{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:19:45Z","timestamp":1786979985989,"version":"build-2736575974"},"reference-count":43,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2024,7,5]],"date-time":"2024-07-05T00:00:00Z","timestamp":1720137600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,7,5]],"date-time":"2024-07-05T00:00:00Z","timestamp":1720137600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The aim of this study is to investigate the added value of diffusion-weighted imaging (DWI) to dynamic-contrast enhanced (DCE)-MRI to identify a pathological complete response (pCR) in patients with HER2-positive breast cancer and radiological complete response (rCR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This is a single-center observational study of 102 patients with stage I-III HER2-positive breast cancer and real-world documented rCR on DCE-MRI. Patients were treated between 2015 and 2019. Both 1.5\u2009T\/3.0\u2009T single-shot diffusion-weighted echo-planar sequence were used. Post neoadjuvant systemic treatment (NST) diffusion-weighted images were reviewed by two readers for visual evaluation and ADCmean. Discordant cases were resolved in a consensus meeting. pCR of the breast (ypT0\/is) was used to calculate the negative predictive value (NPV). Breast pCR-percentages were tested with Fisher\u2019s exact test. ADCmean and \u2206ADCmean(%) for patients with and without pCR were compared using a Mann-Whitney U-test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The NPV for DWI added to DCE is 86% compared to 87% for DCE alone in hormone receptor (HR)-\/HER2-positive and 67% compared to 64% in HR-positive\/HER2-positive breast cancer. Twenty-seven of 39 non-rCR DWI cases were false positives. In HR-positive\/HER2-positive breast cancer the NPV for DCE MRI differs between MRI field strength (1.5 T:\u00a050% vs. 3 T:\u00a081% [\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02]). ADCmean at baseline, post-NST, and \u2206ADCmean were similar between patients with and without pCR.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>DWI has no clinically relevant effect on the NPV of DCE alone to identify a pCR in early HER2-positive breast cancer. The added value of DWI in HR-positive\/HER2-positive breast cancer should be further investigated taken MRI field strength into account.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical relevance statement<\/jats:title>\n                    <jats:p>The residual signal on DWI after neoadjuvant systemic therapy in cases with early HER2-positive breast cancer and no residual pathologic enhancement on DCE-MRI breast should not (yet) be considered in assessing a complete radiologic response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>\n                            <jats:italic>Radiologic complete response is associated with a pathologic complete response (pCR) in HER2+ breast cancer\u00a0but further improvement is warranted.<\/jats:italic>\n                          <\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\n                            <jats:italic>No relevant increase in negative predictive value was observed when DWI was added to DCE.<\/jats:italic>\n                          <\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\n                            <jats:italic>Residual\u00a0signal\u00a0on DW-images without pathologic enhancement on DCE-MRI, does not indicate a lower chance of pCR.<\/jats:italic>\n                          <\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-024-10857-7","type":"journal-article","created":{"date-parts":[[2024,7,5]],"date-time":"2024-07-05T10:23:17Z","timestamp":1720174997000},"page":"7994-8004","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Diffusion-weighted imaging in addition to contrast-enhanced MRI in identifying complete response in HER2-positive breast cancer"],"prefix":"10.1007","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2016-1971","authenticated-orcid":false,"given":"Anna","family":"van der Voort","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kay J. 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Mann.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"R.M. Mann received research funding for studies unrelated to this work from: Siemens Healthineers, Bayer healthcare, Beckton & Dickinson, Screenpoint medical, Koning, PA Imaging. R.M. Mann is advisory editorial board member of <i>European Radiology<\/i>, associate editor for breast imaging of Radiology and member of the executive board of the European Society of Breast Imaging (EUSOBI). G.S. Sonke received institutional research funding from AstraZeneca, Merck, Novartis, Roche and Seagen and consulting fees from Biovica and Seagen, all unrelated to this work. All other authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}},{"value":"M. Lopez-Yurda kindly provided statistical advice for this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and Biometry"}},{"value":"Written informed consent was waived by the Institutional Review Board.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The Institutional Review Board approval from the Review Board of the Netherlands Cancer Institute was obtained.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"A subset of 45 patients have been previously reported in Van Ramshorst MS, Loo CE, Groen EJ et al (2017) MRI predicts pathologic complete response in HER2-positive breast cancer after neoadjuvant chemotherapy. Breast Cancer Res Treat. 164:99-106.\n                      \n                      .","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}