Dynamic contrast-enhanced magnetic resonance imaging in the assessment of inflammatory breast cancer prior to and after neoadjuvant treatment

Abstract

Background: The aim of this study was to describe the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) features of inflammatory breast cancer (IBC) and to assess the value of DCE-MRI for the prediction of pathological complete response (pCR). Methods: Image analysis was performed in 15 patients with IBC (cT4d) and 12 patients with non-IBC (cT2), and included the assessment of BIRADS characteristics, skin alterations, enhancement characteristics, and changes post chemotherapy. Sensitivity and specificity of DCE-MRI for the presence of residual disease were obtained. Pearson's correlation coefficients were calculated comparing the (preoperative) tumor size with the histological size. Results: Skin thickening/enhancement (80%) and non-mass-like enhancement (66.7%) occurred more often in IBC (16.7 vs. 8.3% in non-IBC). In 2 of 3 cases of IBC, pCR was correctly predicted (sensitivity 92%, specificity 67%), compared to 3 of 5 cases in non-IBC (sensitivity 86%, specificity 40%). Lower peak enhancement might be associated with a higher likelihood of pCR in IBC. No other parameters predicted eventual pCR. In IBC, no correlation between preoperative tumor size and histological size was found (r = 0.22, p = 0.50), whereas in non-IBC, size estimations were more accurate (r = 0.75, p = 0.03). Conclusion: IBC is characterized on MRI by skin changes and non-mass-like enhancement. Radiological complete response seems indicative of pCR in IBC and non-IBC. Size estimation of residual disease in IBC appears to be inaccurate.