Role of morphofunctional imaging in assessing residual disease after neoadjuvant chemotherapy

The primary aim of neoadjuvant chemotherapy (NAC) is the achievement of pathologic complete response (pCR) prior to surgery, which has been shown to confer improvements in long-term disease-free and overall survival; a secondary objec-tive in these patients is an improvement of surgical options. The goals of imaging after neoadjuvant therapy are to monitor response to therapy and allow for accurate surgical planning. This review summarizes the role of MRI in assessing tumor response in patients receiving neoadjuvant therapy. Breast MRI accuracy for assessing residual disease after neoadjuvant chemotherapy is accurate but multiple factors, such as cancer subtype and treatment regimen. Both overestimation and underestimation can be observed and might have important clinical impact. The assessment of NAC response with MRI is promising and ready for more multicenter studies that may address these shortcomings.