The Role of Nomogram Based on the Combination of Ultrasound Parameters and Clinical Indicators in the Degree of Pathological Remission of Breast Cancer

Abstract

Background. The mortality rate of breast cancer (BC) ranks first among female tumors worldwide and presents a trend of younger age, which poses a great threat to women’s health and life. Neoadjuvant chemotherapy (NAC) for breast cancer is defined as the first step of treatment for breast cancer patients without distant metastasis before planned surgical treatment or local treatment with surgery and radiotherapy. According to the current NCCN guidelines, patients with different molecular types of BC should receive neoadjuvant chemotherapy (NAC), which can not only achieve tumor downstaging, increase the chance of surgery, and improve the breast-conserving rate. In addition, it can identify new genetic pathways and drugs related to cancer, improve patient survival rate, and make new progress in breast cancer management. Objective. To explore the role of the nomogram established by the combination of ultrasound parameters and clinical indicators in the degree of pathological remission of breast cancer. Methods. A total of 147 breast cancer patients who received neoadjuvant chemotherapy and elective surgery in the Department of Ultrasound, Nantong Cancer Hospital, from May 2014 to August 2021 were retrospectively included. Postoperative pathological remission was divided into two groups according to Miller–Payne classification: no significant remission group (NMHR group, n = 93) and significant remission group (MHR group, n = 54). Clinical characteristics of patients were recorded and collected. The multivariate logistic regression model was used to screen the information features related to the MHR group, and then, a nomogram model was constructed; ROC curve area, consistency index (C-index, CI), calibration curve, and H-L test were used to evaluate the model. And the decision curve is used to compare the net income of the single model and composite model. Results. Among 147 breast cancer patients, 54 (36.7%) had pathological remission. Multivariate logistic regression showed that ER, reduction/disappearance of strong echo halo, Adler classification after NAC, PR + CR, and morphological changes were independent risk factors for pathological remission ( P < 0.05 ). Based on these factors, the nomogram was constructed and verified. The area under the curve (AUC) and CI were 0.966, the sensitivity and specificity were 96.15% and 92.31%, and the positive predictive value (PPV) and negative predictive value (NPV) were 87.72% and 97.15%, respectively. The mean absolute error of the agreement between the predicted value and the real value is 0.026, and the predicted risk is close to the actual risk. In the range of HRT of about 0.0∼0.9, the net benefit of the composite evaluation model is higher than that of the single model. H-L test results showed that χ2 = 8.430, P = 0.393 > 0.05 . Conclusion. The nomogram model established by combining the changes of ultrasound parameters and clinical indicators is a practical and convenient prediction model, which has a certain value in predicting the degree of pathological remission after neoadjuvant chemotherapy.

Predicting pathological complete response after neoadjuvant chemotherapy in breast cancer by clinicopathological indicators and ultrasound parameters using a nomogram

“…Changes in ultrasound parameters during treatment provide more accurate predictions of the extent of pathological remission in NACT compared to ultrasound parameters assessed before treatment in the patient's tumor. Chen et al's study demonstrated a significant correlation between a decrease in tumor blood supply, evaluated through ultrasound during chemotherapy, and a higher rate of pCR, consistent with our findings 26 . However, the distinction lies in the fact that Chen et al evaluated changes in tumor blood supply before and after the entire NACT cycle (4–8 cycles), while our study specifically assessed changes after two cycles of chemotherapy.…”

“…Clinical acquisition of ultrasound images of tumors is also straightforward. Patients' tumors are routinely assessed clinically before and during treatment, with breast ultrasound being the primary choice for evaluating tumors in BC patients due to its cost-effectiveness, non-invasiveness, and accuracy.Nevertheless, few studies have established predictive models for NACT efficacy based on ultrasound parameters and clinical indicators 26 . By integrating breast ultrasound with relevant clinicopathological indicators, we innovatively devised and validated a nomogram.…”