Digital Breast Tomosynthesis as a Predictor of Pathological Response of Breast Cancer after Neoadjuvant Therapy

Background: Breast cancer is a significant public health concern all over the world. Increasing public knowledge of the disease and development in breast imaging have improved screening and early detection of breast cancer. Neoadjuvant therapy (NAT) is the main treatment for locally advanced breast cancer. Its primary clinical benefit is the reduction of tumor burden and downstage breast cancer so that breast-conservative surgery (BCS) can be performed. Accurate evaluation of response to NAT is essential for surgery planning. Objectives: To assess the accuracy of digital breast tomosynthesis (DBT) in predicting the pathological response and assessment of residual tumor size after NAT in patients with locally advanced breast cancer. Methods: This prospective study was carried out between April 2023 and September 2024 and included 150 female patients aged between 28 and 75 years old with pathologically confirmed breast cancer who were candidate for NAT. DBT was done before and after NAT and radiological findings were compared with post-operative pathological results. Results: There was a statistically significant positive relation between DBT residual tumor size and pathological size (correlation coefficient was found to be 0.951). Sensitivity of DBT size in prediction of pathological response to NAT was 93 %, Area under the curve (ROC) was 0.807. Conclusions: DBT has good correlation with histopathology for measuring residual tumor size after NAT. It is a sensitive method in predicting pathological response to NAT.