Research Article
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Year 2022, Volume: 6 Issue: 1, 43 - 48, 01.01.2022
https://doi.org/10.28982/josam.1034379

Abstract

Supporting Institution

yok

Project Number

Etik kurul no: 215

References

  • 1. Huang M, O'Shaughnessy J, Zhao J, Haiderali A, Cortés J, Ramsey SD, et al. Association of Pathologic Complete Response with Long-Term Survival Outcomes in Triple-Negative Breast Cancer: A Meta-Analysis. Cancer Research. 2020 Dec 15;80(24):5427-34. doi: 10.1158/0008-5472.CAN-20-1792
  • 2. Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014 Jul 12;384(9938):164-72. doi: 10.1016/S0140-6736(13)62422-8
  • 3. Liedtke C, Mazouni C, Hess KR, Andre F, Tordai A, Mejia JA, et al. Response to neoadjuvant therapy and long-term survival in patients with triple-negative breast cancer. J Clin Oncol. 2008 Mar 10;26(8):1275–81. doi: 10.1200/JCO.2007.14.4147
  • 4. Takada M, Toi M. Neoadjuvant treatment for Her-2-positive breast cancer. Chin Clin Oncol.2020Jun; 9(3):32. doi: 10.21037/cco-20-123.
  • 5. Yıldız F, Oksuzoglu B. Efficacy and toxicity of everolimus plus exemestane in third and later lines treatment of hormone receptor-positive, HER2-negative metastatic breast cancer. J Surg Med. 2020;4(6):443-446. doi: 10.28982/josam.745731
  • 6. Sardanelli F, Giuseppetti GM, Panizza P, Bazzocchi M, Fausto A, Simonetti G, et al. Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in fatty and dense breast using the whole breast pathologic examination as a gold standard. AJR Am J Roentgenol. 2004 Oct;183:1149-57. doi: 10.2214/ajr.183.4.1831149
  • 7. Gharekhanloo F, Haseli MM, Torabian S. Value of Ultrasound in the Detection of Benign and Malignant Breast Diseases: A Diagnostic Accuracy Study. Oman Med J. 2018 Sept;33(5): 380–6. doi: 10.5001/omj.2018.71
  • 8. Liu H, Zhan H, Sun D. Comparison of BSGI, MRI, mammography, and ultrasound for the diagnosis of breast lesions and their correlations with specific molecular subtypes in Chinese women BMC Medical Imaging. 2020 Aug 15;20(1):98. doi: 10.1186/s12880-020-00497-w
  • 9. Xu HD and Zhang YQ. Evaluation of the efficacy of neoadjuvant chemotherapy for breast cancer using diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging. Neoplasma. 2017;64:430–6. doi: 10.4149/neo_2017_314.
  • 10. Fisher ER, Wang J, Bryant J, Fisher B, Mamounas E, Wolmark N. Pathobiology of preoperative chemotherapy: findings from the National Surgical Adjuvant Breast and Bowel (NSABP) protocol B-18. Cancer. 2002;95:681e95
  • 11. Fan F. Evaluation and reporting of breast cancer after neoadjuvant chemotherapy. Open Pathol J. 2009;3:58e63.
  • 12. Fitzgibbons P, Connolly J, Bose S, Chen Y, Baca M, Ergerton M. CAP protocol for the examination of specimens from patients with ınvasive carcinoma of the breast. Available at: https://documents.cap.org/protocols/cp-breast-invasive-18protocol-4100.pdf [Last accessed on Jun 10, 2021]
  • 13. Goldhirsch A, Winer EP, Coates AS, Gelber RD, Piccart-Gebhart M, Thurlimann B, et al. Personalizing the treatment of women with early breast cancer:Highlights of the St Gallen International Expert Consensus onthe Primary Therapy of Early Breast Cancer 2013. Ann Oncol.2013;24(9):2206-23. doi: 10.1093/annonc/mdt303
  • 14. Bogaerts J, Ford R, Sargent D, Schwartz LH, Rubinstein L, Lacombe D, et al. Individual patient data analysis to assess modifications to the RECIST criteria. Eur J Cancer. 2009 Jan;45(2):248-60. doi: 10.1016/j.ejca.2008.10.027
  • 15. Schwartz LH, Litière S, de Vries E, Ford R, Gwyther S, Mandrekar S, et al. RECIST 1.1-Update and clarification: From the RECIST committee. Eur J Cancer. 2016 Jul;62:132-7. doi: 10.1016/j.ejca.2016.03.081.
  • 16. Kim TH, Kang DK, Yim H, Jung YS, Kim KS, Kang SY. Magnetic resonance imaging patterns of tumor regression after neoadjuvant chemotherapy in breast cancer patients: correlation with pathological response grading system based on tumor cellularity. J Comput Assist Tomogr. 2012 Mar-Apr;36(2):200–6. doi: 10.1097/RCT.0b013e318246abf3
  • 17. Goorts B, Dreuning KMA, Houwers JB, Kooreman LFS, Boerma EG, Mann RM, et al. MRI-based response patterns during neoadjuvant chemotherapy can predict pathological (complete) response in patients with breast cancer. Breast Cancer Res. 2018 Apr 18;20(1):34. doi: 10.1186/s13058-018-0950-x.
  • 18. Ogston KN, Miller ID, Payne S, Hutcheon AW, Sarkar TK, Smith I, et al. A new histological grading system to assess response of breast cancers to primary chemotherapy: prognostic significance and survival. Breast. 2003 Oct;12:320–7. doi: 10.1016/s0960-9776(03)00106-1.
  • 19. MedCalc Software Ltd. Diagnostic test evaluation calculator. https://www.medcalc.org/calc/diagnostic_test.php (Version 20.011; accessed August 28, 2021)
  • 20. Wang B, Jiang T, Huang M, Wang J, Chu Y, Zhong L, Zheng S. Evaluation of the response of breast cancer patients to neoadjuvant chemotherapy by combined contrast-enhanced ultrasonography and ultrasound elastography. Exp Ther Med. 2019 May;17(5):3655-63 doi: 10.3892/etm.2019.7353
  • 21. Melchior NM, Sachs D, Gauvin G, Chang C, Wang CE, Sigurdson ER, et al. Treatment times in breast cancer patients receiving neoadjuvant vs adjuvant chemotherapy: Is efficiency a benefit of preoperative chemotherapy? Cancer Medicine. 2020 Apr;9(8):2742–51 doi: 10.1002/cam4.2912
  • 22. Rauch GM, Adrada BE, Kuerer HM, van la Parra RFD, Leung JWT, Yang WT. Multimodality Imaging for Evaluating Response to Neoadjuvant Chemotherapy in Breast Cancer. American Journal of Roentgenology, 2017 Feb;208(2):290–9. doi: 10.2214/ajr.16.17223
  • 23. Chen AM, Meric-Bernstam F, Hunt KK, Thames HD, Outlaw ED, Strom EA, et al. Breast conservation after neoadjuvant chemotherapy. Cancer. 2005 Feb 15;103(4):689–95. doi: 10.1002/cncr.20815.
  • 24. Kenue JD, Jeffe DB, Schootman M, Hoffman A, Gillanders WE, Aft RL. Accuracy of Ultrasonography and Mammography in Predicting Pathologic Response after Neoadjuvant Chemotherapy for Breast Cancer. Am J Surg. 2010 Apr;199(4):477–84. doi: 10.1016/j.amjsurg.2009.03.012
  • 25. Peitinger F, Kuerer HM, Anderson K, Boughey JC, Meric- Bernstam F, et al. Accuracy of the combination of mammography and sonography in predicting tumor response in breast cancer patients after neoadjuvant chemotherapy. Ann Surg Oncol 2006 Nov;13(11):1443-9. doi: 10.1245/s10434-006-9086-9
  • 26. Skarping I, Förnvik D, Jørgensen UH, Rydén L, Zackrisson S, Borgquist S. Neoadjuvant breast cancer treatment response; tumor size evaluation through different conventional imaging modalities in the NeoDense study. Acta Oncol 2020 Dec;59(12):1528-37. doi: 10.1080/0284186X.2020.1830167.
  • 27. Zhang K, Li J, Zhu Q, Chang C. Prediction of Pathologic Complete Response by Ultrasonography and Magnetic Resonance Imaging After Neoadjuvant Chemotherapy in Patients with Breast Cancer. Cancer Manag Res. 2020 Apr 16;12:2603–12. doi: 10.2147/CMAR.S247279.
  • 28. Kim hayashi HS, Lee CW, Lee ES. Magnetic Resonance Imaging (MRI) Assessment of Residual Breast Cancer After Neoadjuvant Chemotherapy: Relevance to Tumor Subtypes and MRI Interpretation Threshold. Clin Breast Cancer. 2018 Dec;18(6):459-67. doi: 10.1016/j.clbc.2018.05.009.
  • 29. Weber JJ, Jochelson MS, Eaton A, Zabor EC, Barrio AV, Gemignani ML, et al. MRI and Prediction of Pathologic Complete Response in the Breast and Axilla after Neoadjuvant Chemotherapy for Breast Cancer. Am Coll Surg. 2017 Dec;225(6):740-6. doi: 10.1016/j.jamcollsurg.2017.08.027.
  • 30. Hayashi N, Tsunoda H, Namura M, Ochi T, Suzuki K, Yamauchi H, et al. Magnetic Resonance Imaging Combined with Second-look Ultrasonography in Predicting Pathologic Complete Response After Neoadjuvant Chemotherapy in Primary Breast Cancer Patients. Clin Breast Cancer 2019 Feb;19(1):71-7. doi: 10.1016/j.clbc.2018.08.004

Diagnostic performance of breast imaging with ultrasonography, magnetic resonance and mammography in the assessment of residual tumor after neoadjuvant chemotherapy in breast cancer patients

Year 2022, Volume: 6 Issue: 1, 43 - 48, 01.01.2022
https://doi.org/10.28982/josam.1034379

Abstract

Background/Aim: Following the administration of neoadjuvant chemotherapy (NAC), a complete pathological response (pCR) is seen at rates of up to 50-70% in breast cancer patients, especially in triple-negative (TNBC) and HER-2 enriched subgroups and related to increased pCR rates, studies to predict the pathological response with preoperative evaluation are ongoing. The aim of this study was to investigate the correlation of preoperative imaging in breast cancer patients receiving NAC with the pathological response.
Methods: The study, organized as a retrospective cohort study, included 129 breast patients who underwent surgery after NAC between April 2014 and February 2020. The demographic data of the patients, the clinical and radiological findings before and after NAC, operation findings, and the histopathological evaluation results were collected retrospectively from the patient files. The radiological images of the patients were examined by separating into groups of patients with ultrasonography (US), magnetic resonance imaging (MRI), US+MRI, and mammography (MG)+US. The NAC response on preoperative breast US and MG was evaluated according to the RECIST-1.1 system, and the NAC response on MRI with the Goorts et al grading system. In the histopathological examination of operation material, the Miller Payne grading system for breast tissue was used in the determination of NAC response.
Results: The mean age of the patients in the study was 49.17 (11.00) years. The vast majority of the patients (87.6%) were diagnosed with invasive ductal cancer, with 27.13% in luminal A, 35.65% in luminal B, 31.0% in HER-2 enriched, and 6.2% in TNBC subgroups. A statistically significant correlation was determined between the pathological response and the US+MRI, MRI, and US+MG groups, with agreement at a moderate level (Kappa: 0.653, P<0.001; Kappa:0.443, P<0.001; Kappa:0.481, P=0.005, respectively). Within all the groups, the group with the highest sensitivity and accuracy were seen to be the patients evaluated with US+MRI (66.67%, 90.91%, respectively).
Conclusion: The results of this study demonstrated that there is a correlation between the pathological response and US+MRI, MRI, and US+MG evaluation after NAC. The US+MRI group was found to have the highest sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. When possible, the use of these two imaging methods together in the preoperative evaluation of patients is a successful method in the prediction of pathological response.

Project Number

Etik kurul no: 215

References

  • 1. Huang M, O'Shaughnessy J, Zhao J, Haiderali A, Cortés J, Ramsey SD, et al. Association of Pathologic Complete Response with Long-Term Survival Outcomes in Triple-Negative Breast Cancer: A Meta-Analysis. Cancer Research. 2020 Dec 15;80(24):5427-34. doi: 10.1158/0008-5472.CAN-20-1792
  • 2. Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014 Jul 12;384(9938):164-72. doi: 10.1016/S0140-6736(13)62422-8
  • 3. Liedtke C, Mazouni C, Hess KR, Andre F, Tordai A, Mejia JA, et al. Response to neoadjuvant therapy and long-term survival in patients with triple-negative breast cancer. J Clin Oncol. 2008 Mar 10;26(8):1275–81. doi: 10.1200/JCO.2007.14.4147
  • 4. Takada M, Toi M. Neoadjuvant treatment for Her-2-positive breast cancer. Chin Clin Oncol.2020Jun; 9(3):32. doi: 10.21037/cco-20-123.
  • 5. Yıldız F, Oksuzoglu B. Efficacy and toxicity of everolimus plus exemestane in third and later lines treatment of hormone receptor-positive, HER2-negative metastatic breast cancer. J Surg Med. 2020;4(6):443-446. doi: 10.28982/josam.745731
  • 6. Sardanelli F, Giuseppetti GM, Panizza P, Bazzocchi M, Fausto A, Simonetti G, et al. Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in fatty and dense breast using the whole breast pathologic examination as a gold standard. AJR Am J Roentgenol. 2004 Oct;183:1149-57. doi: 10.2214/ajr.183.4.1831149
  • 7. Gharekhanloo F, Haseli MM, Torabian S. Value of Ultrasound in the Detection of Benign and Malignant Breast Diseases: A Diagnostic Accuracy Study. Oman Med J. 2018 Sept;33(5): 380–6. doi: 10.5001/omj.2018.71
  • 8. Liu H, Zhan H, Sun D. Comparison of BSGI, MRI, mammography, and ultrasound for the diagnosis of breast lesions and their correlations with specific molecular subtypes in Chinese women BMC Medical Imaging. 2020 Aug 15;20(1):98. doi: 10.1186/s12880-020-00497-w
  • 9. Xu HD and Zhang YQ. Evaluation of the efficacy of neoadjuvant chemotherapy for breast cancer using diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging. Neoplasma. 2017;64:430–6. doi: 10.4149/neo_2017_314.
  • 10. Fisher ER, Wang J, Bryant J, Fisher B, Mamounas E, Wolmark N. Pathobiology of preoperative chemotherapy: findings from the National Surgical Adjuvant Breast and Bowel (NSABP) protocol B-18. Cancer. 2002;95:681e95
  • 11. Fan F. Evaluation and reporting of breast cancer after neoadjuvant chemotherapy. Open Pathol J. 2009;3:58e63.
  • 12. Fitzgibbons P, Connolly J, Bose S, Chen Y, Baca M, Ergerton M. CAP protocol for the examination of specimens from patients with ınvasive carcinoma of the breast. Available at: https://documents.cap.org/protocols/cp-breast-invasive-18protocol-4100.pdf [Last accessed on Jun 10, 2021]
  • 13. Goldhirsch A, Winer EP, Coates AS, Gelber RD, Piccart-Gebhart M, Thurlimann B, et al. Personalizing the treatment of women with early breast cancer:Highlights of the St Gallen International Expert Consensus onthe Primary Therapy of Early Breast Cancer 2013. Ann Oncol.2013;24(9):2206-23. doi: 10.1093/annonc/mdt303
  • 14. Bogaerts J, Ford R, Sargent D, Schwartz LH, Rubinstein L, Lacombe D, et al. Individual patient data analysis to assess modifications to the RECIST criteria. Eur J Cancer. 2009 Jan;45(2):248-60. doi: 10.1016/j.ejca.2008.10.027
  • 15. Schwartz LH, Litière S, de Vries E, Ford R, Gwyther S, Mandrekar S, et al. RECIST 1.1-Update and clarification: From the RECIST committee. Eur J Cancer. 2016 Jul;62:132-7. doi: 10.1016/j.ejca.2016.03.081.
  • 16. Kim TH, Kang DK, Yim H, Jung YS, Kim KS, Kang SY. Magnetic resonance imaging patterns of tumor regression after neoadjuvant chemotherapy in breast cancer patients: correlation with pathological response grading system based on tumor cellularity. J Comput Assist Tomogr. 2012 Mar-Apr;36(2):200–6. doi: 10.1097/RCT.0b013e318246abf3
  • 17. Goorts B, Dreuning KMA, Houwers JB, Kooreman LFS, Boerma EG, Mann RM, et al. MRI-based response patterns during neoadjuvant chemotherapy can predict pathological (complete) response in patients with breast cancer. Breast Cancer Res. 2018 Apr 18;20(1):34. doi: 10.1186/s13058-018-0950-x.
  • 18. Ogston KN, Miller ID, Payne S, Hutcheon AW, Sarkar TK, Smith I, et al. A new histological grading system to assess response of breast cancers to primary chemotherapy: prognostic significance and survival. Breast. 2003 Oct;12:320–7. doi: 10.1016/s0960-9776(03)00106-1.
  • 19. MedCalc Software Ltd. Diagnostic test evaluation calculator. https://www.medcalc.org/calc/diagnostic_test.php (Version 20.011; accessed August 28, 2021)
  • 20. Wang B, Jiang T, Huang M, Wang J, Chu Y, Zhong L, Zheng S. Evaluation of the response of breast cancer patients to neoadjuvant chemotherapy by combined contrast-enhanced ultrasonography and ultrasound elastography. Exp Ther Med. 2019 May;17(5):3655-63 doi: 10.3892/etm.2019.7353
  • 21. Melchior NM, Sachs D, Gauvin G, Chang C, Wang CE, Sigurdson ER, et al. Treatment times in breast cancer patients receiving neoadjuvant vs adjuvant chemotherapy: Is efficiency a benefit of preoperative chemotherapy? Cancer Medicine. 2020 Apr;9(8):2742–51 doi: 10.1002/cam4.2912
  • 22. Rauch GM, Adrada BE, Kuerer HM, van la Parra RFD, Leung JWT, Yang WT. Multimodality Imaging for Evaluating Response to Neoadjuvant Chemotherapy in Breast Cancer. American Journal of Roentgenology, 2017 Feb;208(2):290–9. doi: 10.2214/ajr.16.17223
  • 23. Chen AM, Meric-Bernstam F, Hunt KK, Thames HD, Outlaw ED, Strom EA, et al. Breast conservation after neoadjuvant chemotherapy. Cancer. 2005 Feb 15;103(4):689–95. doi: 10.1002/cncr.20815.
  • 24. Kenue JD, Jeffe DB, Schootman M, Hoffman A, Gillanders WE, Aft RL. Accuracy of Ultrasonography and Mammography in Predicting Pathologic Response after Neoadjuvant Chemotherapy for Breast Cancer. Am J Surg. 2010 Apr;199(4):477–84. doi: 10.1016/j.amjsurg.2009.03.012
  • 25. Peitinger F, Kuerer HM, Anderson K, Boughey JC, Meric- Bernstam F, et al. Accuracy of the combination of mammography and sonography in predicting tumor response in breast cancer patients after neoadjuvant chemotherapy. Ann Surg Oncol 2006 Nov;13(11):1443-9. doi: 10.1245/s10434-006-9086-9
  • 26. Skarping I, Förnvik D, Jørgensen UH, Rydén L, Zackrisson S, Borgquist S. Neoadjuvant breast cancer treatment response; tumor size evaluation through different conventional imaging modalities in the NeoDense study. Acta Oncol 2020 Dec;59(12):1528-37. doi: 10.1080/0284186X.2020.1830167.
  • 27. Zhang K, Li J, Zhu Q, Chang C. Prediction of Pathologic Complete Response by Ultrasonography and Magnetic Resonance Imaging After Neoadjuvant Chemotherapy in Patients with Breast Cancer. Cancer Manag Res. 2020 Apr 16;12:2603–12. doi: 10.2147/CMAR.S247279.
  • 28. Kim hayashi HS, Lee CW, Lee ES. Magnetic Resonance Imaging (MRI) Assessment of Residual Breast Cancer After Neoadjuvant Chemotherapy: Relevance to Tumor Subtypes and MRI Interpretation Threshold. Clin Breast Cancer. 2018 Dec;18(6):459-67. doi: 10.1016/j.clbc.2018.05.009.
  • 29. Weber JJ, Jochelson MS, Eaton A, Zabor EC, Barrio AV, Gemignani ML, et al. MRI and Prediction of Pathologic Complete Response in the Breast and Axilla after Neoadjuvant Chemotherapy for Breast Cancer. Am Coll Surg. 2017 Dec;225(6):740-6. doi: 10.1016/j.jamcollsurg.2017.08.027.
  • 30. Hayashi N, Tsunoda H, Namura M, Ochi T, Suzuki K, Yamauchi H, et al. Magnetic Resonance Imaging Combined with Second-look Ultrasonography in Predicting Pathologic Complete Response After Neoadjuvant Chemotherapy in Primary Breast Cancer Patients. Clin Breast Cancer 2019 Feb;19(1):71-7. doi: 10.1016/j.clbc.2018.08.004
There are 30 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research article
Authors

Emine Yıldırım 0000-0003-2733-402X

Neşe Uçar 0000-0003-2233-4338

Fırat Yetiş 0000-0003-4989-5514

Yasemin Kayadibi 0000-0003-1590-5382

Sibel Bektaş 0000-0003-0248-9869

Project Number Etik kurul no: 215
Publication Date January 1, 2022
Published in Issue Year 2022 Volume: 6 Issue: 1

Cite

APA Yıldırım, E., Uçar, N., Yetiş, F., Kayadibi, Y., et al. (2022). Diagnostic performance of breast imaging with ultrasonography, magnetic resonance and mammography in the assessment of residual tumor after neoadjuvant chemotherapy in breast cancer patients. Journal of Surgery and Medicine, 6(1), 43-48. https://doi.org/10.28982/josam.1034379
AMA Yıldırım E, Uçar N, Yetiş F, Kayadibi Y, Bektaş S. Diagnostic performance of breast imaging with ultrasonography, magnetic resonance and mammography in the assessment of residual tumor after neoadjuvant chemotherapy in breast cancer patients. J Surg Med. January 2022;6(1):43-48. doi:10.28982/josam.1034379
Chicago Yıldırım, Emine, Neşe Uçar, Fırat Yetiş, Yasemin Kayadibi, and Sibel Bektaş. “Diagnostic Performance of Breast Imaging With Ultrasonography, Magnetic Resonance and Mammography in the Assessment of Residual Tumor After Neoadjuvant Chemotherapy in Breast Cancer Patients”. Journal of Surgery and Medicine 6, no. 1 (January 2022): 43-48. https://doi.org/10.28982/josam.1034379.
EndNote Yıldırım E, Uçar N, Yetiş F, Kayadibi Y, Bektaş S (January 1, 2022) Diagnostic performance of breast imaging with ultrasonography, magnetic resonance and mammography in the assessment of residual tumor after neoadjuvant chemotherapy in breast cancer patients. Journal of Surgery and Medicine 6 1 43–48.
IEEE E. Yıldırım, N. Uçar, F. Yetiş, Y. Kayadibi, and S. Bektaş, “Diagnostic performance of breast imaging with ultrasonography, magnetic resonance and mammography in the assessment of residual tumor after neoadjuvant chemotherapy in breast cancer patients”, J Surg Med, vol. 6, no. 1, pp. 43–48, 2022, doi: 10.28982/josam.1034379.
ISNAD Yıldırım, Emine et al. “Diagnostic Performance of Breast Imaging With Ultrasonography, Magnetic Resonance and Mammography in the Assessment of Residual Tumor After Neoadjuvant Chemotherapy in Breast Cancer Patients”. Journal of Surgery and Medicine 6/1 (January 2022), 43-48. https://doi.org/10.28982/josam.1034379.
JAMA Yıldırım E, Uçar N, Yetiş F, Kayadibi Y, Bektaş S. Diagnostic performance of breast imaging with ultrasonography, magnetic resonance and mammography in the assessment of residual tumor after neoadjuvant chemotherapy in breast cancer patients. J Surg Med. 2022;6:43–48.
MLA Yıldırım, Emine et al. “Diagnostic Performance of Breast Imaging With Ultrasonography, Magnetic Resonance and Mammography in the Assessment of Residual Tumor After Neoadjuvant Chemotherapy in Breast Cancer Patients”. Journal of Surgery and Medicine, vol. 6, no. 1, 2022, pp. 43-48, doi:10.28982/josam.1034379.
Vancouver Yıldırım E, Uçar N, Yetiş F, Kayadibi Y, Bektaş S. Diagnostic performance of breast imaging with ultrasonography, magnetic resonance and mammography in the assessment of residual tumor after neoadjuvant chemotherapy in breast cancer patients. J Surg Med. 2022;6(1):43-8.