Patients who positively respond to neoadjuvant chemotherapy treatment show a reduction in tumor cellularity (the percentage of tissue composed of tumor cells), determined as a reduction in the proportion of viable tumor tissue in posttreatment histologic analysis ( 6, 7).ĭiffusion-weighted imaging (DWI) is a conventional radiologic method that provides noninvasive assessment of cellularity by examining the extent that water self-diffusion is confined ( 8, 9), with the proportion of viable tumor cellularity across whole tumors inferred as the amount of skewness present in histogram distributions ( 10). Although a complete pathologic response can be achieved for up to approximately 60% of patients with triple-negative and human epidermal growth receptor 2–positive breast cancers ( 4, 5), a significant proportion of patients progress or show no response to treatment, leading to unnecessary exposure to drug toxicity and delay to surgical intervention.
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