Mammographic density changes during neoadjuvant breast cancer treatment: NeoDense, a prospective study in Sweden

Breast. 2020 Oct:53:33-41. doi: 10.1016/j.breast.2020.05.013. Epub 2020 Jun 4.


Objectives: To assess if mammographic density (MD) changes during neoadjuvant breast cancer treatment and is predictive of a pathological complete response (pCR).

Methods: We prospectively included 200 breast cancer patients assigned to neoadjuvant chemotherapy (NACT) in the NeoDense study (2014-2019). Raw data mammograms were used to assess MD with a fully automated volumetric method and radiologists categorized MD using the Breast Imaging-Reporting and Data System (BI-RADS), 5th Edition. Logistic regression was used to calculate odds ratios (OR) for pCR comparing BI-RADS categories c vs. a, b, and d as well as with a 0.5% change in percent dense volume adjusting for baseline characteristics.

Results: The overall median age was 53.1 years, and 48% of study participants were premenopausal pre-NACT. A total of 23% (N = 45) of the patients accomplished pCR following NACT. Patients with very dense breasts (BI-RADS d) were more likely to have a positive axillary lymph node status at diagnosis: 89% of the patients with very dense breasts compared to 72% in the entire cohort. A total of 74% of patients decreased their absolute dense volume during NACT. The likelihood of accomplishing pCR following NACT was independent of volumetric MD at diagnosis and change in volumetric MD during treatment. No trend was observed between decreasing density according to BI-RADS and the likelihood of accomplishing pCR following NACT.

Conclusions: The majority of patients decreased their MD during NACT. We found no evidence of MD as a predictive marker of pCR in the neoadjuvant setting.

Keywords: Breast cancer; Breast density; Mammography; Neoadjuvant therapy.

MeSH terms

  • Adult
  • Biomarkers / analysis
  • Breast / diagnostic imaging*
  • Breast / pathology
  • Breast Density*
  • Breast Neoplasms / diagnostic imaging*
  • Breast Neoplasms / therapy
  • Female
  • Humans
  • Image Processing, Computer-Assisted / methods
  • Image Processing, Computer-Assisted / statistics & numerical data*
  • Mammography / methods
  • Mammography / statistics & numerical data*
  • Middle Aged
  • Neoadjuvant Therapy
  • Predictive Value of Tests
  • Prospective Studies
  • Randomized Controlled Trials as Topic
  • Sweden
  • Treatment Outcome
  • Tumor Burden


  • Biomarkers