Accuracy of contrast-enhanced computed tomography in the prediction of residual breast cancer after neoadjuvant chemotherapy

Determination of the extent of residual disease after neoadjuvant chemother apy is sometimes inaccurate by conventional diagnostic methods. The purpose of this study was to evaluate the accuracy of contrast-enhanced computed t omography (CE-CT) in depicting the extent of residual carcinomas. Fifty-sev en patients with breast carcinomas of 3 cm diameter or more received neoadj uvant chemotherapy with four cycles of AT (doxorubicin and docetaxel). Befo re surgery, the patients underwent clinical examination, mammogram (MMG), u ltrasonography (US), and CE-CT. Thirteen patients were not evaluated by CE- CT before surgery. Enhancement patterns on CE-CT were classified into multi ple spots, tumor and spots, solid tumor type, and no enhancement. When all types of cancers were included in the analysis, clinical examination showed the best correlation with the pathology of the extent of residual carcinom as. However, except in invasive lobular carcinoma (ILC) and inflammatory br east carcinoma (IBC), CE-CT showed the best correlation (R-boolean AND2 = 0 .537). More than half of the residual microcalcifications on MMG after neoa djuvant chemotherapy suggested residual viable tumor. In conclusion, CE-CT is the most accurate noninvasive technique for identifying the extent of th e residual carcinoma after neoadjuvant chemotherapy if cases of IBC and ILC are excluded. (C) 2001 Wiley-Liss, Inc.