Multiparametric ultrasound examination for response assessment in breast cancer patients undergoing neoadjuvant therapy

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.

Quantitative Assessment of the Echogenicity of a Breast Tumor Predicts the Response to Neoadjuvant Chemotherapy

“…In the same group, in two parameters analysis using echogenicity and stiffness, an improvement in the statistical parameters was obtained: sensitivity of 82%, specificity of 90%, PPV of 75%, NPV of 93%, accuracy of 88%, and AUC of 0.88. It was noticed that both the stiffness and the hypoechoic nature of the lesions remained unchanged [ 15 ].…”

“…In our study, we focused on the characterization of the tumor echogenicity, which is related to its structure and cellularity, as is the ADC in the MRI image [ 15 , 16 ]. In the classic B-mode examination, echogenicity is assessed in relation to adipose tissue, which makes the assessment more objective and independent of the ultrasonic scanner settings.…”

CT-ML: Diagnosis of Breast Cancer Based on Ultrasound Images and Time-Dependent Feature Extraction Methods Using Contourlet Transformation and Machine Learning

“…Furthermore, a few exploratory investigations utilizing enhanced contrast magnetic resonance imaging, dispersion magnetic resonance, or positron emission high-resolution computed tomography have shown encouraging findings, indicating the need for more study. The ultrasound would have the edge over other scanning technologies in anticipating early tumor responses and developing chemo-switch tactics since it is noninvasive and widely available [ 7 ]. Previous research has focused on the association between diagnostic characteristics and molecular subtypes and distinguishing benign and malignant breast cancers using ultrasound pictures.…”

“…Breast tumors of the triple-negative type had a higher chance of having constricted margins. They had a lower risk of calcifications [ 7 ]. The necessity for an adjuvant screening tool has been recognized because of the reduced sensitivity of screening mammography in thick breasts, and ultrasonography has been proposed as a viable supplementary screening modality [ 7 ].…”

“…They had a lower risk of calcifications [ 7 ]. The necessity for an adjuvant screening tool has been recognized because of the reduced sensitivity of screening mammography in thick breasts, and ultrasonography has been proposed as a viable supplementary screening modality [ 7 ]. Even though ultrasonography is frequently used as a supportive screening technique in Asia [ 8 , 9 ], there has been little research on the survival advantages of screening ultrasound for breast cancer.…”