A retrospective study of 114 patients demonstrated that posttreatment MBI had a lower sensitivity than MRI for detecting residual tumor (70% versus 83%). However, MBI was more specific than MRI in determining CR (90% versus 60%) [99]. At present, there is insufficient literature to support the routine use of Sestamibi MBI in imaging of the breast after initiation or completion of NAC. US Breast US is a reliable modality for determining tumor size, especially if the residual tumor measures >7 mm [100,101]. A decrease in tumor vascularity does appear to correlate with response [28]. In 2 studies, US predicted residual tumor size accurately in 60% to 80% of patients, compared with 32% to 71% for mammography [102,103]. In a study by Keune et al [104], the absence of residual disease on both mammography and US correlated with a pCR in 80% of patients. Although pretreatment tumor stiffness as determined by shear-wave elastography has shown strong correlation with response to therapy, there is insufficient data to support its routine use at this time [105,106]. In addition, there is insufficient data to support the routine use of contrast-enhanced US, although some early research suggests that changes in the time-intensity curves may reliably predict response to therapy [107,108]. Variant 3: Adult female or male or transfeminine (male-to-female) or transmasculine (female-to-male). Known breast cancer, clinically node-negative. Axillary evaluation prior to neoadjuvant chemotherapy. Initial imaging. Digital Breast Tomosynthesis Diagnostic There is no relevant literature to support the use of DBT in the initial imaging evaluation of the axilla before NAC. Mammography or DBT is performed for initial diagnosis of the primary breast cancer. This procedure incompletely images the axilla, although pathologically enlarged stage I and II nodes may be included on the lateral and mediolateral oblique projections.
Monitoring Response to Neoadjuvant Systemic Therapy for Breast Cancer. A retrospective study of 114 patients demonstrated that posttreatment MBI had a lower sensitivity than MRI for detecting residual tumor (70% versus 83%). However, MBI was more specific than MRI in determining CR (90% versus 60%) [99]. At present, there is insufficient literature to support the routine use of Sestamibi MBI in imaging of the breast after initiation or completion of NAC. US Breast US is a reliable modality for determining tumor size, especially if the residual tumor measures >7 mm [100,101]. A decrease in tumor vascularity does appear to correlate with response [28]. In 2 studies, US predicted residual tumor size accurately in 60% to 80% of patients, compared with 32% to 71% for mammography [102,103]. In a study by Keune et al [104], the absence of residual disease on both mammography and US correlated with a pCR in 80% of patients. Although pretreatment tumor stiffness as determined by shear-wave elastography has shown strong correlation with response to therapy, there is insufficient data to support its routine use at this time [105,106]. In addition, there is insufficient data to support the routine use of contrast-enhanced US, although some early research suggests that changes in the time-intensity curves may reliably predict response to therapy [107,108]. Variant 3: Adult female or male or transfeminine (male-to-female) or transmasculine (female-to-male). Known breast cancer, clinically node-negative. Axillary evaluation prior to neoadjuvant chemotherapy. Initial imaging. Digital Breast Tomosynthesis Diagnostic There is no relevant literature to support the use of DBT in the initial imaging evaluation of the axilla before NAC. Mammography or DBT is performed for initial diagnosis of the primary breast cancer. This procedure incompletely images the axilla, although pathologically enlarged stage I and II nodes may be included on the lateral and mediolateral oblique projections.