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

Lee, Youn Joo; Kim, Sung Hun; Kang, Bong Joo; Kim, Yun Ju

doi:10.1055/a-0637-1601

Cited by 33 publications

(24 citation statements)

References 30 publications

(28 reference statements)

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“…Using TIC analyses, a (significant) decrease in wash-in/wash-out AUC 26 as well as an increase in RT 27 can be seen. Some TIC parameters obtained by CEUS may allow prediction of the response of breast cancer to NAC at a very early point of time 10 , 28 , 29 .…”

Section: Discussionmentioning

confidence: 99%

Quantification of dynamic contrast-enhanced ultrasound (CEUS) in non-cystic breast lesions using external perfusion software

Jung¹,

Jung

Stroszczynski³

et al. 2021

Sci Rep

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The aim of this present clinical pilot study is the display of typical perfusion results in patients with solid, non-cystic breast lesions. The lesions were characterized using contrast enhanced ultrasound (CEUS) with (i) time intensity curve analyses (TIC) and (ii) parametric color maps. The 24 asymptomatic patients included were genetically tested for having an elevated risk for breast cancer. At a center of early detection of familial ovary and breast cancer, those patients received annual MRI and grey-scale ultrasound. If lesions remained unclear or appeared even suspicious, those patients also received CEUS. CEUS was performed after intravenous application of sulfur hexafluoride microbubbles. Digital DICOM cine loops were continuously stored for one minute in PACS (picture archiving and communication system). Perfusion images and TIC analyses were calculated off-line with external perfusion software (VueBox). The lesion diameter ranged between 7 and 15 mm (mean 11 ± 3 mm). Five hypoechoic irregular lesions were scars, 6 lesions were benign and 12 lesions were highly suspicious for breast cancer with irregular enhancement at the margins and a partial wash out. In those 12 cases, histopathology confirmed breast cancer. All the suspicious lesions were correctly identified visually. For the perfusion analysis only Peak Enhancement (PE) and Area Under the Curve (AUC) added more information for correctly identifying the lesions. Typical for benign lesions is a prolonged contrast agent enhancement with lower PE and prolonged wash out, while scars are characterized typically by a reduced enhancement in the center. No differences (p = 0.428) were found in PE in the center of benign lesions (64.2 ± 28.9 dB), malignant lesions (88.1 ± 93.6 dB) and a scar (40.0 ± 17.0 dB). No significant differences (p = 0.174) were found for PE values at the margin of benign lesions (96.4 ± 144.9 dB), malignant lesions (54.3 ± 86.2 dB) or scar tissue (203.8 ± 218.9 dB). Significant differences (p < 0.001) were found in PE of the surrounding tissue when comparing benign lesions (33.6 ± 25.2 dB) to malignant lesions (15.7 ± 36.3 dB) and scars (277.2 ± 199.9 dB). No differences (p = 0.821) were found in AUC in the center of benign lesions (391.3 ± 213.7), malignant lesions (314.7 ± 643.9) and a scar (213.1 ± 124.5). No differences (p = 0.601) were found in AUC values of the margin of benign lesions (313.3 ± 372.8), malignant lesions (272.6 ± 566.4) or scar tissue (695.0 ± 360.6). Significant differences (p < 0.01) were found in AUC of the surrounding tissue for benign lesions (151.7 ± 127.8), malignant lesions (177.9 ± 1345.6) and scars (1091 ± 693.3). There were no differences in perfusion evaluation for mean transit time (mTT), rise time (RT) and time to peak (TTP) when comparing the center to the margins and the surrounding tissue. The CEUS perfusion parameters PE and AUC allow a very good assessment of the risk of malignant breast lesions and thus a downgrading of BI-RADS 4 lesions. The use of the external perfusion software (VueBox, Bracco, Milan, Italy) did not lead to any further improvement in the diagnosis of suspicious breast lesions and does appears not to have any additional diagnostic value in breast lesions.

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Section: Discussionmentioning

confidence: 99%

Quantification of dynamic contrast-enhanced ultrasound (CEUS) in non-cystic breast lesions using external perfusion software

Jung¹,

Jung

Stroszczynski³

et al. 2021

Sci Rep

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“…A change in dynamic contrast curves after neoadjuvant treatment has been shown to correspond to treatment response. 5 , 7 A reduction in PI, gradient, and increase in TTP indicates response due to the decrease in blood flow and reduction of blood vessel density in tumor tissue. If a lack of response can be identified early in the course of the treatment, an alternative treatment strategy can be implemented to benefit the patient.…”

Section: Discussionmentioning

confidence: 99%

“… 4 CEUS seems to be a promising method to monitor response during and after neoadjuvant treatment. 5 – 7 …”

Section: Introductionmentioning

confidence: 99%

Contrast-enhanced ultrasound of breast tumors: an initial experience

Kristiansen

Martiniussen

Larsen

2022

Acta Radiologica Open

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Background The increase of neoadjuvant treatment for breast cancer creates a capacity challenge as response evaluation by magnetic resonance imaging (MRI) is a limited resource. Contrast-enhanced ultrasound (CEUS) has been proposed as an alternative imaging strategy. Purpose To get experience with examination of malignant breast tumors with CEUS and evaluate the potential for future use in response evaluation of neoadjuvant treatment. Material and methods In this pilot study, the dynamic contrast-enhancement of ultrasound and MRI examinations were analyzed in 14 women with histologically verified breast cancer. Results Analysis of the time intensity curve of CEUS demonstrated the difference between tumor and normal tissue. The peak intensity was five times higher in tumor tissue (mean increase 397%, 95% CI 250–545). The curve was steeper for tumor tissue (mean 1.76, 95% CI 1.26–2.26) than for normal tissue (mean 0.43, 95% CI 0.24–0.62). Conclusion CEUS is a feasible method of examining blood flow in malignant breast tumors.

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“…52,53 TIC parameters were analyzed for different ROIs in Lee et al research. 54 ROI 1, ROI 2, ROI 3, and ROI 4 targeted the hotspot area of greatest enhancement, area of hyperenhancement, entire tumor on grayscale ultrasound and normal parenchyma, respectively, and the results led to a recommendation for the less subjective ROI 2 or ROI 3. Studies have confirmed that breast CEUS combined with TIC curve analysis not only provides information about blood perfusion but also provides a variety of quantitative parameters that greatly improve the accuracy of predicting the response to NAC.…”

Section: Contrast-enhanced Ultrasound (Ceus) For Assessing Response To Nacmentioning

confidence: 99%

A Narrative Review of Ultrasound Technologies for the Prediction of Neoadjuvant Chemotherapy Response in Breast Cancer

Wang

Chu

Wang

2021

CMAR

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The incidence and mortality rate of breast cancer (BC) in women currently ranks first worldwide, and neoadjuvant chemotherapy (NAC) is widely used in patients with BC. A variety of imaging assessment methods have been used to predict and evaluate the response to NAC. Ultrasound (US) has many advantages, such as being inexpensive and offering a convenient modality for follow-up detection without radiation emission. Although conventional grayscale US is typically used to predict the response to NAC, this approach is limited in its ability to distinguish viable tumor tissue from fibrotic scar tissue. Contrast-enhanced ultrasound (CEUS) combined with a time-intensity curve (TIC) not only provides information on blood perfusion but also reveals a variety of quantitative parameters; elastography has the potential capacity to predict NAC efficiency by evaluating tissue stiffness. Both CEUS and elastography can greatly improve the accuracy of predicting NAC responses. Other US techniques, including three-dimensional (3D) techniques, quantitative ultrasound (QUS) and US-guided near-infrared (NIR) diffuse optical tomography (DOT) systems, also have advantages in assessing NAC response. This paper reviews the different US technologies used for predicting NAC response in BC patients based on the previous literature.

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

Abstract: Some TIC parameters obtained by CEUS may allow prediction of the response of breast cancer to NAC at a very early time point.

Cited by 33 publications

References 30 publications

Quantification of dynamic contrast-enhanced ultrasound (CEUS) in non-cystic breast lesions using external perfusion software

Quantification of dynamic contrast-enhanced ultrasound (CEUS) in non-cystic breast lesions using external perfusion software

Contrast-enhanced ultrasound of breast tumors: an initial experience

A Narrative Review of Ultrasound Technologies for the Prediction of Neoadjuvant Chemotherapy Response in Breast Cancer

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