Correlation of Histopathological and Radiological Response Patterns and Their Prognostic Implications in Breast Cancer After Neoadjuvant Chemotherapy

Ahmet Bozer,1,2 Cengiz Yilmaz,3 Hülya Çetin Tunçez,1,2 Demet Kocatepe Çavdar,4 Zehra Hilal Ad&inodot;belli1,2,5 1Department of Radiology, Izmir City Hospital, Izmir, Turkey; 2Department of Radiology, Bozyaka Education and Research Hospital, Izmir, Turkey; 3Department of Medical Oncology, Izmir City Hospital, Izmir, Turkey; 4Department of Pathology, Izmir City Hospital, Izmir, Turkey; 5Department of Radiology, Izmir Faculty of Medicine, University of Health Sciences, Izmir, TurkeyCorrespondence: Ahmet Bozer, Department of Radiology, Izmir City Hospital, Izmir, Laka, 35040, Bayrakl&inodot;/Izmir, Turkey, Tel +902329550500, Email [email protected]: In breast cancer (BC), neoadjuvant chemotherapy (NAC) responses can be categorized as concentric shrinkage (CS), non-concentric shrinkage (non-CS), and complete response, influencing surgical planning and survival. This study evaluates the correlation between histopathological and radiological response patterns in BC patients after NAC and their impact on overall survival (OS) and disease-free survival (DFS).Patients and Methods: This retrospective study analyzed 168 BC patients who received NAC between 2018 and 2022. Tumor response was evaluated radiologically using MRI and histopathologically after surgery. Radiological response patterns were categorized into CS, non-CS, and radiological complete response (rCR). Histopathologically, patients were classified into CS, non-CS, and pathological complete response (pCR). Concordance between radiological and histopathological classifications was assessed using the kappa statistic. Survival outcomes, including OS and DFS, were analyzed using Kaplan-Meier methods.Results: Histopathological response patterns were distributed as CS (31.5%), non-CS (34.5%), and pCR (34%). Moderate agreement was observed between radiological and histopathological assessments (κ: 0.439, p < 0.001). Radiological evaluation identified 64% of CS, 50% of non-CS, and 74% of pCR cases accurately. Tumor molecular subtypes significantly correlated with both radiologic and histopathologic response patterns (p < 0.001). Subtype analysis revealed higher pCR rates in TN, HER2-enriched, and Luminal B-HER2(+) tumors, while non-CS was predominant in Luminal A tumors. No significant correlation was observed between histopathological or radiological patterns and OS (p: 0.291, p: 0.515) or DFS (p: 0.599, p: 0.899). However, patients achieving pCR tended to have better survival outcomes.Conclusion: We observed moderate concordance between histopathological and radiological response patterns in BC patients after NAC, but discrepancies highlight the limitations of radiological evaluation alone. These patterns did not significantly correlate with prognosis. Higher pCR rates were associated with better outcomes, but response patterns alone may not predict survival, warranting further research in larger cohorts.Keywords: breast cancer, neoadjuvant chemotherapy, tumor shrinkage patterns, survival outcomes, radiologic response