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Mammographic density as an image-based biomarker of therapy response in neoadjuvant-treated breast cancer patients.

Authors
  • Skarping, Ida1
  • Förnvik, Daniel2
  • Heide-Jørgensen, Uffe3
  • Sartor, Hanna4
  • Hall, Per5, 6
  • Zackrisson, Sophia4
  • Borgquist, Signe7, 8
  • 1 Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Skane University Hospital, Barngatan 4, 221 85, Lund, Sweden. [email protected] , (Sweden)
  • 2 Department of Translational Medicine, Medical Radiation Physics, Lund University, Skane University Hospital, Malmö, Sweden. , (Sweden)
  • 3 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. , (Denmark)
  • 4 Department of Translational Medicine, Diagnostic Radiology, Lund University, Skane University Hospital, Lund and Malmö, Sweden. , (Sweden)
  • 5 Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden. , (Sweden)
  • 6 Department of Oncology, Södersjukhuset, Stockholm, Sweden. , (Sweden)
  • 7 Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Skane University Hospital, Barngatan 4, 221 85, Lund, Sweden. , (Sweden)
  • 8 Department of Oncology, Aarhus University Hospital, Aarhus, Denmark. , (Denmark)
Type
Published Article
Journal
Cancer Causes & Control
Publisher
Springer-Verlag
Publication Date
Mar 01, 2021
Volume
32
Issue
3
Pages
251–260
Identifiers
DOI: 10.1007/s10552-020-01379-w
PMID: 33377172
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Personalized cancer treatment requires predictive biomarkers, including image-based biomarkers. Breast cancer (BC) patients receiving neoadjuvant chemotherapy (NACT) are in a clinically vulnerable situation with the tumor present. This study investigated whether mammographic density (MD), assessed pre-NACT, is predictive of pathological complete response (pCR). A total of 495 BC patients receiving NACT in Sweden 2005-2019 were included, merged from two different cohorts. Cohort 1 was retrospectively collected (n = 295) and cohort 2 was prospectively collected (n = 200). Mammograms were scored for MD pre-NACT according to the Breast Imaging-Reporting and Data System (BI-RADS), 5th Edition. The association between MD and accomplishing pCR post-NACT was analyzed using logistic regression models-for the whole cohort, stratified by menopausal status, and in different St. Gallen surrogate subtypes. In comparison to patients with low MD (BI-RADS a), the multivariable-adjusted odds ratio (OR) of accomplishing pCR following NACT was on a descending scale: 0.62 (95% confidence interval (CI) 0.24-1.57), 0.38 (95% CI 0.14-1.02), and 0.32 (95% CI 0.09-1.08) for BI-RADS b, c, and d, respectively. For premenopausal patients selectively, the corresponding point estimates were lower, although wider CIs: 0.31 (95% CI 0.06-1.62), 0.24 (95% CI 0.04-1.27), and 0.13 (95% CI 0.02-0.88). Subgroup analyses based on BC subtypes resulted in imprecise estimates, i.e., wide CIs. It seemed as though patients with higher MD at baseline were less likely to reach pCR after NACT-a finding more pronounced in premenopausal women. Larger multicenter studies are needed to enable analyses and interpretation for different BC subtypes.

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