CONDOR
Research type
Research Study
Full title
CONtrast-enhanced Digital breast tomosynthesis for the monitoring Of Response to neoadjuvant chemotherapy
IRAS ID
244564
Contact name
Andy Evans
Contact email
Sponsor organisation
University of Dundee
Duration of Study in the UK
1 years, 0 months, 17 days
Research summary
Summary of Research
More and more women who have breast cancer are treated with chemotherapy before surgery, (neoadjuvant chemotherapy (NACT)), to reduce the size of operation needed. It is important to monitor how the cancer responds to this treatment. This is currently done using magnetic resonance imaging (MRI). This involves the patient lying on their front within the MRI machine - a narrow tunnel - for up to 40 minutes. Unfortunately, many patients either cannot have, or are unable to manage an MRI. Patients may have to wait for an available MRI appointment due to service pressures and it is an expensive and time-consuming technique.
Contrast-enhanced digital breast tomosynthesis (CE-DBT) is a new type of imaging which combines contrast-enhanced spectral mammography (CESM); which shows the blood flow and new blood vessel formation found in most tumours, and digital breast tomosynthesis (DBT); which takes pictures in slices through the breast making cancers easier to see. Unlike MRI, CE-DBT only takes about 10 minutes to complete and is similar to a standard mammogram.
We think CE-DBT may offer an alternative way to monitor breast cancers which is preferred by patients and is more economical than MRI.
Patients being treated with NACT at Ninewells Hospital, Dundee would be invited to participate in this study. As well as monitoring with MRI at the start, mid-point and end of NACT they would also have a CE-DBT. Accuracy for assessment of response to NACT will be evaluated in comparison with final surgical pathology. This will be compared to the accuracy of MRI. Patient preference will be considered and measured using questionnaires after the initial and final CE-DBT and MRI.Summary of Results
This small pilot study compared how good two types of breast imaging were at showing how well breast cancer responds to chemotherapy when it is given before surgery, neoadjuvant chemotherapy (NACT). A new mammogram test called contrast enhanced tomosynthesis (CE-DBT) which is a combination of contrast enhanced spectral mammography (CESM) combined and digital breast tomosynthesis (DBT), was compared to the existing gold-standard test, magnetic resonance imaging (MRI). There were two parts to this study, the first looked at the accuracy of the two tests, the second looked at how the women involved found the different tests.
All women involved in the study were invited to have CESM alongside the usual MRI before they started chemotherapy and after they finished chemotherapy, before surgery. Women were asked to complete a questionnaire about their experiences after each imaging test. The questionnaires included ten questions on various aspects of their experiences and one question asked which test they would choose if the tests were equally good.
Test accuracy: Eighteen patients enrolled into the pilot study, of which 14 of these completed all imaging tests. Two patients had two cancer, so 16 cancers were included in the analysis. The chemotherapy caused a complete response (no remaining cancer cells) in ten cancers.
The test that was best at predicting if the cancer had completely responded was CESM, MRI was also very good. CESM was also best at predicting the size of invasive cancer, MRI was better at predicting size of all cancer cells, including early cancer cells lining the ducts but not spread into the breast tissue (DCIS). Adding tomosynthesis to CEM did not improve the accuracy of the test.
As the number of patients is small, we cannot be sure the differences are real or due to chance. However, we have shown that both CEM and MRI are very good for showing how a breast cancer responds to chemotherapy.
Patient preference and experience: Matched CE-DBT and MRI questionnaires were completed after 22 patient episodes. Patient preference was indicated after 31 patient episodes. Overall, more than three in four occasions women preferred CE-DBT. There was difference when the test happened before or after chemotherapy. Overall experience, non-breast pain, anxiety and feeling of being put at ease by staff was better for CE-DBT. However, more breast pain was experienced during CE-DBT.REC name
West of Scotland REC 3
REC reference
19/WS/0034
Date of REC Opinion
19 Mar 2019
REC opinion
Further Information Favourable Opinion