Ultrasound is at least as good as magnetic resonance imaging in predicting tumour size post-neoadjuvant chemotherapy in breast cancer

Birgitte Vriens, Bart de Vries, Marc B. I. Lobbes, Saskia M. van Gastel, Franchette W. P. J. van den Berkmortel, Tineke J. Smilde, Laurence J. C. van Warmerdam, Maaike de Boer, Dick Johan van Spronsen, Marjolein L. Smidt, Petronella G. M. Peer, Maureen Aarts - Essers, Vivianne C. G. Tjan-Heijnen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: The aim of this study was to evaluate the accuracy of clinical imaging of the primary breast tumour post-neoadjuvant chemotherapy (NAC) related to the post-neoadjuvant histological tumour size (gold standard) and whether this varies with breast cancer subtype. In this study, results of both magnetic resonance imaging (MRI) and ultrasound (US) were reported.
Methods: Patients with invasive breast cancer were enrolled in the INTENS study between 2006 and 2009. We included 182 patients, of whom data were available for post-NAC MRI (n = 155), US (n = 123), and histopathological tumour size.
Results: MRI estimated residual tumour size with <10-mm discordance in 54% of patients, overestimated size in 28% and underestimated size in 18% of patients. With US, this was 63%, 20% and 17%, respectively. The negative predictive value in hormone receptor-positive tumours for both MRI and US was low, 26% and 33%, respectively. The median deviation in clinical tumour size as percentage of pathological tumour was 63% (P25 = 26, P75 = 100) and 49% (P25 = 22, P75 = 100) for MRI and US, respectively (P = 0.06).
Conclusions: In this study, US was at least as good as breast MRI in providing information on residual tumour size post-neoadjuvant chemotherapy. However, both modalities suffered from a substantial percentage of over- and underestimation of tumour size and in addition both showed a low negative predictive value of pathologic complete remission (Gov nr: NCT00314977).
Original languageEnglish
Pages (from-to)67-76
Number of pages10
JournalEuropean Journal of Cancer
Publication statusPublished - Jan 2016


  • Breast cancer
  • Neoadjuvant chemotherapy
  • Ultrasound (US)
  • Magnetic resonance imaging (MRI)


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