Breast MRI gauges therapy success in women with inflammatory disease

2019 07 22 20 17 2160 Mri Breast 400

Performing baseline breast MRI scans in women with inflammatory breast cancer can help clinicians gauge the success of preoperative chemotherapy, which if it is successful, improves mastectomy outcomes, according to a study published September 21 in Academic Radiology.

The results are good news for women suffering from this rare and aggressive cancer, as well as for the physicians treating them, wrote a team led by first author Dr. Eren Yeh of Brigham and Women's Hospital in Boston.

"[Breast] MRI is a useful adjunct modality to help clinicians establish the diagnosis of inflammatory breast cancer by illustrating skin involvement as thickening and enhancement," the group wrote. "Additionally, breast MRI is a valuable post-preoperative systemic therapy assessment tool to confirm the degree of imaging response in the affected breast and nodal groups."

Inflammatory breast cancer is uncommon, but it has a poor prognosis. It tends to manifest as skin thickening or redness and swelling in the breast. Also, since it isn't able to be easily resected when it appears, patients initially undergo a chemotherapy course before mastectomy to reduce tumor burden and thus make surgery more successful and prevent recurrence.

Yet despite the effort to mitigate disease burden before surgery, cancer can remain in the skin even after therapy, the team noted.

"[When] there are residual skin changes such as skin thickening, erythema, and edema on clinical examination following preoperative systemic therapy, it can be challenging for the treatment team to decide whether to proceed to mastectomy, continue systemic treatment, or have radiation prior to surgery," the authors wrote.

Breast MRI is often used for initial assessment of inflammatory breast cancer, as well as the disease's response to chemotherapy, according to Yeh and colleagues. But the specifics of breast MRI skin findings and inflammatory breast cancer response to treatment haven't been outlined, the researchers wrote.

To address this knowledge gap, Yeh's group reviewed 152 baseline and postchemotherapy breast MRIs from 76 women with inflammatory breast cancer. The team used the American College of Radiology's (ACR) MRI lexicon to match skin thickness and qualitative enhancement with pathologic skin response at mastectomy.

All 76 of the women showed skin thickening on baseline breast MRI, and 99% showed skin enhancement, Yeh's group found. After chemotherapy, 87% had residual skin thickening, with 84% demonstrating a decrease compared with baseline MRI results; 43% had continued skin enhancement. The investigators did not find any connection between postchemotherapy skin thickness on breast MRI and local-regional recurrence.

Although skin thickening and enhancement persisted after chemotherapy, they were reduced -- which suggests that patients can move forward with surgery and that recurrence rates will be low, the team noted.

"Despite persistent skin changes on MRI, patients achieving a partial or complete parenchymal response to preoperative systemic therapy may proceed to mastectomy with low local-regional recurrence rates," the authors concluded.

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