Abstract
To investigate the performance of multiparametric ultrasound for the evaluation of treatment response in breast cancer patients undergoing neoadjuvant chemotherapy (NAC). The IRB approved this prospective study. Breast cancer patients who were scheduled to undergo NAC were invited to participate in this study. Changes in tumour echogenicity, stiffness, maximum diameter, vascularity and integrated backscatter coefficient (IBC) were assessed prior to treatment and 7 days after four consecutive NAC cycles. Residual malignant cell (RMC) measurement at surgery was considered as standard of reference. RMC < 30% was considered a good response and > 70% a poor response. The correlation coefficients of these parameters were compared with RMC from post-operative histology. Linear Discriminant Analysis (LDA), cross-validation and Receiver Operating Characteristic curve (ROC) analysis were performed. Thirty patients (mean age 56.4 year) with 42 lesions were included. There was a significant correlation between RMC and echogenicity and tumour diameter after the 3rd course of NAC and average stiffness after the 2nd course. The correlation coefficient for IBC and echogenicity calculated after the first four doses of NAC were 0.27, 0.35, 0.41 and 0.30, respectively. Multivariate analysis of the echogenicity and stiffness after the third NAC revealed a sensitivity of 82%, specificity of 90%, PPV = 75%, NPV = 93%, accuracy = 88% and AUC of 0.88 for non-responding tumours (RMC > 70%). High tumour stiffness and persistent hypoechogenicity after the third NAC course allowed to accurately predict a group of non-responding tumours. A correlation between echogenicity and IBC was demonstrated as well.
Highlights
To investigate the performance of multiparametric ultrasound for the evaluation of treatment response in breast cancer patients undergoing neoadjuvant chemotherapy (NAC)
We examined the performance of multi-parametric ultrasound metrics, including echogenicity, stiffness, maximal tumour diameter and vascularity to diagnose treatment response in neoadjuvant chemotherapy (NAC) patients with respect to histopathological results of residual malignant cell (RMC)
All remaining patients underwent a full course of NAC therapy
Summary
To investigate the performance of multiparametric ultrasound for the evaluation of treatment response in breast cancer patients undergoing neoadjuvant chemotherapy (NAC). Previous studies have shown promising results in assessing breast tumors using combining B-mode US features and quantitative parameters such as CEUS, Doppler, and elastography[9,10,11] This multi-parameter approach is important in the assessment of post-NAC response, as it asseses tissue structural changes, changes in angiogenesis, and tumor biomechanical properties in the context of histopathological verification. Another promising direction for the early evaluation of tumour responses to NAC therapy is the use of quantitative ultrasound (QUS). Some initial studies were able to identify changes on QUS as early as one week after NAC, using parameters such as integrated backscattering coefficient (IBC) and average acoustic concentration[12,13]
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