Abstract 222P
Background
Inflammatory breast cancer (IBC) is an aggressive breast malignancy with rapid onset and poor outcomes. Correct diagnosis and efficient treatment in the form of neoadjuvant chemotherapy (NAC) improve these patients' prognosis. However, the biopsy is often falsely negative, and the effect of NAC is rarely predictable. This study is aimed at the role of MRI in diagnosis, staging (lymph nodes LN) and NAC response prediction of IBC.
Methods
In the retrospective study (01/2016 – 06/2020), 31 patients with clinical signs of IBC underwent pre-treatment core-cut and punch skin biopsy and MR, response to NAC (doxorubicin and/or taxane regimen, HER2+ with trastuzumab if applicable) was assessed by MRI after 2nd cycle (MRI-2). Response to NAC and local staging was evaluated postoperatively and compared with preoperative MRI signs (diagnosis of IBC, response to NAC, level of pathological LN).
Results
MRI confirmed correctly all cases of IBC, preoperative skin biopsy match was 66.66%. Pathological 3rd level LN were in 11(35.5%) cases of MRI: in 8 (72.7%) associated with pathological no response (pNR, p=0.08). 2nd level LN in 11(35.5%) patients: 6 (54.5%) with pNR, 1st level pathological LN appeared in 9 (29%) cases: 2 (22.22%) with pNR (p=0.03). MRI-2 identified 18 (58.05%) non-responders: 10 (55.56%) achieved pNR, 7 (38.89%) had residual disease (pRD), 1 (5,56%) complete response (pCR, p=0.001) and 10 (32.24%) responders: 9 (90%) with pCR/pRD, 1(10%) pNR. 3 patients (9.7%) with MRI-2 after 4. cycle (responders) achieved pNR.
Conclusions
Initial MRI is a superior method for diagnostics of IBC, where it is more reliable than skin biopsy. It also provides valuable predictive information: level of affected LN can predict achieved pathological response to NAC: patients with the 3rd level lymphadenopathy are more likely to have pNR. Finally, according to our observations, the non-responders to NAC identified by MR after the 2nd cycle rarely achieve pCR and are more likely to have pNR or pRD even after the change of regimen of NAC.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.