Magnetic resonance imaging and ultrasound for prediction of residual tumor size in early breast cancer within the ADAPT subtrials

Monika Graeser*, Simone Schrading, Oleg Gluz, Kevin Strobel, Christopher Herzog, Lale Umutlu, Alex Frydrychowicz, Dorothea Rjosk-Dendorfer, Rachel Würstlein, Ralph Culemann, Christine Eulenburg, Jascha Adams, Henrik Nitzsche, Anna Prange, Sherko Kümmel, Eva Maria Grischke, Helmut Forstbauer, Michael Braun, Jochem Potenberg, Raquel von SchumannBahriye Aktas, Cornelia Kolberg-Liedtke, Nadia Harbeck, Christiane K. Kuhl, Ulrike Nitz

*Corresponding author for this work


    Background: Prediction of histological tumor size by post-neoadjuvant therapy (NAT) ultrasound and magnetic resonance imaging (MRI) was evaluated in different breast cancer subtypes. Methods: Imaging was performed after 12-week NAT in patients enrolled into three neoadjuvant WSG ADAPT subtrials. Imaging performance was analyzed for prediction of residual tumor measuring ≤10 mm and summarized using positive (PPV) and negative (NPV) predictive values. Results: A total of 248 and 588 patients had MRI and ultrasound, respectively. Tumor size was over- or underestimated by < 10 mm in 4.4% and 21.8% of patients by MRI and in 10.2% and 15.8% by ultrasound. Overall, NPV (proportion of correctly predicted tumor size ≤10 mm) of MRI and ultrasound was 0.92 and 0.83; PPV (correctly predicted tumor size > 10 mm) was 0.52 and 0.61. MRI demonstrated a higher NPV and lower PPV than ultrasound in hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-positive and in HR−/HER2+ tumors. Both methods had a comparable NPV and PPV in HR−/HER2− tumors. Conclusions: In HR+/HER2+ and HR−/HER2+ breast cancer, MRI is less likely than ultrasound to underestimate while ultrasound is associated with a lower risk to overestimate tumor size. These findings may help to select the most optimal imaging approach for planning surgery after NAT. Trial registration:, NCT01815242 (registered on March 21, 2013), NCT01817452 (registered on March 25, 2013), and NCT01779206 (registered on January 30, 2013).

    Original languageEnglish
    Article number36
    JournalBreast Cancer Research
    Issue number1
    Pages (from-to)36
    Publication statusPublished - 18.03.2021

    Research Areas and Centers

    • Academic Focus: Biomedical Engineering


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