Predicting Treatment Response of Breast Cancer to Neoadjuvant Chemotherapy Using Ultrasound-Guided Diffuse Optical Tomography

Abstract

PURPOSE: To prospectively investigate ultrasound-guided diffuse optical tomography (US-guided DOT) in predicting breast cancer response to neoadjuvant chemotherapy (NAC). MATERIALS AND METHODS: Eighty-eight breast cancer patients, with a total of 93 lesions, were included in our study. Pre– and post–last chemotherapy, size and total hemoglobin concentration (THC) of each lesion were measured by conventional US and US-guided DOT 1 day before biopsy (time point t0, THC THC0, SIZE S0) and 1 to 2 days before surgery (time point tL, THCL, SL). The relative changes in THC and SIZE of lesions after the first and last NAC cycles were considered as the variables ΔTHC and ΔSIZE. Receiver operating characteristic curve was performed to calculate ΔTHC and ΔSIZE cutoff values to evaluate pathologic response of 93 breast cancers to NAC, which were then prospectively used to predicate response of 61 breast cancers to NAC. RESULTS: The cutoff values of ΔTHC and ΔSIZE for evaluation of breast cancers NAC treatment response were 23.9% and 42.6%. At ΔTHC 23.9%, the predicted treatment response in 61 breast lesions for the time points t1 to t3 was calculated by area under the curve (AUC), which were AUC1 0.534 (P = .6668), AUC2 0.604 (P = .1893), and AUC3 0.674(P =. 0.027), respectively; for ΔSIZE 42.6%, at time points t1 to t3, AUC1 0.505 (P = .9121), AUC2 0.645 (P = .0115), and AUC3 0.719 (P = .0018). CONCLUSION: US-guided DOT ΔTHC 23.9% and US ΔSIZE 42.6% can be used for the response evaluation and earlier prediction of the pathological response after three rounds of chemotherapy.

Diffuse optical spectroscopy for monitoring the responses of patients with breast cancer to neoadjuvant chemotherapy

“…DOT can detect changes in tumor absorption within the first days after the treatment and thus could characterize breast tumor response to NAC at an earlier time than other modalities. [ 4 – 6 ] Previous studies [ 6 – 15 ] showed that DOT is a promising technique for identifying pathologic complete response (pCR) to NAC. However, the diagnostic performance of DOT varies, and it has not been subjected to multicenter studies with large samples.…”

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

“…90 DOT is an optical imaging technique that uses near-infrared light to probe the absorption and scattering properties of biological tissues and to acquire information on tumor physiology, biochemistry, angiogenesis, and hypoxia. [91][92][93][94][95] DOT combined with US has been explored for breast cancer diagnosis and monitoring NAC responses in BC. Combining pretreatment hemoglobin content and hemoglobin changes measured at early treatment cycles with standard pathological variables improves the predictive accuracy of NAC.…”

“…Combining pretreatment hemoglobin content and hemoglobin changes measured at early treatment cycles with standard pathological variables improves the predictive accuracy of NAC. 96 The size and total hemoglobin concentration (THC) of the lesions were measured 1 day before biopsy and 1 to 2 days before surgery to predict BC response to NAC using US-guided DOT in the research of Zhi et al 91 The sensitivity, specificity, accuracy, PPV, NPV, and AUC were 74% and 80%, 77% and 53%, 77% and 38%, 93% and 88%, 74% and 77%, 0.75 and 0.69, respectively, when ΔTHC was 23.9% and ΔSIZE was 42.6%. Moreover, ΔTHC and ΔSIZE can be used for response evaluation and earlier prediction of the response after three rounds of NAC.…”

“…Reprinted from Translational Oncology , Vol 11/edition number 1, Zhi W, Liu G, Chang C, et al, Predicting treatment response of breast cancer to neoadjuvant chemotherapy using ultrasound-guided diffuse optical tomography, Pages No.56–64, Copyright (2018), with permission from Elsevier. 91 ⑦ Changes in peripheral vessels before and after completion of NAC in breast cancer patients displayed by 3D-CEUS. ( A ) Before NAC, the 3D-CEUS image showed coarse peripheral vessels with radial distribution (arrow) at the strongest stage of perfusion.…”

Two-layer spatial frequency domain imaging of compression-induced hemodynamic changes in breast tissue

“…Near-infrared (NIR) optical imaging methods have shown potential for prediction of treatment outcome in women undergoing neoadjuvant chemotherapy (NAC) for breast cancer via longitudinal tracking of hemoglobin concentration within the breast. [1][2][3][4][5][6][7][8][9][10][11][12][13] Pathologic complete response (pCR) to NAC (assessed histologically after surgery) is associated with improved survival, 14,15 but the results of structural imaging modalities such as ultrasonography and x-ray mammography are poor predictors of patient outcome. 16,17 Predicating the response early in the course of therapy could potentially enable treatment alternatives.…”