Ability of contrast-enhanced ultrasonography to determine clinical responses of breast cancer to neoadjuvant chemotherapy

Abstract

Objective: We aimed to determine whether contrast-enhanced ultrasonography can predict the effects of neoadjuvant chemotherapy on breast cancer. Methods: The clinical responses of 63 consecutive patients with breast cancer (T1-4, N0-1, M0) to neoadjuvant chemotherapy between October 2012 and May 2015 were assessed using contrastenhanced magnetic resonance imaging, positron emission tomography/computed tomography and contrast-enhanced ultrasonography. Perfusion parameters for contrast-enhanced ultrasonography were created from time-intensity curves based on enhancement intensity and temporal changes to objectively evaluate contrast-enhanced ultrasonography findings. The sensitivity, specificity and accuracy of contrast-enhanced ultrasonography, magnetic resonance imaging and positron emission tomography/computed tomography to predict a pathological complete response were compared after confirming the pathological findings of surgical specimens. Results: Twenty-three (36.5%) of the 63 patients achieved pathological complete response. The sensitivity, specificity and accuracy of contrast-enhanced ultrasonography for predicting pathological complete response were 95.7% (82.5-99.2%), 77.5% (69.9-79.5%) and 84.1% (74.5-86.7%). The sensitivity of contrast-enhanced ultrasonography was significantly greater than that of magnetic resonance imaging (95.7 vs. 69.6%, P = 0.047). The specificity and accuracy were significantly greater and tended to be greater, respectively, for contrast-enhanced ultrasonography than positron emission tomography/computed tomography (specificity, 77.5 vs. 52.5%, P = 0.02; accuracy, 84.1 vs. 69.8%, P = 0.057). Conclusions: Contrast-enhanced ultrasonography might serve as a new diagnostic modality when planning therapeutic strategies for patients with breast cancer after neoadjuvant chemotherapy.

Progress in the clinical detection of heterogeneity in breast cancer

“…This result is consistent with other studies [96,97]. CEUS also achieved high accuracy in predicting the heterogeneity of the response of breast cancer to neoadjuvant chemotherapy [98,99]. The use of microbubbles labeled by specific antibodies also allows CEUS to achieve the level of detail of molecular imaging.…”

Contrast-Enhanced Ultrasound for Early Prediction of Response of Breast Cancer to Neoadjuvant Chemotherapy

“…The ability of CEUS to predict a pathological complete response in patients with breast cancer who have received NAC has been reported previously [20 -25]. In a study of 63 patients, Amioka et al [20] reported that both the peak intensity and the ascending slope were significantly lower in those who achieved a pathological complete response than in those who did not. However, unlike in our study, Amioka et al performed CEUS after completing four cycles of NAC and placed the ROI at the largest tumor contour.…”

“…These changes may occur earlier than a reduction in tumor size. Nonetheless, previous reports have not fully evaluated the reproducibility of CEUS [17,20,21,23,25] and debate persists regarding the most appropriate region of interest (ROI) for quantitative analysis of the time-intensity curve (TIC) [9,21,24].…”

Contrast-Enhanced Ultrasound for Early Prediction of Response of Breast Cancer to Neoadjuvant Chemotherapy

“…The ability of CEUS to predict a pathological complete response in patients with breast cancer who have received NAC has been reported previously [20][21][22][23][24][25]. In a study of 63 patients, Amioka et al [20] reported that both the peak intensity and the ascending slope were significantly lower in those who achieved a pathological complete response than in those who did not. However, unlike in our study, Amioka et al performed CEUS after completing four cycles of NAC and placed the ROI at the largest ▶ Fig.…”

“…The reason for performing the second CEUS examination after the first cycle was that prediction of the response at an early time point is important for treatment modification in non-responders [3,4]. Several studies have evaluated the ability of CEUS to predict early response to NAC [20][21][22][23][24][25]. CEUS is superior to conventional imaging methods when measuring angiogenic changes as an indicator of response.…”