Role of contrast enhanced spectral mammography in predicting pathological response of locally advanced breast cancer post neo-adjuvant chemotherapy

Objective To evaluate the accuracy of CESM technique in predicting the final pathological response and residual tumor size post NAC in LABC. Patients and methods This study was prospectively carried on 21 female patients diagnosed with stage II and III breast cancer. CESM was done at the end of last cycle of chemotherapy and before definitive surgery. Results The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), false negative and false positive of the CESM were assessed by comparing the enhancement of the residual lesions and their size post neoadjuvant chemotherapy (NAC) with the final pathological response and residual tumor size in the MD Anderson system. The specificity of the CESM in predicting the tumor response to NAC in this initial study is 91%, sensitivity was 40% and the NPV and PPV were 80% and 62.5% respectively. The sensitivity of this technique for complete response detection was 100% with a specificity 83% and lowered sensitivity in detecting chemoresistant tumors (33.3%). Conclusion CESM is an emerging easy technique that can predict the final pathologic tumor response after NAC especially complete response acting as a good negative technique.