Prediction of treatment responses to neoadjuvant chemotherapy in breast cancer using contrast-enhanced ultrasound

Yunxia Huang; Jian Le; Aiyu Miao; Wenxiang Zhi; Fen Wang; Yaling Chen; Shichong Zhou; Cai Chang

doi:10.21037/gs-20-836

Prediction of treatment responses to neoadjuvant chemotherapy in breast cancer using contrast-enhanced ultrasound

Gland Surg. 2021 Apr;10(4):1280-1290. doi: 10.21037/gs-20-836.

Authors

Yunxia Huang^{1

2}, Jian Le^{1

2}, Aiyu Miao^{1

2}, Wenxiang Zhi^{1

2}, Fen Wang^{1

2}, Yaling Chen^{1

2}, Shichong Zhou^{1

2}, Cai Chang^{1

2}

Affiliations

¹ Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.
² Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.

Abstract

Background: Elucidation the efficacy of neoadjuvant chemotherapy (NAC) in breast cancer is important for informing therapeutic decisions. This study aimed at evaluating the potential value of contrast-enhanced ultrasound (CEUS) parameters in predicting breast cancer responses to NAC.

Methods: We performed CEUS examinations before and after two cycles of NAC. Quantitative CEUS parameters [maximum intensity (IMAX), rise time (RT), time to peak (TTP), and mean transit time (mTT)], tumor diameter, and their changes were measured and compared to histopathological responses, according to the Miller-Payne Grading (MPG) system (score 1, 2, or 3: minor response; score 4 or 5: good response). Prediction models for good response were developed by multiple logistic regression analysis and internally validated through bootstrap analysis. The receiver operating characteristic (ROC) curve was used to evaluate the performance of prediction models.

Results: A total of 143 patients were enrolled in this study among whom 98 (68.5%) achieved a good response and while 45 (31.5%) exhibited a minor response. Several imaging variables including diameter, IMAX, changes in diameter (Δdiameter), IMAX (ΔIMAX) and TTP (ΔTTP) were found to be significantly associated with good therapeutic responses (P<0.05). The areas under the curve (AUC) increased from 0.748 to 0.841 in the multivariate model that combined CEUS parameters and molecular subtypes with a sensitivity and specificity of 0.786, 0.745, respectively. Tumor molecular subtype was the primary predictor of primary endpoint.

Conclusions: CEUS is a potential tool for predicting responses to NAC in locally advanced breast cancer patients. Compared to the other molecular subtypes, triple negative and HER2+/ER- subtypes are more likely to exhibit a good response to NAC.

Keywords: Breast cancer; contrast-enhanced ultrasound (CEUS); neoadjuvant chemotherapy (NAC); treatment response prediction.