Ultrasound Strain Elastography and Contrast‐Enhanced Ultrasound in Predicting the Efficacy of Neoadjuvant Chemotherapy for Breast Cancer: A Nomogram Integrating Ki‐67 and Ultrasound Features

Abstract

Objectives-To explore whether conventional elastography and contrast-enhanced ultrasound (CEUS) combined with histopathology can monitor the efficacy of neoadjuvant chemotherapy (NAC) for breast cancer (BC), and develop a Nomogram prediction model monitoring response to NAC.Methods-From February 2010 to November 2015, 91 BC patients who received NAC were recruited. The maximum diameter, stiffness, and CEUS features were assessed. Core biopsy, surgical pathology immunophenotype, and Miller-Payne (MP) evaluation were documented. Univariate and multivariate analysis was performed using receiver operating characteristic (ROC) analysis and logistic regression analysis.Results-There were 37 cases showing pathological complete response (pCR) and 54 of non-pCR. The changes of maximal diameter were correlated with MP (P < .05). The sensitivity (SEN), specificity (SPE), and area under the ROC curve (AUC) of baseline size predicting pCR were 57.40%, 70.30%, and 0.64 (P = .024). Baseline Ki-67 index of pCR group is significantly higher than that of non-pCR group (P = .029), and the ROC analysis of baseline Ki-67 indicates the SEN, SPE, and AUC of 51.70%, 78.00%, and 0.638 (P = .050). When combined with size, CEUS features, stiffness, and Ki-67 of baseline, the ROC curve shows good performance with SEN, SPE, and AUC of 70.00%, 76.19%, 0.821 (P = .004). Incorporating the change of characteristics into multivariate regression analysis, the results demonstrate excellent performance (SEN 100.00%, SPE 95.24%, AUC 0.986, P = .000).Conclusions-The change of the maximum size was correlated with MP score, which can provide reference to predict efficacy of NAC and evaluate residual lesions. When combining with elastography, CEUS, and Ki-67, better performance in predicting pathological response was shown.

Ultrasound features combined with tumor-infiltrating lymphocytes for prediction of pathological response to neoadjuvant chemotherapy in breast cancer

“…The occurrence, progress, metastasis, and response to a breast cancer drug is a complex process. Previous studies showed better performance in predicting pathological response when combined with US features and Ki-67 [14]. These findings further revealed that imaging biomarkers combined with pathological indicators may acquire better progress.…”

“…Early and accurate selection of patients most likely to benefit from NAC is essential and can help patients avoid ineffective treatment and seize the best time for surgery. Primary studies on the association between breast US and response to NAC have paid attention to the changes in lesion size [14]. Indeed, there were limits to this approach.…”

“…However, pre-treatment imaging features had been reported to be less accurate [13]. Imaging features combined with clinical information and pathological findings take advantage of gaining additional information from both imaging and pathology, which were proven to improve the accuracy [14,15]. Therefore, we hypothesized that baseline US features combined with TIL levels could better reflect NAC efficacy.…”

The ultrasound elastography findings in lateral epicondylitis in comparison with healthy individuals

“…Numerous clinical SEL applications and studies were found to evaluate diagnosis and assessment of changes in tissue stiffness and elasticity in pathological conditions. [9][10][11][12][13][14] However, clinical utility of elastography has been infrequently studied in LE and has not been evaluated with tendon thickness.…”

Development of a multiparametric model for predicting the response to neoadjuvant chemotherapy in breast cancer

“…Several studies have examined the multidimensional features of tumor tissues using imaging parameters, such as ultrasound, 18 F-FDG PET/CT, and magnetic resonance imaging (MRI) scanning, to predict breast cancer patients’ responses to treatment and prognosis early ( 16 - 18 ). Changes in the maximum size of the breast cancer combined with ultrasonography can be informative in predicting NAC efficacy and evaluating residual lesions ( 19 ). Notably, the volumetric parameters of 18 F-FDG PET/CT before NAC, such as the metabolic tumor volume and total lesion glycolysis, are significantly correlated with the disease-free survival of breast cancer patients ( 20 ).…”