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Neoadjuvant Chemotherapy
Amy M. Fowler, MD, PhD; Wei Tse Yang, MBBS; Amal Melhem-Bertrandt, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Primary systemic neoadjuvant chemotherapy (NAC) or endocrine therapy (NET) prior to breast surgery
              • ↓ tumor burden to convert inoperable to operable; mastectomy to breast-conserving therapy (BCT); &/or downstage axilla
            • Assessment of response: Physical exam, imaging, pathology
            • Imaging Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1
              • Complete response: Resolution of imaging finding(s)
              • Progressive disease: 20% ↑ in lesion diameter &/or appearance of new lesions
              • Partial response: ≥ 30% ↓ in lesion diameter
              • Stable disease: Residual tumor, neither partial response nor progressive disease
            • Adjuvant therapy: Chemotherapy &/or endocrine therapy after definitive breast surgery

          IMAGING

          • Mammographic Findings

            • Ultrasonographic Findings

              • MR Findings

                • Nuclear Medicine Findings

                  • Image-Guided Biopsy

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • Staging, Grading, & Classification

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        • Reporting Tips

                                          Selected References

                                          1. The University of Texas MD Anderson Cancer Center: Residual Cancer Burden Calculator. Accessed January 16, 2019.
                                          2. Fukada I et al: Pattern of tumor shrinkage during neoadjuvant chemotherapy is associated with prognosis in low-grade luminal early breast cancer. Radiology. 286(1):49-57, 2018
                                          3. Mazari FAK et al: Human epidermal growth factor 2-positive breast cancer with mammographic microcalcification: relationship to pathologic complete response after neoadjuvant chemotherapy. Radiology. 170960, 2018
                                          4. Moy L: Do tumor shrinkage patterns at breast MR imaging predict survival? Radiology. 286(1):58-9, 2018
                                          5. Chen L et al: Direct comparison of PET/CT and MRI to predict the pathological response to neoadjuvant chemotherapy in breast cancer: a meta-analysis. Sci Rep. 7(1):8479, 2017
                                          6. Expert Panel on Breast Imaging et al: ACR Appropriateness Criteria® monitoring response to neoadjuvant systemic therapy for breast cancer. J Am Coll Radiol. 14(11S):S462-S475, 2017
                                          7. Fowler AM et al: Imaging neoadjuvant therapy response in breast cancer. Radiology. 285(2):358-375, 2017
                                          8. Symmans WF et al: Long-term prognostic risk after neoadjuvant chemotherapy associated with residual cancer burden and breast cancer subtype. J Clin Oncol. 35(10):1049-60, 2017
                                          9. Leddy R et al: Effects of neoadjuvant chemotherapy on benign breast lesions compared to cancers: should an additional lesion on magnetic resonance imaging responding similar to cancer after neoadjuvant chemotherapy be viewed with suspicion? J Clin Imaging Sci. 6:39, 2016
                                          10. De Los Santos JF et al: Magnetic resonance imaging as a predictor of pathologic response in patients treated with neoadjuvant systemic treatment for operable breast cancer. Translational Breast Cancer Research Consortium trial 017. Cancer. 119(10):1776-83, 2013
                                          11. Hylton N: MR imaging for the prediction of breast cancer response to neoadjuvant chemotherapy. Radiology. 266(1):367, 2013
                                          12. Luparia A et al: Accuracy of tumour size assessment in the preoperative staging of breast cancer: comparison of digital mammography, tomosynthesis, ultrasound and MRI. Radiol Med. 118(7):1119-36, 2013
                                          13. O'Sullivan TD et al: Optical imaging correlates with magnetic resonance imaging breast density and reveals composition changes during neoadjuvant chemotherapy. Breast Cancer Res. 15(1):R14, 2013
                                          14. Baselga J et al: Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO): a randomised, open-label, multicentre, phase 3 trial. Lancet. 2012 Feb 18;379(9816):633-40. Epub 2012 Jan 17. Erratum in: Lancet. 379(9816):616, 2012
                                          15. Esserman LJ et al: Pathologic complete response predicts recurrence-free survival more effectively by cancer subset: results from the I-SPY 1 TRIAL--CALGB 150007/150012, ACRIN 6657. J Clin Oncol. 30(26):3242-9, 2012
                                          16. Houssami N et al: Meta-analysis of the association of breast cancer subtype and pathologic complete response to neoadjuvant chemotherapy. Eur J Cancer. 48(18):3342-54, 2012
                                          17. Hylton NM et al: Locally advanced breast cancer: MR imaging for prediction of response to neoadjuvant chemotherapy--results from ACRIN 6657/I-SPY TRIAL. Radiology. 263(3):663-72, 2012
                                          18. Kuzucan A et al: Diagnostic performance of magnetic resonance imaging for assessing tumor response in patients with HER2-negative breast cancer receiving neoadjuvant chemotherapy is associated with molecular biomarker profile. Clin Breast Cancer. 12(2):110-8, 2012
                                          19. Shin HJ et al: Prediction of pathologic response to neoadjuvant chemotherapy in patients with breast cancer using diffusion-weighted imaging and MRS. NMR Biomed. 25(12):1349-59, 2012
                                          20. Tateishi U et al: Neoadjuvant chemotherapy in breast cancer: prediction of pathologic response with PET/CT and dynamic contrast-enhanced MR imaging--prospective assessment. Radiology. 263(1):53-63, 2012
                                          21. Untch M et al: Lapatinib versus trastuzumab in combination with neoadjuvant anthracycline-taxane-based chemotherapy (GeparQuinto, GBG 44): a randomised phase 3 trial. Lancet Oncol. 13(2):135-44, 2012
                                          22. Wahner-Roedler DL et al: The use of molecular breast imaging to assess response in women undergoing neoadjuvant therapy for breast cancer: a pilot study. Clin Nucl Med. 37(4):344-50, 2012
                                          23. Chen JH et al: Breast cancer: evaluation of response to neoadjuvant chemotherapy with 3.0-T MR imaging. Radiology. 261(3):735-43, 2011
                                          24. Loo CE et al: Magnetic resonance imaging response monitoring of breast cancer during neoadjuvant chemotherapy: relevance of breast cancer subtype. J Clin Oncol. 29(6):660-6, 2011
                                          25. Martoni AA et al: Prospective study on the FDG-PET/CT predictive and prognostic values in patients treated with neoadjuvant chemoradiation therapy and radical surgery for locally advanced rectal cancer. Ann Oncol. 22(3):650-6, 2011
                                          26. McGuire KP et al: MRI staging after neoadjuvant chemotherapy for breast cancer: does tumor biology affect accuracy? Ann Surg Oncol. 18(11):3149-54, 2011
                                          27. Gianni L et al: Neoadjuvant chemotherapy with trastuzumab followed by adjuvant trastuzumab versus neoadjuvant chemotherapy alone, in patients with HER2-positive locally advanced breast cancer (the NOAH trial): a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet. 375(9712):377-84, 2010
                                          28. Park SH et al: Diffusion-weighted MR imaging: pretreatment prediction of response to neoadjuvant chemotherapy in patients with breast cancer. Radiology. 257(1):56-63, 2010
                                          29. Straver ME et al: MRI-model to guide the surgical treatment in breast cancer patients after neoadjuvant chemotherapy. Ann Surg. 251(4):701-7, 2010
                                          30. Woodhams R et al: Identification of residual breast carcinoma following neoadjuvant chemotherapy: diffusion-weighted imaging--comparison with contrast-enhanced MR imaging and pathologic findings. Radiology. 254(2):357-66, 2010
                                          31. Yuan Y et al: Accuracy of MRI in prediction of pathologic complete remission in breast cancer after preoperative therapy: a meta-analysis. AJR Am J Roentgenol. 195(1):260-8, 2010
                                          32. Kelly AM et al: Breast cancer sentinel node identification and classification after neoadjuvant chemotherapy-systematic review and meta analysis. Acad Radiol. 16(5):551-63, 2009
                                          33. Lee JH et al: The role of radiotracer imaging in the diagnosis and management of patients with breast cancer: part 1--overview, detection, and staging. J Nucl Med. 50(4):569-81, 2009
                                          34. Pons F et al: Breast cancer therapy: the role of PET-CT in decision making. Q J Nucl Med Mol Imaging. 53(2):210-23, 2009
                                          35. Seo JH et al: Meta-analysis of pre-operative aromatase inhibitor versus tamoxifen in postmenopausal woman with hormone receptor-positive breast cancer. Cancer Chemother Pharmacol. 63(2):261-6, 2009
                                          36. Wahl RL et al: From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med. 50 Suppl 1:122S-50S, 2009
                                          37. Chen JH et al: Inflammatory breast cancer after neoadjuvant chemotherapy: can magnetic resonance imaging precisely diagnose the final pathological response? Ann Surg Oncol. 15(12):3609-13, 2008
                                          38. Chen JH et al: MRI evaluation of pathologically complete response and residual tumors in breast cancer after neoadjuvant chemotherapy. Cancer. 2008 Jan 1;112(1):17-26. Erratum in: Cancer. 112(7):1642, 2008
                                          39. Emmering J et al: Preoperative [18F] FDG-PET after chemotherapy in locally advanced breast cancer: prognostic value as compared with histopathology. Ann Oncol. 19(9):1573-7, 2008
                                          40. Padhani AR et al: Prediction of clinicopathologic response of breast cancer to primary chemotherapy at contrast-enhanced MR imaging: initial clinical results. Radiology. 239(2):361-74, 2006
                                          41. Peintinger F et al: Accuracy of the combination of mammography and sonography in predicting tumor response in breast cancer patients after neoadjuvant chemotherapy. Ann Surg Oncol. 13(11):1443-9, 2006
                                          42. Partridge SC et al: MRI measurements of breast tumor volume predict response to neoadjuvant chemotherapy and recurrence-free survival. AJR Am J Roentgenol. 184(6):1774-81, 2005
                                          43. Yeh E et al: Prospective comparison of mammography, sonography, and MRI in patients undergoing neoadjuvant chemotherapy for palpable breast cancer. AJR Am J Roentgenol. 184(3):868-77, 2005
                                          44. Londero V et al: Locally advanced breast cancer: comparison of mammography, sonography and MR imaging in evaluation of residual disease in women receiving neoadjuvant chemotherapy. Eur Radiol. 14(8):1371-9, 2004
                                          45. Tseng J et al: 18F-FDG kinetics in locally advanced breast cancer: correlation with tumor blood flow and changes in response to neoadjuvant chemotherapy. J Nucl Med. 45(11):1829-37, 2004
                                          46. Rosen EL et al: Accuracy of MRI in the detection of residual breast cancer after neoadjuvant chemotherapy. AJR Am J Roentgenol. 181(5):1275-82, 2003
                                          47. Burcombe RJ et al: Evaluation of good clinical response to neoadjuvant chemotherapy in primary breast cancer using [18F]-fluorodeoxyglucose positron emission tomography. Eur J Cancer. 38(3):375-9, 2002
                                          48. Partridge SC et al: Accuracy of MR imaging for revealing residual breast cancer in patients who have undergone neoadjuvant chemotherapy. AJR Am J Roentgenol. 179(5):1193-9, 2002
                                          49. Rouzier R et al: Primary chemotherapy for operable breast cancer: incidence and prognostic significance of ipsilateral breast tumor recurrence after breast-conserving surgery. J Clin Oncol. 19(18):3828-35, 2001
                                          50. Schelling M et al: Positron emission tomography using [(18)F]Fluorodeoxyglucose for monitoring primary chemotherapy in breast cancer. J Clin Oncol. 18(8):1689-95, 2000
                                          51. Young H et al: Measurement of clinical and subclinical tumour response using [18F]-fluorodeoxyglucose and positron emission tomography: review and 1999 EORTC recommendations. European Organization for Research and Treatment of Cancer (EORTC) PET Study Group. Eur J Cancer. 35(13):1773-82, 1999
                                          52. Bassa P et al: Evaluation of preoperative chemotherapy using PET with fluorine-18-fluorodeoxyglucose in breast cancer. J Nucl Med. 37(6):931-8, 1996
                                          53. Helvie MA et al: Locally advanced breast carcinoma: accuracy of mammography versus clinical examination in the prediction of residual disease after chemotherapy. Radiology. 198(2):327-32, 1996
                                          54. Vinnicombe SJ et al: Primary breast cancer: mammographic changes after neoadjuvant chemotherapy, with pathologic correlation. Radiology. 198(2):333-40, 1996
                                          55. Dershaw DD et al: Assessment of response to therapy of primary breast cancer by mammography and physical examination. Cancer. 75(8):2093-8, 1995
                                          56. Moskovic EC et al: Mammography in the assessment of response to medical treatment of large primary breast cancer. Clin Radiol. 47(5):339-44, 1993
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Pathology

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Definitions

                                                    • Primary systemic neoadjuvant chemotherapy (NAC) or endocrine therapy (NET) prior to breast surgery
                                                      • ↓ tumor burden to convert inoperable to operable; mastectomy to breast-conserving therapy (BCT); &/or downstage axilla
                                                    • Assessment of response: Physical exam, imaging, pathology
                                                    • Imaging Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1
                                                      • Complete response: Resolution of imaging finding(s)
                                                      • Progressive disease: 20% ↑ in lesion diameter &/or appearance of new lesions
                                                      • Partial response: ≥ 30% ↓ in lesion diameter
                                                      • Stable disease: Residual tumor, neither partial response nor progressive disease
                                                    • Adjuvant therapy: Chemotherapy &/or endocrine therapy after definitive breast surgery

                                                  IMAGING

                                                  • Mammographic Findings

                                                    • Ultrasonographic Findings

                                                      • MR Findings

                                                        • Nuclear Medicine Findings

                                                          • Image-Guided Biopsy

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • Staging, Grading, & Classification

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Consider

                                                                              • Image Interpretation Pearls

                                                                                • Reporting Tips

                                                                                  Selected References

                                                                                  1. The University of Texas MD Anderson Cancer Center: Residual Cancer Burden Calculator. Accessed January 16, 2019.
                                                                                  2. Fukada I et al: Pattern of tumor shrinkage during neoadjuvant chemotherapy is associated with prognosis in low-grade luminal early breast cancer. Radiology. 286(1):49-57, 2018
                                                                                  3. Mazari FAK et al: Human epidermal growth factor 2-positive breast cancer with mammographic microcalcification: relationship to pathologic complete response after neoadjuvant chemotherapy. Radiology. 170960, 2018
                                                                                  4. Moy L: Do tumor shrinkage patterns at breast MR imaging predict survival? Radiology. 286(1):58-9, 2018
                                                                                  5. Chen L et al: Direct comparison of PET/CT and MRI to predict the pathological response to neoadjuvant chemotherapy in breast cancer: a meta-analysis. Sci Rep. 7(1):8479, 2017
                                                                                  6. Expert Panel on Breast Imaging et al: ACR Appropriateness Criteria® monitoring response to neoadjuvant systemic therapy for breast cancer. J Am Coll Radiol. 14(11S):S462-S475, 2017
                                                                                  7. Fowler AM et al: Imaging neoadjuvant therapy response in breast cancer. Radiology. 285(2):358-375, 2017
                                                                                  8. Symmans WF et al: Long-term prognostic risk after neoadjuvant chemotherapy associated with residual cancer burden and breast cancer subtype. J Clin Oncol. 35(10):1049-60, 2017
                                                                                  9. Leddy R et al: Effects of neoadjuvant chemotherapy on benign breast lesions compared to cancers: should an additional lesion on magnetic resonance imaging responding similar to cancer after neoadjuvant chemotherapy be viewed with suspicion? J Clin Imaging Sci. 6:39, 2016
                                                                                  10. De Los Santos JF et al: Magnetic resonance imaging as a predictor of pathologic response in patients treated with neoadjuvant systemic treatment for operable breast cancer. Translational Breast Cancer Research Consortium trial 017. Cancer. 119(10):1776-83, 2013
                                                                                  11. Hylton N: MR imaging for the prediction of breast cancer response to neoadjuvant chemotherapy. Radiology. 266(1):367, 2013
                                                                                  12. Luparia A et al: Accuracy of tumour size assessment in the preoperative staging of breast cancer: comparison of digital mammography, tomosynthesis, ultrasound and MRI. Radiol Med. 118(7):1119-36, 2013
                                                                                  13. O'Sullivan TD et al: Optical imaging correlates with magnetic resonance imaging breast density and reveals composition changes during neoadjuvant chemotherapy. Breast Cancer Res. 15(1):R14, 2013
                                                                                  14. Baselga J et al: Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO): a randomised, open-label, multicentre, phase 3 trial. Lancet. 2012 Feb 18;379(9816):633-40. Epub 2012 Jan 17. Erratum in: Lancet. 379(9816):616, 2012
                                                                                  15. Esserman LJ et al: Pathologic complete response predicts recurrence-free survival more effectively by cancer subset: results from the I-SPY 1 TRIAL--CALGB 150007/150012, ACRIN 6657. J Clin Oncol. 30(26):3242-9, 2012
                                                                                  16. Houssami N et al: Meta-analysis of the association of breast cancer subtype and pathologic complete response to neoadjuvant chemotherapy. Eur J Cancer. 48(18):3342-54, 2012
                                                                                  17. Hylton NM et al: Locally advanced breast cancer: MR imaging for prediction of response to neoadjuvant chemotherapy--results from ACRIN 6657/I-SPY TRIAL. Radiology. 263(3):663-72, 2012
                                                                                  18. Kuzucan A et al: Diagnostic performance of magnetic resonance imaging for assessing tumor response in patients with HER2-negative breast cancer receiving neoadjuvant chemotherapy is associated with molecular biomarker profile. Clin Breast Cancer. 12(2):110-8, 2012
                                                                                  19. Shin HJ et al: Prediction of pathologic response to neoadjuvant chemotherapy in patients with breast cancer using diffusion-weighted imaging and MRS. NMR Biomed. 25(12):1349-59, 2012
                                                                                  20. Tateishi U et al: Neoadjuvant chemotherapy in breast cancer: prediction of pathologic response with PET/CT and dynamic contrast-enhanced MR imaging--prospective assessment. Radiology. 263(1):53-63, 2012
                                                                                  21. Untch M et al: Lapatinib versus trastuzumab in combination with neoadjuvant anthracycline-taxane-based chemotherapy (GeparQuinto, GBG 44): a randomised phase 3 trial. Lancet Oncol. 13(2):135-44, 2012
                                                                                  22. Wahner-Roedler DL et al: The use of molecular breast imaging to assess response in women undergoing neoadjuvant therapy for breast cancer: a pilot study. Clin Nucl Med. 37(4):344-50, 2012
                                                                                  23. Chen JH et al: Breast cancer: evaluation of response to neoadjuvant chemotherapy with 3.0-T MR imaging. Radiology. 261(3):735-43, 2011
                                                                                  24. Loo CE et al: Magnetic resonance imaging response monitoring of breast cancer during neoadjuvant chemotherapy: relevance of breast cancer subtype. J Clin Oncol. 29(6):660-6, 2011
                                                                                  25. Martoni AA et al: Prospective study on the FDG-PET/CT predictive and prognostic values in patients treated with neoadjuvant chemoradiation therapy and radical surgery for locally advanced rectal cancer. Ann Oncol. 22(3):650-6, 2011
                                                                                  26. McGuire KP et al: MRI staging after neoadjuvant chemotherapy for breast cancer: does tumor biology affect accuracy? Ann Surg Oncol. 18(11):3149-54, 2011
                                                                                  27. Gianni L et al: Neoadjuvant chemotherapy with trastuzumab followed by adjuvant trastuzumab versus neoadjuvant chemotherapy alone, in patients with HER2-positive locally advanced breast cancer (the NOAH trial): a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet. 375(9712):377-84, 2010
                                                                                  28. Park SH et al: Diffusion-weighted MR imaging: pretreatment prediction of response to neoadjuvant chemotherapy in patients with breast cancer. Radiology. 257(1):56-63, 2010
                                                                                  29. Straver ME et al: MRI-model to guide the surgical treatment in breast cancer patients after neoadjuvant chemotherapy. Ann Surg. 251(4):701-7, 2010
                                                                                  30. Woodhams R et al: Identification of residual breast carcinoma following neoadjuvant chemotherapy: diffusion-weighted imaging--comparison with contrast-enhanced MR imaging and pathologic findings. Radiology. 254(2):357-66, 2010
                                                                                  31. Yuan Y et al: Accuracy of MRI in prediction of pathologic complete remission in breast cancer after preoperative therapy: a meta-analysis. AJR Am J Roentgenol. 195(1):260-8, 2010
                                                                                  32. Kelly AM et al: Breast cancer sentinel node identification and classification after neoadjuvant chemotherapy-systematic review and meta analysis. Acad Radiol. 16(5):551-63, 2009
                                                                                  33. Lee JH et al: The role of radiotracer imaging in the diagnosis and management of patients with breast cancer: part 1--overview, detection, and staging. J Nucl Med. 50(4):569-81, 2009
                                                                                  34. Pons F et al: Breast cancer therapy: the role of PET-CT in decision making. Q J Nucl Med Mol Imaging. 53(2):210-23, 2009
                                                                                  35. Seo JH et al: Meta-analysis of pre-operative aromatase inhibitor versus tamoxifen in postmenopausal woman with hormone receptor-positive breast cancer. Cancer Chemother Pharmacol. 63(2):261-6, 2009
                                                                                  36. Wahl RL et al: From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med. 50 Suppl 1:122S-50S, 2009
                                                                                  37. Chen JH et al: Inflammatory breast cancer after neoadjuvant chemotherapy: can magnetic resonance imaging precisely diagnose the final pathological response? Ann Surg Oncol. 15(12):3609-13, 2008
                                                                                  38. Chen JH et al: MRI evaluation of pathologically complete response and residual tumors in breast cancer after neoadjuvant chemotherapy. Cancer. 2008 Jan 1;112(1):17-26. Erratum in: Cancer. 112(7):1642, 2008
                                                                                  39. Emmering J et al: Preoperative [18F] FDG-PET after chemotherapy in locally advanced breast cancer: prognostic value as compared with histopathology. Ann Oncol. 19(9):1573-7, 2008
                                                                                  40. Padhani AR et al: Prediction of clinicopathologic response of breast cancer to primary chemotherapy at contrast-enhanced MR imaging: initial clinical results. Radiology. 239(2):361-74, 2006
                                                                                  41. Peintinger F et al: Accuracy of the combination of mammography and sonography in predicting tumor response in breast cancer patients after neoadjuvant chemotherapy. Ann Surg Oncol. 13(11):1443-9, 2006
                                                                                  42. Partridge SC et al: MRI measurements of breast tumor volume predict response to neoadjuvant chemotherapy and recurrence-free survival. AJR Am J Roentgenol. 184(6):1774-81, 2005
                                                                                  43. Yeh E et al: Prospective comparison of mammography, sonography, and MRI in patients undergoing neoadjuvant chemotherapy for palpable breast cancer. AJR Am J Roentgenol. 184(3):868-77, 2005
                                                                                  44. Londero V et al: Locally advanced breast cancer: comparison of mammography, sonography and MR imaging in evaluation of residual disease in women receiving neoadjuvant chemotherapy. Eur Radiol. 14(8):1371-9, 2004
                                                                                  45. Tseng J et al: 18F-FDG kinetics in locally advanced breast cancer: correlation with tumor blood flow and changes in response to neoadjuvant chemotherapy. J Nucl Med. 45(11):1829-37, 2004
                                                                                  46. Rosen EL et al: Accuracy of MRI in the detection of residual breast cancer after neoadjuvant chemotherapy. AJR Am J Roentgenol. 181(5):1275-82, 2003
                                                                                  47. Burcombe RJ et al: Evaluation of good clinical response to neoadjuvant chemotherapy in primary breast cancer using [18F]-fluorodeoxyglucose positron emission tomography. Eur J Cancer. 38(3):375-9, 2002
                                                                                  48. Partridge SC et al: Accuracy of MR imaging for revealing residual breast cancer in patients who have undergone neoadjuvant chemotherapy. AJR Am J Roentgenol. 179(5):1193-9, 2002
                                                                                  49. Rouzier R et al: Primary chemotherapy for operable breast cancer: incidence and prognostic significance of ipsilateral breast tumor recurrence after breast-conserving surgery. J Clin Oncol. 19(18):3828-35, 2001
                                                                                  50. Schelling M et al: Positron emission tomography using [(18)F]Fluorodeoxyglucose for monitoring primary chemotherapy in breast cancer. J Clin Oncol. 18(8):1689-95, 2000
                                                                                  51. Young H et al: Measurement of clinical and subclinical tumour response using [18F]-fluorodeoxyglucose and positron emission tomography: review and 1999 EORTC recommendations. European Organization for Research and Treatment of Cancer (EORTC) PET Study Group. Eur J Cancer. 35(13):1773-82, 1999
                                                                                  52. Bassa P et al: Evaluation of preoperative chemotherapy using PET with fluorine-18-fluorodeoxyglucose in breast cancer. J Nucl Med. 37(6):931-8, 1996
                                                                                  53. Helvie MA et al: Locally advanced breast carcinoma: accuracy of mammography versus clinical examination in the prediction of residual disease after chemotherapy. Radiology. 198(2):327-32, 1996
                                                                                  54. Vinnicombe SJ et al: Primary breast cancer: mammographic changes after neoadjuvant chemotherapy, with pathologic correlation. Radiology. 198(2):333-40, 1996
                                                                                  55. Dershaw DD et al: Assessment of response to therapy of primary breast cancer by mammography and physical examination. Cancer. 75(8):2093-8, 1995
                                                                                  56. Moskovic EC et al: Mammography in the assessment of response to medical treatment of large primary breast cancer. Clin Radiol. 47(5):339-44, 1993