Accuracy of mammography and echography versus clinical palpation in the assessment of response to primary chemotherapy in breast cancer patients withoperable disease

The response to primary chemotherapy is an important prognostic factor in p atients with non metastatic breast cancer. In this study we compared the as sessment of response performed by clinical palpation to that performed by e chography and mammography in 141 out of 157 consecutive breast cancer patie nts (T2-4, N0-1, M0) submitted to primary chemotherapy. A low relationship was recorded between tumor size assessed clinically and that evaluated by e ither mammography: Spearman R = 0.38 or echography: R = 0.24, while a great er correlation was found between the tumor dimension obtained by the two im aging techniques (R = 0.62). According to the WHO criteria, the grade of re sponse of breast cancer to primary chemotherapy, showed by mammography and echography, was less marked than the grade of response seen at clinical exa mination. Residual tumor size assessed clinically depicted a stronger corre lation with pathological findings (R = 0.68) than the residual disease asse ssed by echography (R = 0.29) and mammography (R = 0.33). Post-chemotherapy histology evaluation revealed pathological complete response in three case s (2.1%). Two of these cases were judged as complete responders by clinical palpation but only one was recognized by mammography, and none by echograp hy. Clinical response, but not the response obtained by the two imaging tec hniques, was a significant predictor for longer disease free survival (p = 0.04). To conclude, physical examination measurements remain the method of choice in evaluating preoperatively the disease response in trials of prima ry chemotherapy. Prediction of pathological outcome is not improved by echo graphy and mammography.