Ultrasound-based prediction of pathologic response to neoadjuvant chemotherapy in breast cancer patients

Baumgartner, Annina; Tausch, Christoph; Hosch, Stefanie; Papassotiropoulos, Bärbel; Varga, Zsuzsanna; Rageth, Christoph; Baege, Astrid

doi:10.1016/j.breast.2018.02.028

Cited by 48 publications

(42 citation statements)

References 31 publications

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“…The moderate accuracy of all three imaging modalities indicates that they are not reliable enough to predict pCR in a clinical setting, as was concluded in previous studies. 22,25,32 As is indicated in other studies, 15,17,21,28,33 this study showed that the diagnostic performance of US or MRI varied between different histological and molecular subtypes. This may be correlated with the different pCR rates between these groups.…”

Section: Discussionsupporting

confidence: 72%

“…Numerous studies on the diagnostic performance of imaging to evaluate the primary tumor response to NAC in breast cancer have been published. However, the definitions of pCR varied from the absence of residual invasive cancer with or without cancer in situ (ypT0/is) 14,17,21,24 to the absence of residual invasive and noninvasive cancer (ypT0) 15,16,25 in the primary tumor area. What is more, some studies defined the presence of a pCR as positivity, 16,17,21 whereas others considered the presence of residual tumor as positivity 14,15,22,23,25 when they analyzed the diagnostic performance of imaging with sensitivity, specificity, accuracy, PPV, and NPV, and so on.…”

Section: Discussionmentioning

confidence: 99%

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<p>Prediction of Pathologic Complete Response by Ultrasonography and Magnetic Resonance Imaging After Neoadjuvant Chemotherapy in Patients with Breast Cancer</p>

Zhang¹,

Li²,

Zhu³

et al. 2020

CMAR

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These authors contributed equally to this workPurpose: To compare the diagnostic performance for pathologic complete response (pCR) in breast cancer after neoadjuvant chemotherapy (NAC) between ultrasound (US) and magnetic resonance imaging (MRI). Patients and Methods: A total of 1,219 breast cancer patients with 1,232 tumors who accepted US and/or MRI examination after NAC and before breast surgery were included. The diagnostic performance of US, MRI, and US plus MRI in predicting pCR was compared. Results: The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of US for pCR were 36.2%, 90.2%, 71.0%, 67.3%, and 71.9%, respectively, while for MRI they were 44.4%, 92.9%, 75.6%, 77.7%, and 75.0%, respectively. The combination of US and MRI had increased specificity (98.0%) and PPV (86.8%), decreased sensitivity (22.5%) and NPV (68.8%), but similar accuracy (70.5%) in comparison with US or MRI alone. The prediction of pCR by imaging differed in different histological, molecular subtypes and primary tumor size. Conclusion: Neither US nor MRI could predict a pCR with sufficient accuracy. The combination of US and MRI could not predict a pCR reliably either. The explanation of imaging for pCR should take into account histological, molecular subtypes, and primary tumor size.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

<p>Prediction of Pathologic Complete Response by Ultrasonography and Magnetic Resonance Imaging After Neoadjuvant Chemotherapy in Patients with Breast Cancer</p>

Zhang¹,

Li²,

Zhu³

et al. 2020

CMAR

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“…There are also reports that sensitivity and specificity of axillary ultrasound alone after NAC are 55% and 88 %, respectively, which is very close to the results of our research (You et al, 2015;Baumgartner et al, 2018;Le-Petross et al, 2018). However, pathological confirmation of the ycN stage is very important in surgical decision making, especially taking in to account that ultrasound method is highly operator dependent.…”

Section: Discussionsupporting

confidence: 89%

Role of Percutaneous Needle Biopsy of Axillary Lymph Nodes to Evaluate Node Positive Breast Cancer after Neoadjuvant Chemotherapy

Līcīte

Irmejs

Maksimenko

et al. 2019

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

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The aim of the study was to evaluate the role of ultrasound guided fine needle aspiration cytology (FNAC) in the restaging of node positive breast cancer after neoadjuvant chemotherapy (NAC). From January 2016 – October 2018, 90 node positive stage IIA-IIIC breast cancer cases undergoing NAC were included in the study. The largest, most superficial and the most caudal axillary node metastasis confirmed by fine needle aspiration cytology (FNAC) was marked with clip. After NAC, restaging of axilla was performed with ultrasound and FNAC of the marked and/or the most suspicious axillary node. Of the 90 cases, 58 with available ultrasound guided percutaneous needle biopsy data were further evaluated. Axilla conserving surgery was performed in 37 of 58 cases and axillary lymph node dissection (ALND) in 21 of 58 cases. False Positive Rate (FPR) of FNAC after NAC was 12%, False Negative Rate (FNR) — 58%, sensitivity — 54%, specificity — 82%, accuracy 62%. FNAC after NAC had low FPR and was found to be useful in predicting residual axillary disease and to streamline surgical decision making regarding ALND. However, FNR was unacceptably high and FNAC alone was not able to predict ypCR and omission of further axillary surgery.

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“…Various investigations have focused on predicting the efficacy of NCT in patients with breast cancer, including the analysis of inflammatory markers, 28 application of histomorphological factors, 29 analysis of molecular biomarkers, 30 and the use of medical imaging indicators. 31,32 However, given the heterogeneity of tumors, the accuracy of predicting efficacy using a single factor is limited; therefore, researchers have attempted to predict the efficacy of NCT using a multifactorial model. Takada et al developed a prediction model for pCR after NCT using ADTree, 8 in which the fluorouracil, epirubicin, and cyclophosphamide (FEC) regimen was used for the whole study population; however, they failed to take into account the use of targeted drugs in patients with HER2?…”

Section: Discussionmentioning

confidence: 99%

Can We Reliably Identify the Pathological Outcomes of Neoadjuvant Chemotherapy in Patients with Breast Cancer? Development and Validation of a Logistic Regression Nomogram Based on Preoperative Factors

Zhang

Xiao

et al. 2020

Ann Surg Oncol

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Background Pathological responses of neoadjuvant chemotherapy (NCT) are associated with survival outcomes in patients with breast cancer. Previous studies constructed models using out-of-date variables to predict pathological outcomes, and lacked external validation, making them unsuitable to guide current clinical practice. Objective The aim of this study was to develop and validate a nomogram to predict the objective remission rate (ORR) of NCT based on pretreatment clinicopathological variables. Methods Data from 110 patients with breast cancer who received NCT were used to establish and calibrate a nomogram for pathological outcomes based on multivariate logistic regression. The predictive performance of this model was further validated using a second cohort of 55 patients with breast cancer. Discrimination of the prediction model was assessed using an area under the receiver operating characteristic curve (AUC), and calibration was assessed using calibration plots. The diagnostic odds ratio (DOR) was calculated to further evaluate the performance of the nomogram and determine the optimal cut-off value. Results The final multivariate regression model included age, NCT cycles, estrogen receptor, human epidermal growth factor receptor 2 (HER2), and lymphovascular invasion. A nomogram was developed as a graphical representation of the model and showed good calibration and discrimination in both sets (an AUC of 0.864 and 0.750 for the training and validation cohorts, respectively). Finally, according to the Youden index and DORs, we assigned an optimal ORR cut-off value of 0.646. Conclusion We developed a nomogram to predict the ORR of NCT in patients with breast cancer. Using the nomogram, for patients who are operable and whose ORR is < 0.646, we believe that the benefits of NCT are limited and these patients can be treated directly using surgery.

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Ultrasound-based prediction of pathologic response to neoadjuvant chemotherapy in breast cancer patients

Cited by 48 publications

References 31 publications

<p>Prediction of Pathologic Complete Response by Ultrasonography and Magnetic Resonance Imaging After Neoadjuvant Chemotherapy in Patients with Breast Cancer</p>

<p>Prediction of Pathologic Complete Response by Ultrasonography and Magnetic Resonance Imaging After Neoadjuvant Chemotherapy in Patients with Breast Cancer</p>

Role of Percutaneous Needle Biopsy of Axillary Lymph Nodes to Evaluate Node Positive Breast Cancer after Neoadjuvant Chemotherapy

Can We Reliably Identify the Pathological Outcomes of Neoadjuvant Chemotherapy in Patients with Breast Cancer? Development and Validation of a Logistic Regression Nomogram Based on Preoperative Factors

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