Evaluation of the response of breast cancer patients to neoadjuvant chemotherapy by combined contrast‑enhanced ultrasonography and ultrasound elastography

Abstract

The purpose of the present study was to investigate whether contrast-enhanced ultrasonography (CEUS) in combination with ultrasound elastography (UE) is able to accurately predict the efficacy of neoadjuvant chemotherapy (NAC) in breast cancer patients. A total of 65 breast cancer patients who received NAC at the First Affiliated Hospital of Zhejiang University (Hangzhou, China) between February 2016 and August 2017 and were recruited for the present study. Prior to and after NAC, examination by CEUS, UE or their combination was performed. Pathological results were obtained at the end of each chemotherapy cycle, based on which 41 cases were assigned to the response group and 24 to the non-response group. Kappa values were 0.710, 0.434 and 0.836 for CEUS, UE and CEUS+UE, respectively. The area under the receiver operating characteristic curves for CEUS, UE and CEUS+UE for determining the response to NAC was 0.864 [95% confidence interval (CI), 0.765–0.964], 0.715 (95% CI, 0.579–0.850) and 0.910 (95% CI, 0.826–0.993), respectively. It was identified that the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CEUS+UE were higher than those of CEUS and US individually. The prediction accuracy was 89.2, 90.8 and 100% for CEUS, UE and their combination, respectively. CEUS and UE have their own advantages in evaluating the clinical efficacy of NAC in breast cancer, and a higher accuracy was achieved when the two techniques were applied in combination. Therefore, a combination of CEUS and UE may be a preferred method for the clinical assessment of the efficacy of NAC in breast cancer patients.

Contrast-Enhanced Ultrasonography in the Diagnosis and Treatment Modulation of Breast Cancer

“…Ultrasound elastography showed a considerably reduced strain ratio after NAC in responders compared to non-responders (2.11 ± 0.52 versus 3.71 ± 1.29) and without a significant difference at baseline but, when combined with CEUS, the Se, Sp, positive predictive value (PPV), negative predictive value (NPV) and accuracy were higher than those of CEUS or elastography alone [ 67 ].…”

Elastography in Breast Imaging

“…Darüber hinaus konnte eine im vergangenen Jahr veröffentlichte Arbeit zeigen, dass die konventionelle 2D-Scherwellen-Elastografie die pathologische Komplettremission nach neoadjuvanter Chemotherapie nach drei Behandlungszyklen besser vorhersagen kann, als konventioneller US und MRT zusammen [21,22]. Diese Ergebnisse wurden durch Publikationen untermauert, die aufzeigen, dass die Strain-Elastografie nach zwei Wochen Chemotherapie eine pathologische Komplettremission vorhersagen kann und dass die Ergebnisse durch die Kombination von Elastografie mit kontrastverstärktem Ultraschall weiter verbessert werden können [23][24][25].…”

“…In one recent article here in EJU 3D shear-wave elastography was shown to be a feasible imaging modality to evaluate volumetric changes in breast tumors following neoadjuvant chemotherapy, while an article published last year showed conventional 2D shear-wave elastography to be able to better predict pathological complete response to neoadjuvant chemotherapy after three cycles of treatment than both conventional US and MRI [21,22]. These results have been substantiated by articles showing that strain elastography can predict pathological complete response after two weeks of chemotherapy treatment and that results may further be improved when combining elastography with contrast-enhanced ultrasound [23][24][25].…”

Modified Model for Diagnosing Breast Imaging Reporting and Data System Category 3 to 5 Breast Lesions

“…6 Using the characteristics of the blood flow distribution and microcirculation perfusion to improve the diagnostic accuracy of BI-RADS category 3 to 5 breast lesions is an important recent research topic. 5,[7][8][9][10] Qualitative and quantitative indicators have been studied for the application of CEUS in breast disease for decades, and their importance has been proven. [11][12][13] Studies show differences between benign and malignant breast lesions in CEUS characteristics.…”

“…For lesions that cannot be characterized by B‐mode US, CEUS can provide diagnostic information 6 . Using the characteristics of the blood flow distribution and microcirculation perfusion to improve the diagnostic accuracy of BI‐RADS category 3 to 5 breast lesions is an important recent research topic 5,7–10 …”