Mammography Diagnostic Mammography, US, and MRI are complementary modalities for assessing primary tumor size before treatment because they are reliable tools to determine tumor size at diagnosis [1,11-15]. Mammography is most accurate for ductal and low-grade malignancies and less accurate for invasive lobular cancers and higher-grade lesions [11-16]. DBT addresses some of the limitations encountered with standard mammographic views. In addition to planar images, DBT creates thin-section reconstructed images, which decreases the lesion-masking effect of overlapping normal tissue. In the screening setting, some authors found the advantages of DBT to be especially pronounced in patients <50 years of age [17,18], in patients with dense breasts [17,19], and with lesion types including spiculated masses [20] and asymmetries [21]. DBT can also be useful in the diagnostic setting, improving lesion characterization [22-25] in noncalcified lesions compared with conventional mammography. Monitoring Response to Neoadjuvant Chemotherapy A prospective study of 166 patients with breast cancer compared DM to combined DM plus DBT for accuracy of local tumor staging. They demonstrated better accuracy of DM plus DBT for detecting additional ipsilateral and contralateral disease in patients with nondense breasts [26]. A retrospective study of 222 cancers demonstrated that pathologic response to NAC was less likely with the baseline mammographic finding of spiculation [27]. Because of the presence of dense tissue in up to 50% of patients, obscured margins may limit evaluation of the extent of disease [28]. Therefore, mammography or DBT is most often combined with other modalities, such as US or MRI, to guide clinical management. MRI Breast Without and With IV Contrast MRI is complementary to mammography and US for assessing tumor size before treatment. MRI permits evaluation of a viable tumor before and after NAC by detecting changes in tumor vascularity [31].
Monitoring Response to Neoadjuvant Systemic Therapy for Breast Cancer. Mammography Diagnostic Mammography, US, and MRI are complementary modalities for assessing primary tumor size before treatment because they are reliable tools to determine tumor size at diagnosis [1,11-15]. Mammography is most accurate for ductal and low-grade malignancies and less accurate for invasive lobular cancers and higher-grade lesions [11-16]. DBT addresses some of the limitations encountered with standard mammographic views. In addition to planar images, DBT creates thin-section reconstructed images, which decreases the lesion-masking effect of overlapping normal tissue. In the screening setting, some authors found the advantages of DBT to be especially pronounced in patients <50 years of age [17,18], in patients with dense breasts [17,19], and with lesion types including spiculated masses [20] and asymmetries [21]. DBT can also be useful in the diagnostic setting, improving lesion characterization [22-25] in noncalcified lesions compared with conventional mammography. Monitoring Response to Neoadjuvant Chemotherapy A prospective study of 166 patients with breast cancer compared DM to combined DM plus DBT for accuracy of local tumor staging. They demonstrated better accuracy of DM plus DBT for detecting additional ipsilateral and contralateral disease in patients with nondense breasts [26]. A retrospective study of 222 cancers demonstrated that pathologic response to NAC was less likely with the baseline mammographic finding of spiculation [27]. Because of the presence of dense tissue in up to 50% of patients, obscured margins may limit evaluation of the extent of disease [28]. Therefore, mammography or DBT is most often combined with other modalities, such as US or MRI, to guide clinical management. MRI Breast Without and With IV Contrast MRI is complementary to mammography and US for assessing tumor size before treatment. MRI permits evaluation of a viable tumor before and after NAC by detecting changes in tumor vascularity [31].