ) to assess the tumor response of breast cancer to a preoperative regimen of concurrent radiochemotherapy for large breast cancers , using pathologic data as the reference . METHODS AND MATERIAL S Sixty women were accrued . Treatment consisted of 4 cycles of ( 5-fluorouracil-vinorelbine ) chemotherapy with , starting with the second cycle of chemotherapy , locoregional radiotherapy to the breast and the internal mammary and supraclavicular and infraclavicular lymph nodes . Breast surgery and axillary lymph node dissection were subsequently performed . Breast imaging assessment s were performed both before chemotherapy and preoperatively . RESULTS The correlation coefficients between tumor dimension at imaging and pathology were statistically significant for US scan ( r = 0.4 ; p = 0.006 ) and MRI ( r = 0.4 ; p = 0.004 ) but not for clinical examination ( r = 0.2 ; p = 0.16 ) or mammography ( r = -0.15 ; p = 0.31 ) . Furthermore , the area under the receiver operating characteristic curve for MRI was 0.81 , compared with 0.67 for US scan . At the optimal threshold score , MRI performed with 81 % sensitivity and 75 % specificity . CONCLUSION Compared with clinical examination , US scan , or mammography , MRI substantially improved the prediction of pathologic tumor response to preoperative concurrent radiochemotherapy for large breast cancers Background : The aim of this was to evaluate FDG-PET ( 2-(fluorine-18)-fluoro-2-deoxy-D-glucose positron emission tomography ) for assessment of residual tumour after primary chemotherapy of large and locally advanced breast cancer in comparison with conventional imaging modalities . Methods : In a prospect i ve multicentre trial , 99 patients underwent one or more breast imaging modalities before surgery in addition to clinical examination , namely , FDG-PET ( n=89 ) , mammography ( n=47 ) , ultrasound ( n=46 ) , and magnetic resonance imaging ( MRI ) ( n=46 ) . The presence of residual tumour by conventional imaging , dichotomised as positive or negative , and the level of FDG uptake ( st and ardised uptake values , SUV ) were compared with histopathology , which served as the reference st and ard . Patients with no residual tumour or only small microscopic foci of residual tumour were classified as having minimal residual disease and those with extensive microscopic and macroscopic residual tumour tissue were classified as having gross residual disease . Results : By applying a threshold SUV of 2.0 , the sensitivity of FDG-PET for residual tumour was 32.9 % ( specificity , 87.5 % ) and increased to 57.5 % ( specificity , 62.5 % ) at a threshold SUV of 1.5 . Conventional imaging modalities were more sensitive in identifying residual tumour , but had a low corresponding specificity ; sensitivity and specificity were as follows : MRI 97.6 and 40.0 % , mammography 92.5 and 57.1 % , ultrasound 92.0 and 37.5 % , respectively . Breast MRI provided the highest accuracy ( 91.3 % ) , whereas FDG-PET had the lowest accuracy ( 42.7 % ) . Conclusions : FDG-PET does not provide an accurate assessment of residual tumour after primary chemotherapy of breast cancer . Magnetic resonance imaging offers the highest sensitivity , but all imaging modalities have distinct limitations in the assessment of residual tumour tissue when compared with histopathology PURPOSE This study was design ed to determine the effect of adding docetaxel ( T ) to preoperative doxorubicin and cyclophosphamide ( AC ) on  breast cancer response rates and disease-free survival ( DFS ) and overall survival ( OS ) . PATIENTS AND METHODS Women with operable breast cancer ( N = 2,411 ) were r and omly assigned to receive preoperative AC followed by surgery , AC followed by T and surgery , or AC followed by surgery and then T. Tamoxifen was initiated concurrently with chemotherapy . Median time on study for 2,404 patients with follow-up was 77.9 months . RESULTS Addition of T to AC did not significantly impact DFS or OS . There were trends toward improved DFS with addition of T. The addition of T reduced the incidence of local recurrences as first events ( P = .0034 ) . Preoperative T , but not postoperative T , significantly improved DFS in patients who had a clinical partial response after AC ( hazard ratio [ HR ] = 0.71 ; 95 % CI , 0.55 to 0.91 ; P = .007 ) . Pathologic complete response , which was doubled by addition of preoperative T , was a significant predictor of OS regardless of treatment ( HR = 0.33 ; 95 % CI , 0.23 to 0.47 ; P < .0001 ) . Pathologic nodal status after chemotherapy was a significant predictor of OS ( P < .0001 ) . CONCLUSION The addition of preoperative or postoperative T after preoperative AC did not significantly affect OS , slightly improved DFS , and decreased the incidence of local recurrences . The sample size of this study was not sufficient to yield significance for the moderate DFS improvement . Concurrent use of tamoxifen may have limited the impact of adding In clinical measurement comparison of a new measurement technique with an established one is often needed to see whether they agree sufficiently for the new to replace the old . Such investigations are often analysed inappropriately , notably by using correlation coefficients . The use of correlation is misleading . An alternative approach , based on graphical techniques and simple calculations , is described , together with the relation between this analysis and the assessment of repeatability We compared dynamic contrast-enhanced MRI ( DCE-MRI ) and sonography ( US ) for monitoring tumour size in 21 patients with breast cancer undergoing primary chemotherapy ( PCT ) followed by surgery . The correlation between DCE-MRI and US  measurements of tumour size , defined as the product of the two major diameters , was 0.555 ( P=0.009 ) , 0.782 ( P<0.001 ) , and 0.793 ( P<0.001 ) at baseline , and after two and four cycles of PCT , respectively . The median tumour size was significantly larger when measured by DCE-MRI than by US at baseline ( 1472 vs 900 mm2 , P<0.001 ) and after two cycles of PCT ( 600 vs 400 mm2 , P=0.009 ) . After PCT , the median tumour size measured by the two techniques was similar ( 256 vs 289 mm2 for DCE-MRI and US , respectively , P=0.859 ) . The correlation with the histopathological major tumour diameter was 0.824 ( P<0.001 ) and 0.705 ( P<0.001 ) for post-treatment DCE-MRI and US , respectively . Measurements of the final major tumour diameter by DCE-MRI tended to be more precise , including cases achieving a pathological complete response . R and omized trials are warranted to establish the clinical impact of the initial discrepancy in tumour size estimates between DCE-MRI and US , and the trend towards a better definition of the final tumour size provided by DCE-MRI in this clinical setting Contrast-enhanced magnetic resonance imaging ( MRI ) was used to monitor the response of patients undergoing neoadjuvant chemotherapy for breast cancer with the aim of undergoing breast-conserving surgery ( BCS ) . Patients were prospect ively recruited to undergo MRI as well as conventional methods of clinical examination , mammography ( MM ) and ultrasonography ( USS ) and response was assessed by each of these methods . Thirty-two patients with primary breast cancer were recruited . Magnetic resonance imaging correlation with histopathological size ( r=0.71 ) was superior to USS ( r=0.65 ) and to MM where tumour size was not measurable following chemotherapy in 71 % of patients . Magnetic resonance imaging had 87.5 % sensitivity ( 95 % CI=68–97 % ) and 50 % specificity ( 95 % CI=16–84 % ) for a PPV ( positive predictive value ) of 99.8 % and NPV ( negative predictive value ) of 80 % for the detection of residual invasive cancer . Magnetic resonance imaging displayed 80 % sensitivity ( 95 % CI=28.4–99.5 % ) and 89 % specificity ( 95 % CI=71–98 % ) to detect pathological pCR in the breast . Eighty-four per cent of recruited patients were identified as potentially suitable c and i date s for BCS following chemotherapy and of those choosing to accept BCS , breast conservation was achieved in 90.5 % , or 65.6 % of all patients . Of those who proceeded to BCS , 9.5 % required a re-do mastectomy because of positive margins ; however , no residual tumour was found on histological examination of mastectomy specimens . Magnetic resonance imaging appears to be superior to conventional methods for assessing pathological response and the low rate of re-operation for positive margins indicates a valuable role in aiding the decision to undergo BCS or mastectomy AIMS We prospect ively compared the ability of magnetic resonance imaging ( MRI ) to measure residual breast cancer in patients treated with different neoadjuvant chemotherapy regimen . METHODS Forty patients with locally advanced breast carcinoma underwent neoadjuvant chemotherapy . Twelve patients received 5-fluoro-uracyl-epirubicin-cyclophosphamide ( FEC-group , six cycles ) , 28 ( DXL-group ) received docetaxel-based chemotherapy ( six cycles DXL-epirubicin : 13 patients , eight cycles DXL alone : 15 patients ) . All patients had baseline and preoperative MRI .  The spread of pathologic residual disease ( PRd ) was compared to preoperative MRI measures according to chemotherapy regimen . RESULTS MRI over/underestimation of the spread of residual tumour was never superior to 15 mm in FEC group , whereas it appeared in 11/28 ( 39 % , 30 - 48%-95 % CI ) patients in DXL group ( p=0.017 ) . Tumour shrinkage led to single nodular residual lesions in FEC group , whereas vast numerous microscopic nests were observed in docetaxel group in pathology . CONCLUSION Among tumours treated with a taxane-containing regimen , residual disease was frequently underestimated by MRI because of PRd features BACKGROUND Assessment of the change in tumour burden is an important feature of the clinical evaluation of cancer therapeutics : both tumour shrinkage ( objective response ) and disease progression are useful endpoints in clinical trials . Since RECIST was published in 2000 , many investigators , cooperative groups , industry and government authorities have adopted these criteria in the assessment of treatment outcomes . However , a number of questions and issues have arisen which have led to the development of a revised RECIST guideline ( version 1.1 ) . Evidence for changes , summarised in separate papers in this special issue , has come from assessment of a large data warehouse ( > 6500 patients ) , simulation studies and literature review s. HIGHLIGHTS OF REVISED RECIST 1.1 : Major changes include : Number of lesions to be assessed : based on evidence from numerous trial data bases merged into a data warehouse for analysis purpose s , the number of lesions required to assess tumour burden for response determination has been reduced from a maximum of 10 to a maximum of five total ( and from five to two per organ , maximum ) . Assessment of pathological lymph nodes is now incorporated : nodes with a short axis of 15 mm are considered measurable and assessable as target lesions . The short axis measurement should be included in the sum of lesions in calculation of tumour response . Nodes that shrink to < 10 mm short axis are considered normal . Confirmation of response is required for trials with response primary endpoint but is no longer required in r and omised studies since the control arm serves as appropriate means of interpretation of data . Disease progression is clarified in several aspects : in addition to the previous definition of progression in target disease of 20 % increase in sum , a 5 mm absolute increase is now required as well to guard against over calling PD when the total sum is very small . Furthermore , there is guidance offered on what constitutes ' unequivocal progression ' of non-measurable/non-target disease , a source of confusion in the original RECIST guideline . Finally , a section on detection of new lesions , including the interpretation of FDG-PET scan assessment is included . Imaging guidance : the revised RECIST includes a new imaging appendix with up date d recommendations on the optimal anatomical assessment of lesions . FUTURE WORK A key question considered by the RECIST Working Group in developing RECIST 1.1 was whether it was appropriate to move from anatomic unidimensional assessment of tumour burden to either volumetric anatomical assessment or to functional assessment with PET or MRI . It was concluded that , at present , there is not sufficient st and ardisation or evidence to ab and on anatomical assessment of tumour burden . The only exception to this is in the use of FDG-PET imaging as an adjunct to determination of progression . As is detailed in the final paper in this special issue , the use of these promising newer approaches requires appropriate clinical validation studies PURPOSE Accur 
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Conclusions There was no systematic bias in MRI tumor measurement , but LOA are large enough to be clinical ly important .
MRI ’s performance was generally superior to ultrasound , mammography , and clinical examination , and it may be considered the most appropriate test in this setting .