Baseline factors predicting a response to neoadjuvant chemotherapy with implications for non-surgical management of triple-negative breast cancer

Parra, Raquel F. D. van la; Tadros, Audree B; Checka, Cristina M.; Rauch, Gaiane M.; Lucci, Anthony; Smith, Benjamin D.; Krishnamurthy, Savitri; Valero, Vicente; Yang, Wei Tse; Kuerer, Henry Mark

doi:10.1002/bjs.10755

Cited by 20 publications

(23 citation statements)

References 30 publications

(58 reference statements)

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“…This is consistent with existing evidence that comedo-type, casting and pleomorphic microcalcifications on initial mammography are associated with poorer prognosis [22–26]. Interestingly, in contrast to two recent studies, we found no correlation between microcalcification and poorer response to NACT in the TN cancers [7, 8]. This may be due to the differing definitions of complete response; whilst in our study pCR is considered the absence of invasive disease the previous studies considered complete response to be the absence of both invasive and in-situ disease.…”

Section: Discussionsupporting

confidence: 92%

“…Evidence pertaining to baseline ultrasound and mammography, however, remains scant. Two recent papers considered triple negative cancers alone; one study of 328 patients found the presence of microcalcification on the initial mammogram was significantly associated with residual disease (presumed to include in-situ disease) [7]. A further study comparing tumours that completely responded to tumours with residual in-situ disease following NACT found that the absence of mammographic microcalcification, round shape and posterior enhancement on baseline ultrasound were significantly more common amongst tumours which demonstrated pCR with no residual in-situ disease [8].…”

Section: Introductionmentioning

confidence: 99%

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Are baseline ultrasound and mammographic features associated with rates of pathological completes response in patients receiving neoadjuvant chemotherapy for breast cancer?

et al. 2019

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Background 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. Methods A 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. Results Of 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. Conclusion A 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 registration UK Clinical Trials Gateway: registration number 16712.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Are baseline ultrasound and mammographic features associated with rates of pathological completes response in patients receiving neoadjuvant chemotherapy for breast cancer?

et al. 2019

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“…Previous research showed better pCR rates for patients with accompanying DCIS ranging from 28 to 36%. [22][23][24][25] The lower pCR rates Another controversial discussion focuses on which tumor stages and tumor biology should be considered for risk-adaptive breast cancer surgery as well as on how to integrate surgical treatment of the axilla. Current research has shown that TNBC or HER2?…”

Section: Discussionmentioning

confidence: 99%

Vacuum-Assisted Breast Biopsy After Neoadjuvant Systemic Treatment for Reliable Exclusion of Residual Cancer in Breast Cancer Patients

et al. 2021

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Background About 40 % of women with breast cancer achieve a pathologic complete response in the breast after neoadjuvant systemic treatment (NST). To identify these women, vacuum-assisted biopsy (VAB) was evaluated to facilitate risk-adaptive surgery. In confirmatory trials, the rates of missed residual cancer [false-negative rates (FNRs)] were unacceptably high (> 10%). This analysis aimed to improve the ability of VAB to exclude residual cancer in the breast reliably by identifying key characteristics of false-negative cases. Methods Uni- and multivariable logistic regressions were performed using data of a prospective multicenter trial (n = 398) to identify patient and VAB characteristics associated with false-negative cases (no residual cancer in the VAB but in the surgical specimen). Based on these findings FNR was exploratively re-calculated. Results In the multivariable analysis, a false-negative VAB result was significantly associated with accompanying ductal carcinoma in situ (DCIS) in the initial diagnostic biopsy [odds ratio (OR), 3.94; p < 0.001], multicentric disease on imaging before NST (OR, 2.74; p = 0.066), and age (OR, 1.03; p = 0.034). Exclusion of women with DCIS or multicentric disease (n = 114) and classication of VABs that did not remove the clip marker as uncertain representative VABs decreased the FNR to 2.9% (3/104). Conclusion For patients without accompanying DCIS or multicentric disease, performing a distinct representative VAB (i.e., removing a well-placed clip marker) after NST suggests that VAB might reliably exclude residual cancer in the breast without surgery. This evidence will inform the design of future trials evaluating risk-adaptive surgery for exceptional responders to NST.

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“…Literature is limited regarding the utility of baseline imaging features to predict response to NAC or survival outcomes in breast cancer. A study involving patients with triple-negative breast cancer (TNBC) analyzing clinic-pathological factors, found that the presence of microcalcifications on baseline imaging was associated with predicting residual disease as opposed to patients with pCR [ 29 ]. Radiogenomics involves the integration of imaging characteristics with molecular information and has shown promising results in breast cancer using baseline MRI features [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Quantitative ultrasound radiomics using texture derivatives in prediction of treatment response to neo-adjuvant chemotherapy for locally advanced breast cancer

et al. 2020

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Background: To investigate quantitative ultrasound (QUS) based higher-order texture derivatives in predicting the response to neoadjuvant chemotherapy (NAC) in patients with locally advanced breast cancer (LABC). Materials and Methods: 100 Patients with LABC were scanned before starting NAC. Five QUS parametric image-types were generated from radio-frequency data over the tumor volume. From each QUS parametric-image, 4 grey level co-occurrence matrix-based texture images were derived (20 QUS-Tex 1 ), which were further processed to create texture derivatives (80 QUS-Tex 1 -Tex 2 ). Patients were classified into responders and non-responders based on clinical/pathological responses to treatment. Three machine learning algorithms based on linear discriminant (FLD), k -nearest-neighbors (KNN), and support vector machine (SVM) were used for developing radiomic models of response prediction. Results: A KNN-model provided the best results with sensitivity, specificity, accuracy, and area under curve (AUC) of 87%, 81%, 82%, and 0.86, respectively. The most helpful features in separating the two response groups were QUS-Tex 1 -Tex 2 features. The 5-year recurrence-free survival (RFS) calculated for KNN predicted responders and non-responders using QUS-Tex 1 -Tex 2 model were comparable to RFS for the actual response groups. Conclusions: We report the first study demonstrating QUS texture-derivative methods in predicting NAC responses in LABC, which leads to better results compared to using texture features alone.

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Baseline factors predicting a response to neoadjuvant chemotherapy with implications for non-surgical management of triple-negative breast cancer

Cited by 20 publications

References 30 publications

Are baseline ultrasound and mammographic features associated with rates of pathological completes response in patients receiving neoadjuvant chemotherapy for breast cancer?

Are baseline ultrasound and mammographic features associated with rates of pathological completes response in patients receiving neoadjuvant chemotherapy for breast cancer?

Vacuum-Assisted Breast Biopsy After Neoadjuvant Systemic Treatment for Reliable Exclusion of Residual Cancer in Breast Cancer Patients

Quantitative ultrasound radiomics using texture derivatives in prediction of treatment response to neo-adjuvant chemotherapy for locally advanced breast cancer

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