Accuracy of unidimensional and volumetric ultrasound measurements in predicting good pathological response to neoadjuvant chemotherapy in breast cancer patients

Gounaris, Ioannis; Provenzano, Elena; Vallier, Anne-Laure; Hiller, Louise; Iddawela, Mahesh; Hilborne, Sarah; Taylor, Kathryn M.; Britton, Philip N; Earl, Helena; Sinnatamby, R.

doi:10.1007/s10549-011-1454-x

Cited by 22 publications

(22 citation statements)

References 33 publications

(35 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the neoadjuvant setting, accurate assessment of early response to NAC may assist in tailoring therapy to increase rates of pCR, DFS and OS . Although some randomised controlled trials demonstrating those potential benefits have assessed response by US, and despite US being commonly used for this purpose in clinical practice, the literature on US accuracy is sparse. This study is not only the largest to explore the accuracy of US for response prediction but also the first to systematically investigate accuracy using recommended 2D and 1D response assessment criteria for predicting multiple commonly applied pCR outcomes, and assess the incremental contribution of US over other predictive variables.…”

Section: Discussionmentioning

confidence: 99%

“…Studies investigating the accuracy of testing mid‐treatment have therefore focussed on MRI . However, it is not clear whether the potential benefits of US early response assessment found in randomised trials are applicable to MRI, and despite the RECIST recommendations, US is commonly used in clinical practice . Few studies have investigated the accuracy of US for predicting pCR, and the optimal method for response assessment has not been established …”

mentioning

confidence: 99%

See 1 more Smart Citation

Accuracy of ultrasound for predicting pathologic response during neoadjuvant therapy for breast cancer

Marinovich

Houssami

Macaskill

et al. 2014

Intl Journal of Cancer

View full text Add to dashboard Cite

Early assessment of response to neoadjuvant chemotherapy (NAC) for breast cancer allows therapy to be tailored; however, optimal response assessment methods have not been established. We estimated the accuracy of ultrasound (US) to predict pathologic complete response (pCR) using common response criteria and pCR definitions, and estimated incremental accuracy over known prognostic variables. Participants undergoing US after two cycles in the GeparTrio trial randomised to no change in NAC were eligible. US response by World Health Organisation (WHO) criteria (1D or 2D) and Response Evaluation Criteria In Solid Tumours (RECIST) was assessed. Four pCR definitions were applied. Sensitivity (correct prediction of pCR), specificity (correct prediction of no-pCR) and diagnostic odds ratios (DORs) were calculated. Areas under the curve (AUCs) were derived from logistic regression including patient variables with and without US. In 832 patients, DORs decreased as pCR definitions became less stringent (p 5 0.01). For WHO-2D, DORs were as follows: 4.07 (ypT0,ypN0), 3.75 (ypT0/is,ypN0), 3.14 (ypT0/ is,ypN1/2) and 2.65 (ypT0/is/1a,ypN1/2). DORs did not differ between US criteria (p 5 0.60). High sensitivity and lower specificity were found for WHO-2D and RECIST; WHO-1D was highly specific with low sensitivity. Sensitivity was highest for WHO-2D predicting ypT0,ypN0 (sensitivity 5 81.7%, specificity 5 47.6% vs. 42.3% and 80.4% for WHO-1D). Adding US to models including patient variables (age, T-stage, histology and subtype) improved AUCs for predicting pCR by 2-3%. In conclusion, US accuracy is highest for predicting ypT0,ypN0, shown to be most prognostic of long-term survival. WHO-2D and RECIST maximise sensitivity; WHO-1D maximises specificity. US modestly improves the prediction of pCR by patient characteristics.Neoadjuvant chemotherapy (NAC) has a well-established role in the management of breast cancer, with randomised controlled trials showing similar long-term disease-free survival (DFS) and overall survival (OS), and increased rates of breast conserving surgery compared with upfront surgery and adjuvant therapy. 1 A key advantage of NAC is the opportunity to assess response early during treatment as a predictor of pathologic complete response (pCR) at the end of therapy 2 (a surrogate marker for prolonged DFS and OS), and for treatment modification to increase DFS and OS in hormone receptor positive breast cancers. 3 Randomised controlled trials that assessed early response by clinical examination and ultrasound (US) have indicated benefits of therapy modification in responders and non-responders. Increased rates of pCR, breast conservation and improved OS were found in the Aberdeen trial for responders randomised to taxanes after four cycles of anthracycline-based NAC relative to those continuing treatment. 4,5 The GeparTrio trial randomised early responders to standard or extended anthracycline/taxanebased NAC and found longer DFS and a trend towards longer OS when therapy was extended. 6 Improved DFS and treatment ...

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Accuracy of ultrasound for predicting pathologic response during neoadjuvant therapy for breast cancer

Marinovich

Houssami

Macaskill

et al. 2014

Intl Journal of Cancer

View full text Add to dashboard Cite

show abstract

“…(ASCO 2009. Manuscript 3D US assessment: (Gounaris et al , 2011). Manuscript including patients from Neo-tAnGo(Ismail et al , 2010).…”

mentioning

confidence: 99%

A central review of histopathology reports after breast cancer neoadjuvant chemotherapy in the neo-tango trial

et al. 2013

View full text Add to dashboard Cite

Background:Neo-tAnGo, a National Cancer Research Network (NCRN) multicentre randomised neoadjuvant chemotherapy trial in early breast cancer, enroled 831 patients in the United Kingdom. We report a central review of post-chemotherapy histopathology reports on the surgical specimens, to assess the presence and degree of response.Methods:A central independent two-reader review (EP and HME) of histopathology reports from post-treatment surgical specimens was performed. The quality and completeness of pathology reporting across all centres was assessed. The reviews included pathological response to chemotherapy (pathological complete response (pCR); minimal residual disease (MRD); and lesser degrees of response), laterality, the number of axillary metastases and axillary nodes, and the type of surgery. A consensus was reached after discussion.Results:In all, 825 surgical reports from 816 patients were available for review. Out of 4125 data items there were 347 discrepant results (8.4% of classifications), which involved 281 patients. These involved grading of breast response (169 but only 9 involving pCR vs MRD); laterality (6); presence of axillary metastasis (35); lymph node counts (108); and type of axillary surgery (29). Excluding cases with pCR, only 45% of reports included any comment regarding response in the breast and 30% in the axillary lymph nodes.Conclusion:We found considerable variability in the completeness of reporting of surgical specimens within this national neoadjuvant breast cancer trial. This highlights the need for consensus guidelines among trial groups on histopathology reporting, and the participation of histopathologists throughout the development and analysis of neoadjuvant trials.

show abstract

“…In the multivariate analysis, only sonographic response after 2 cycles and hormonal receptor status were predictive of a final pCR (10). However, retrospective data from a subset of patients enrolled in the Neo-tAnGo trial showed that at mid-treatment (after 4 cycles out of total 8 cycles of NAC) proportional tumor size changes (on the basis of the RECIST criteria) assessed by conventional US were not predictive of good pathological response at end-treatment (11). Our own data also indicated that pCR after 4 cycles of anthracycline or taxane-based NAC cannot be reliably predicted by PC measured by conventional US after 2 cycles of NAC (AUC=0.65) (12).…”

Section: Discussionmentioning

confidence: 99%

“…First and foremost, it is very difficult for US to differentiate residual tumor from post-treatment fibrosis. The presence of other post-treatment changes such as tumor fragmentation, stromal reaction and residual carcinoma in situ make the situation even more complicated (27). The consequence is that US often shows a residual mass in cases where pathological examination reveals pCR or minimum residual disease.…”

Section: Discussionmentioning

confidence: 99%

Early prediction of pathological outcomes to neoadjuvant chemotherapy in breast cancer patients using automated breast ultrasound

Wang

Huo

et al. 2016

Chinese Journal of Cancer Research

View full text Add to dashboard Cite

ObjectiveEarly assessment of response to neoadjuvant chemotherapy (NAC) for breast cancer allows therapy to be individualized. The optimal assessment method has not been established. We investigated the accuracy of automated breast ultrasound (ABUS) to predict pathological outcomes after NAC.MethodsA total of 290 breast cancer patients were eligible for this study. Tumor response after 2 cycles of chemotherapy was assessed using the product change of two largest perpendicular diameters (PC) or the longest diameter change (LDC). PC and LDC were analyzed on the axial and the coronal planes respectively. Receiver operating characteristic (ROC) curves were used to evaluate overall performance of the prediction methods. Youden's indexes were calculated to select the optimal cut-off value for each method. Sensitivity, specificity, positive and negative predictive values (PPV and NPV) and the area under the ROC curve (AUC) were calculated accordingly.ResultsypT0/is was achieved in 42 patients (14.5%) while ypT0 was achieved in 30 patients (10.3%) after NAC. All four prediction methods (PC on axial planes, LDC on axial planes, PC on coronal planes and LDC on coronal planes) displayed high AUCs (all>0.82), with the highest of 0.89 [95% confidence interval (95% CI), 0.83-0.95] when mid-treatment ABUS was used to predict final pathological complete remission (pCR). High sensitivities (85.7%-88.1%) were observed across all four prediction methods while high specificities (81.5%-85.1%) were observed in two methods used PC. The optimal cut-off values defined by our data replicate the WHO and the RECIST criteria. Lower AUCs were observed when mid-treatment ABUS was used to predict poor pathological outcomes.ConclusionsABUS is a useful tool in early evaluation of pCR after NAC while less reliable when predicting poor pathological outcomes.

show abstract

Accuracy of unidimensional and volumetric ultrasound measurements in predicting good pathological response to neoadjuvant chemotherapy in breast cancer patients

Cited by 22 publications

References 33 publications

Accuracy of ultrasound for predicting pathologic response during neoadjuvant therapy for breast cancer

Accuracy of ultrasound for predicting pathologic response during neoadjuvant therapy for breast cancer

A central review of histopathology reports after breast cancer neoadjuvant chemotherapy in the neo-tango trial

Early prediction of pathological outcomes to neoadjuvant chemotherapy in breast cancer patients using automated breast ultrasound

Contact Info

Product

Resources

About