Breast MRI Trumps Clinical Exams in Predicting Chemo’s Response

The following article was written by Nola Hylton, Ph.D., Professor of Radiology, Director of the Breast MRI Research Program at UCSF.

New findings show that MRI is more effective than clinical examination for identifying patients whose tumors will respond well to chemotherapy before breast cancer surgery.  Traditionally, women who undergo pre-surgery chemotherapy are monitored with clinical examination to keep track of the tumor size and location. However, our findings have shown that MRI measurements taken throughout the chemotherapy process—before, during and after, are far more accurate than traditional clinical monitoring results.

It’s not uncommon for doctors to order MRIs following chemotherapy to determine the extent of remaining disease, but adding MRIs before and during the chemo cycle add a more accurate tumor diagnosis. We are trying to fine-tune MRI, so it can be a more sensitive measure of whether people are responding to chemotherapy.

The study’s initial findings show that after only one cycle of treatment, measuring the change in the tumor volume by MRI is very predictive of whether a patient ultimately has a good response to all of the chemotherapy. Results confirm that MRI has the greatest relative benefit over clinical exam when used early in the course of treatment.  This information might ultimately be used to guide treatment modifications based on an early assessment of response.

What we can see in these images helps us define, not only the size of the tumor, but its biological activity, as well. We can observe if the signal increases after contrast injection, and interpret that increase as angiogenic activity. Ongoing studies are also using water diffusion measurements with MRI to provide an indirect reflection of the density of the cells. These options are not possible with clinical examination.

For more information on breast MRI, please see here.