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KMID : 0880420230240050384
Korean Journal of Radiology
2023 Volume.24 No. 5 p.384 ~ p.394
Changes in Automated Mammographic Breast Density Can Predict Pathological Response After Neoadjuvant Chemotherapy in Breast Cancer
Ahn Jee-Hyun

Go Ji-Eon
Lee Suk-Jun
Kim Jee-Ye
Park Hyung-Seok
Kim Seung-Il
Park Byeong-Woo
Vivian Youngjean Park
Yoon Jung-Hyun
Kim Min-Jung
Park Se-Ho
Abstract
Objective : Mammographic density is an independent risk factor for breast cancer that can change after neoadjuvant chemotherapy (NCT). This study aimed to evaluate percent changes in volumetric breast density (¥ÄVbd%) before and after NCT measured automatically and determine its value as a predictive marker of pathological response to NCT.

Materials and Methods : A total of 357 patients with breast cancer treated between January 2014 and December 2016 were included. An automated volumetric breast density (Vbd) measurement method was used to calculate Vbd on mammography before and after NCT. Patients were divided into three groups according to ¥ÄVbd%, calculated as follows: Vbd (post-NCT ? pre-NCT)/pre-NCT Vbd ¡¿ 100 (%). The stable, decreased, and increased groups were defined as -20% ¡Â ¥ÄVbd% ¡Â 20%, ¥ÄVbd% < -20%, and ¥ÄVbd% > 20%, respectively. Pathological complete response (pCR) was considered to be achieved after NCT if there was no evidence of invasive carcinoma in the breast or metastatic tumors in the axillary and regional lymph nodes on surgical pathology. The association between ¥ÄVbd% grouping and pCR was analyzed using univariable and multivariable logistic regression analyses.

Results : The interval between the pre-NCT and post-NCT mammograms ranged from 79 to 250 days (median, 170 days). In the multivariable analysis, ¥ÄVbd% grouping (odds ratio for pCR of 0.420 [95% confidence interval, 0.195?0.905; P = 0.027] for the decreased group compared with the stable group), N stage at diagnosis, histologic grade, and breast cancer subtype were significantly associated with pCR. This tendency was more evident in the luminal B-like and triple-negative subtypes.

Conclusion : ¥ÄVbd% was associated with pCR in breast cancer after NCT, with the decreased group showing a lower rate of pCR than the stable group. Automated measurement of ¥ÄVbd% may help predict the NCT response and prognosis in breast cancer.
KEYWORD
Mammography, Breast density, Breast neoplasm, Neoadjuvant therapy, Biomarkers, Predictive value of tests
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