From the Research
The optimal timing for restaging imaging after completion of neoadjuvant chemotherapy (NAC) in breast cancer is 4-8 weeks, as it is associated with increased overall survival (OS) and disease-free survival (DFS) 1. This timing allows for the resolution of acute inflammatory changes from chemotherapy while still providing an accurate assessment of tumor response before surgery. The optimal window balances the need to evaluate treatment response with the goal of not delaying definitive surgical management. Imaging modalities commonly used include:
- Mammography
- Ultrasound
- Breast MRI, with MRI generally considered the most accurate for assessing residual disease. The timing may be adjusted based on individual patient factors, the specific chemotherapy regimen used, and institutional protocols. Some centers may perform imaging closer to 2 weeks post-chemotherapy if planning immediate surgery, while others might wait until 4 weeks for more complete resolution of treatment-related changes. This restaging is crucial for surgical planning, as it helps determine whether breast-conserving surgery is feasible or if mastectomy is necessary based on the extent of residual disease. A study published in the European journal of surgical oncology found that patients who had surgery within 8 weeks of completion of NACT had a statistically significant improved OS and DFS compared to those who had surgery after 8 weeks 1. Another study published in Clinical imaging found that the median time interval between end-of-treatment and surgery was 6 weeks, and 90% had surgery within 8 weeks of NAT completion, with no significant correlation between any of the time intervals and the tumor size as captured in the pathology report 2. However, the study published in 2021 1 is the most recent and highest quality study, and its findings should be prioritized when determining the optimal timing for restaging imaging after completion of NAC in breast cancer.