Fusion Imaging Using Magnetic Resonance and Scintimammography for Locally Advanced Breast Cancer. Correlation Analysis in Patients Submitted To Neoajduvant Chemotherapy

INTRODUCTION: The scintimammography (SM) and its fusion with breast magnetic resonance imaging (MRI) was evaluated in breast cancer showing good results, but it was not used in local advanced breast cancer (LABC). PATIENTS AND METHODS: A prospective non-randomized trial, aproved by Ethics Committee 135/2008 (NCT 00820690) was conducted from July 2008 to December 2011. The study was performed in patients with LABC, clinical stage III. The patients were submitted to NAC. All the patients were submitted to MRI, SM. The Fusion software was created (ET) using MATLAB software plataform. Fusion of MRI / SM preoperatively and postoperatively. We conducted a correlation with the PE of the preoperative and with anatomopathological examination (AP) of the postoperative. We evaluated the largest tumor size by using the intraclass correlation coefficient (r) in order to perform a comparison among the different assessment methods. RESULTS: We evaluated 31 patients. In the pre-NAC the gold standard physical examination was adopted PE, and in the post the anatomopathological examination (AP) was used. The values of those coefficients in the pre NAC were PE vs MRI r = 0. 74, PE vs SMr = 0. 74, PF vs fusion of MRI/ SM r = 0. 69. The values of those coefficients in the post-treatment AP vs PE r = 0. 60, AP vs MRI r= 0.58, AP vs SM r = 0. 68, AP vs fusion MRI/SM r = 0.51 significance level 5%. The fusion of MRI /SM despite having shown a strong correlation (r = 0. 69) with the findings of PE pre-neoadjuvant chemotherapy in measuring the largest tumor size, showed no superiority of that method of associating images compared to the other two examinations (MRI and isolated SM). We observed a moderate correlation in relation to post-NAC (r = 0.51) for the fusion of MRI/SM vs AP for the largest tumor size, that correlation was lower than the other three methods evaluated in this time of the study (MRI r = 0.58; SM r = 0. 68, and PE r = 0. 60). DISCUSSION: There is no radiological imaging exams that gives the correct correlation between radiologicy and pathological tumor size. MRI seens to have the best correlation. The use of a new Fusion Imaging Software in patients submitted to surgery, showed a good correlation between Fusion Imaging (MRI + SM) and pathologic results. This is the first study to use this software in LABC. CONCLUSION: SM both in pre-NAC and post-NAC showed a strong correlation which is promising to that type of assessment.