Contrast-enhanced ultrasound (CEUS) in assessing early response among patients with invasive breast cancer undergoing neoadjuvant chemotherapy

Abstract

Background One of the big challenges in onco-radiology is to find a reliable imaging method that may predict early response during the first cycles of any neoadjuvant chemotherapy. Purpose To evaluate the use of real-time harmonic contrast-enhanced ultrasound (CEUS) in predicting early response in breast cancer tumors under neoadjuvant chemotherapy (NAC) treatment. Material and Methods Nineteen consecutive patients with invasive breast cancer were evaluated with a bolus dose of 2.4 mL contrast agent using CEUS, before and after two cycles of epirubicin and docetaxel. The lognormal function was used for quantitative analysis of kinetic data to evaluate early response. Results There was statistically significant difference in time-to-peak ( t) between responders and non-responders (two sample t-test, P = 0.027) where t was significantly longer at the week 5 than at the baseline scan among responders when compared to non-responders. Conclusion In-flow of intravascular contrast agent in tumors is significantly slower in responders at real-time harmonic CEUS, and might be effectively used for the evaluation of early response to chemotherapy in invasive breast cancer. However, further investigations in a larger and more heterogeneous population should be performed to corroborate the reliability of the method.

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.…”

“…b After the first cycle of NAC, the wash-out rate on ROI 1/4 was 53 au and the AUC was 0.81 (p = 0.001) with a cut-off value of 29.58. tumor contour. In another study that included 19 patients, Saracco et al [23] concluded that the TTP was significantly longer in responders after two cycles on the whole tumor ROI at week 5 than at the baseline scan when compared with non-responders. However, unlike the previous data, the data obtained before and after the first NAC cycle in our study had no significant ability to predict the tumor response to NAC by peak enhancement or TTP for any of the six ROIs.…”

“…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.…”

Quantitative, noninvasive assessment of intra‐ and extraocular perfusion by contrast‐enhanced ultrasonography and its clinical applicability in healthy dogs

“…Interestingly, in human renal carcinomas, TTP was shorter compared to normal kidneys and malignant breast cancer was differentiated from benign lesions by a significantly reduced TTP . Saracco et al recently showed that TTP can indicate responsiveness to neoadjuvant chemotherapy in invasive breast cancer. The diagnostic value of TTP for objective, quantitative diagnosis and monitoring in canine ocular and orbital neoplasias deserves further study.…”

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

“…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].…”