Abstract
BackgroundIncreasing numbers of breast cancer patients receive neoadjuvant chemotherapy (NACT). We seek to investigate whether baseline mammographic and ultrasound features are associated with complete pathological response (pCR) after NACT.MethodsA database of NACT patients was reviewed. Baseline imaging parameters assessed were ultrasound: posterior effect; echo pattern; margin and lesion diameter; mammography: spiculation and microcalcification. Core biopsy grade and immunophenotype were documented. Data were analysed for the whole study group and by immunophenotype.ResultsOf the 222 cancers, 83 (37%) were triple negative (TN), 61 (27%) ER positive/HER-2 negative and 78 (35%) HER-2 positive. A pCR occurred in 46 of 222 cancers (21%). For the whole group, response was associated with high core biopsy grade (grade 3 vs. grade 1 or 2) (26% vs. 9%, p = 0.0044), absence of posterior shadowing on ultrasound (26% vs. 10%, p < 0.001) and the absence of mammographic spiculation (26 vs. 6%, p < 0.001). Within the HER-2 positive group; the absence of shadowing and spiculation remained highly associated with pCR, in addition to small ultrasound size (AUC = 0.71, p < 0.001) and the absence of microcalcification (39% vs. 21%, p < 0.02). On multivariable analysis absence of spiculation and core grade remained significant for the whole cohort, size and absence of spiculation remained significant for HER-2 positive tumours. No feature predicted pCR in TN tumours.ConclusionA pCR is less likely when there is mammographic spiculation. Small ultrasound size is associated with pCR in HER-2 positive tumours. These findings may be helpful when discussing NACT and surgical options with patients.Trial registrationUK Clinical Trials Gateway: registration number 16712.
Highlights
Increasing numbers of breast cancer patients receive neoadjuvant chemotherapy (NACT)
Similar rates of pathological response (pCR) were seen in the triple negative (TN) and HER-2 positive groups; (19/83) 22.9% and (23/78) 29.4% respectively
We have demonstrated that baseline imaging features on both US and mammography are associated with pCR rates, and may be a useful tool in identifying patients who will respond well
Summary
Increasing numbers of breast cancer patients receive neoadjuvant chemotherapy (NACT). We seek to investigate whether baseline mammographic and ultrasound features are associated with complete pathological response (pCR) after NACT. Increasing numbers of breast cancer patients are receiving neoadjuvant chemotherapy (NACT). Whilst in some patients this results in down-staging of an initially inoperable tumour or reduces the extent of surgery required in the breast and axilla, others derive little, if any, benefit from NACT yet experience the associated morbidity of treatments. Patients might choose to have chemotherapy post operatively if they were aware that NACT was unlikely to result in a sufficiently good response to alter the surgical plan. Increasing the physician’s ability to predict at baseline the response to NACT would be helpful for patient selection
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