Whitney J. Palmer

For patients with breast cancer receiving neoadjuvant therapy, MRI-guided breast biopsy could be a good way to assess how well they are responding to the treatment, according to the findings from a new study.

investigators from Memorial Sloan Kettering Cancer Center detailed how they used MRI-guided breast biopsy to correctly assess almost all patients post-chemotherapy. This outcome, they said, indicates that this strategy could give patients and providers an option other than surgical resection.

“This study’s results suggest that the accuracy of MRI-guided biopsy to diagnose a post-[neoadjuvant chemotherapy] [pathologic complete response] approaches that of reference-standard surgical resection,” said the team led by Elizabeth Sutton, M.D., breast MR expert and assistant professor of radiology at Weill Cornell Medical College. “MRI-guided biopsy may be a viable alternative to surgical resection for this population after [neoadjuvant chemotherapy].”

 Image-Guided Biopsy Picks Up Lingering Breast Cancer

Currently, the only available methods for evaluating a patient’s response to neoadjuvant therapy – treatments administered to side-step more invasive options – is surgical resection. Consequently, the push is on to find non-invasive ways to determine pathologic complete response in this patient group.

Sutton’s group decided to test MRI-guided biopsy because of the modality’s high level of sensitivity. To do this, they enrolled 20 patients between September 2017 to July 2019 into a non-randomized controlled trial. With this sample size, the team said, they had enough participants to accurately evaluate whether the strategy could reach a negative predictive value of at least 85 percent. The biopsy technique surpassed that benchmark, reaching a negative predictive value of nearly 95 percent, they found.

During the study, all participants received standard-of-care neoadjuvant chemotherapy, as well as definitive surgery for the treatment of stage IA to IIIC biopsy-proven operable invasive breast cancer. In addition, they also underwent non-contrast enhanced MRI both prior to and post-neoadjuvant chemotherapy.

Using a 1.5T or 3T whole body MRI scanner, as well as a vacuum-assisted biopsy system, the team removed between seven to 12 tissues samples from each patient via a single incision site which they marked before beginning chemotherapy.

According to their pathological analysis, 11 patients showed no residual cancer evidence, and eight were diagnosed with residual invasive cancer. Only one receive a ductal carcinoma in situ diagnosis. Of this group, the MRI-guided biopsy correctly pinpointed all the patients who did not have residual invasive cancer, but it did return a false-negative to a woman who had a residual cancer that measured less than 0.2 cm. In addition, they said, the MRI-guided biopsy also missed the ductal carcinoma in situ, returning a false negative to that patient, as well.

Overall, the team determined, MRI-guided biopsy offers a negative predictive value of 93 percent for invasive cancer and 86 percent for both in situ and invasive cancers.

“These preliminary results suggest that MRI-guided biopsy was an accurate approach for evaluating the extent of residual disease after [neoadjuvant chemotherapy],” the team concluded. “With an increasing focus on mitigating overtreatment and limiting potential toxic effects and cost, MRI-guided biopsy may be a viable alternative to surgical resection for appropriately selected patients after [neoadjuvant chemotherapy.]”

Still, they stressed, their results are not applicable to other patient populations, and further study around MRI-guided biopsy is needed.

For more coverage based on industry expert insights and research, subscribe to the Diagnostic Imaging e-Newsletter 

Articles

Using MRI-guided biopsy could help women avoid surgical resection to determine how well chemotherapy is working.

MRI-Guided Breast Biopsy Could Provide Non-Invasive Evaluation of Response to Neoadjuvant Treatment

In this week’s preview, here are some highlights of what you can expect to see coming soon:

Last week, you saw news that dense breast notification laws are working – just not as well as anyone had originally hoped. More women are learning about their particular circumstances and their individual characteristics that can place them at greater risk for an undetected breast cancer, but there is still work to do. But, do not get too discouraged. According to breast imaging expert Stamatia Destounis, M.D., FACR, with Elizabeth Wende Breast Care, there is more to be hopeful and excited about when it comes to the impact of these laws. Look for her input later this week.

For more coverage about breast density and dense breast notification laws, click 

Traumatic brain injury (TBI) can be devastating for any patient, and it can affect individuals differently. In a recent study from the National Institute of Neurological Disorders and Stroke, investigators have looked into how TBI can specifically affect women. Published in the 

researchers examine the growing opportunities and strategies, including imaging studies, to better understand how women experience these injuries. Keep an eye out for the study in the coming days.

For additional articles on traumatic brain injury, click 

Bone pain from cancer can be debilitating, so effective strategies to minimize what patients experience are important. In a new study from 

Clinical and Translational Radiation Oncology, 

investigators from The Netherlands look at the efficacy of MR-Guided High Intensity Focused Ultrasound as a potential tool to relief pain in patients. Read more about their findings later this week.

Here's what to expect this week on Diagnostic Imaging.

Diagnostic Imaging's A Look Ahead: Jan. 18, 2021, to Jan. 22, 2021

An artificial intelligence (AI) tool, developed using MRI data, could soon top the list of strategies used to determine which men are most likely to experience a prostate cancer recurrence.

Together with a small group of institutions, Case Western Reserve University has developed RadClip, an AI tool that is designed to make it easier for providers target patients with better treatment options. The team, led by Case Western doctoral Lin Li, published the details of their development recently in 

“This tool can help urologists, oncologists, and surgeons create better treatment plans so that their patients can have the most precise treatment,” said Li, who is working on her doctorate from Case Western’s Center for Computational Imaging and Personalized Diagnostics (CCIPD).

Being able to pinpoint which men might have a recurrence or who might die from prostate cancer is vital because it helps providers deliver additional therapy to those men earlier. RadClip can help with these predictions, she said, and it can also identify, on pre-operative MRI, the small heterogeneity and texture pattern differences both inside and outside the tumor area. This way, she added, estimating and predicting post-surgical outcomes is easier.

To accomplish this, RadClip uses AI algorithms to examine MRI scan and molecular data culled from Cleveland Clinic, University Hospitals, and Louis Stokes Cleveland Veterans Administration Medical Center. For this multi-institutional study, Li’s team applied RadClip to pre-operative MRI scans from nearly 200 patients who had undergone radical prostatectomy.

“We’re bringing together and connecting a variety of information, from radiologic scans like MRI to digitized pathology specimen slides and genomic data, for providing a more comprehensive characterization of the disease,” said senior study author Anat Madabhushi, CCIPD director and Donnell Institute biomedical engineering professor at Case Western.

The team, then, compared its results to other predictive strategies, including Cancer of the Prostate Risk Assessment (CAPRA) score and the genomic-based Decipher ® Prostate Cancer Test. Their analysis showed that RadClip gleans superior prognostic information to these tools.

“Genomic-based tests cost several thousand dollars and involve destructive testing of the tissue,” Madabhushi said. “Prognostic predictions from an MRI scan provide a non-invasive method for making both short-term and long-term decisions on treatment.”

The information gathered with RadClip offers several benefits to both prostate surgery and post-operative management, Li said. Surgeons can use the predictive data about cancer existence and extent collected from pre-operative MRI to determine how much tissue to remove, and oncologists can use the estimates of recurrence to target patients who need post-surgical adjuvant treatment, including radiation therapy or chemotherapy.

“Having this information before surgery,” she said, “provides surgeons and oncologists the time and space to adjust treatment plans and come up with a plan that’s best suited to the patient.”

Using pre-operative MRI data, an AI algorithm can help predict recurrence better than existing models.

MRI AI Tool Could Lead to More Targeted Prostate Cancer Treatment

Hyperfine Research, Inc., secure 510(k) clearance from the U.S. Food & Drug Administration for its Advanced AI image assessment software that can automatically measure and return annotated and segmented brain images.

This software works with Hyperfine’s Swoop™ Portable MR Imaging System, the first MRI system develop to capture brain MRI images at the patient’s bedside. In particular, this tool offers ventricular volume, image extraction, alignment, and midline shift. This data gives providers of all expertise levels the quantitate markers that are necessary for decision support, as well as the immediate feedback that can be critical for diagnostic feedback.

“With this powerful tool now built into the Swoop™ system, we are making MR imaging not only accessible at the bedside, but making it easier for providers to move quickly from scan to a recommended course of treatment,” said Khan Siddiqui, M.D., Hyperfine’s chief medical officer. “The data provided by Hyperfine’s deep learning software will liberate users of our MR technology by providing simple, accessible information in just minutes.”

Software provides annotated and segmented brain images captured by Hyperfine’s portable MRI system.

Whitney J. Palmer

Articles

MRI-Guided Breast Biopsy Could Provide Non-Invasive Evaluation of Response to Neoadjuvant Treatment

Diagnostic Imaging's A Look Ahead: Jan. 18, 2021, to Jan. 22, 2021

MRI AI Tool Could Lead to More Targeted Prostate Cancer Treatment

Hyperfine’s Image Assessment Software Captures FDA Clearance