Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Changes in Automated Mammographic Breast Density Can Predict Pathological Response After Neoadjuvant Chemotherapy in Breast Cancer

  • Jee Hyun Ahn (Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine) ;
  • Jieon Go (Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine) ;
  • Suk Jun Lee (Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine) ;
  • Jee Ye Kim (Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine) ;
  • Hyung Seok Park (Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine) ;
  • Seung Il Kim (Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine) ;
  • Byeong-Woo Park (Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine) ;
  • Vivian Youngjean Park (Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Jung Hyun Yoon (Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Min Jung Kim (Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Seho Park (Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine)
  • Received : 2022.08.27
  • Accepted : 2023.03.10
  • Published : 2023.05.01
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Abstract

Objective: Mammographic density is an independent risk factor for breast cancer that can change after neoadjuvant chemotherapy (NCT). This study aimed to evaluate percent changes in volumetric breast density (ΔVbd%) before and after NCT measured automatically and determine its value as a predictive marker of pathological response to NCT. Materials and Methods: A total of 357 patients with breast cancer treated between January 2014 and December 2016 were included. An automated volumetric breast density (Vbd) measurement method was used to calculate Vbd on mammography before and after NCT. Patients were divided into three groups according to ΔVbd%, calculated as follows: Vbd (post-NCT - pre-NCT)/pre-NCT Vbd × 100 (%). The stable, decreased, and increased groups were defined as -20% ≤ ΔVbd% ≤ 20%, ΔVbd% < -20%, and ΔVbd% > 20%, respectively. Pathological complete response (pCR) was considered to be achieved after NCT if there was no evidence of invasive carcinoma in the breast or metastatic tumors in the axillary and regional lymph nodes on surgical pathology. The association between ΔVbd% grouping and pCR was analyzed using univariable and multivariable logistic regression analyses. Results: The interval between the pre-NCT and post-NCT mammograms ranged from 79 to 250 days (median, 170 days). In the multivariable analysis, ΔVbd% grouping (odds ratio for pCR of 0.420 [95% confidence interval, 0.195-0.905; P = 0.027] for the decreased group compared with the stable group), N stage at diagnosis, histologic grade, and breast cancer subtype were significantly associated with pCR. This tendency was more evident in the luminal B-like and triple-negative subtypes. Conclusion: ΔVbd% was associated with pCR in breast cancer after NCT, with the decreased group showing a lower rate of pCR than the stable group. Automated measurement of ΔVbd% may help predict the NCT response and prognosis in breast cancer.

Keywords

Acknowledgement

This study was supported by a faculty research grant of Yonsei University College of Medicine (6-2019-0168). This work was also supported by the Korea Medical Device Development Fund grant funded by the Korean government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, Republic of Korea, the Ministry of Food and Drug Safety) (Project Number: KMDF202011A01-04) and MSIT (NRF-2021R1A2C3006264).

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