Ultrasound-based prediction of pathologic response to neoadjuvant chemotherapy in breast cancer patients |
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| Affiliation: | 1. University of Zurich, Faculty of Medicine, Rämistrasse 71, 8008 Zurich, Switzerland;2. Breast Center Zurich, Seefeldstrasse 214, 8008 Zurich, Switzerland;3. University Hospital Zurich, Department of Pathology and Molecular Pathology, Rämistrasse 100, 8091 Zurich, Switzerland;4. University Hospital Zurich, Department of Gynecology, Frauenklinikstrasse 10, 8091 Zurich, Switzerland;1. Department of Breast Oncology and Surgery, Tokyo Medical University Hospital, Tokyo, Japan;2. Department of Medical Informatics, Niigata University Medical and Dental Hospital, Niigata, Japan;3. Department of Breast Surgery, Hirosaki Municipal Hospital, Aomori, Japan;4. Department of Breast and Endocrine Surgery, Gunma University Hospital, Gunma, Japan;5. Department of Breast and Endocrine Surgery, Toranomon Hospital, Tokyo, Japan;6. Department of Breast Surgery, Kobe Kaisei Hospital, Hyogo, Japan;1. Department of Breast Surgery, Guy''s and St. Thomas'' NHS Foundation Trust, London, UK;2. Department of Pathology, Guy''s and St Thomas'' NHS Foundation Trust, London, UK;3. Department of Radiology, Guy''s and St. Thomas'' NHS Foundation Trust, London, UK;1. Breast Center, Peking University People''s Hospital, Beijing, China;2. Department of Radiology, Breast Center, Peking University People''s Hospital, Beijing, China;1. University Breast Unit, Department of Gynecology, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany;2. Institute of Pathology, Im Neuenheimer Feld 220/221/224, 69120, Heidelberg, Germany;3. Institute of Medical Biometry, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany;4. National Center of Tumor Disease (NCT), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany;1. Department of Clinical Oncology, Leiden University Medical Center, The Netherlands;2. Department of Surgery, Leiden University Medical Center, The Netherlands;3. Department of Radiology, Leiden University Medical Center, The Netherlands;4. Department of Pathology, Leiden University Medical Center, The Netherlands;5. Department of Medical Statistics, Leiden University Medical Center, The Netherlands;6. Dutch Breast Cancer Research Group (BOOG), The Netherlands |
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| Abstract: | BackgroundAccuracy in predicting pathologic response to neoadjuvant chemotherapy (NACT) in breast cancer is essential for the determination of therapeutic efficacy and surgical planning. This study aimed to assess the precision of ultrasound (US) for predicting pathologic complete response (pCR = ypT0) after NACT.MethodsThis retrospective mono-center study included 124 invasive breast cancer patients treated with NACT. Patients received US before and after NACT with documentation of clinical partial response (cPR) and clinical complete response (cCR). Post-operatively, the pathologic response was defined as absence of tumor cells (ypT0), presence of non-invasive tumor cells (ypTis) or invasive tumor cells (ypTinv). Sensitivity and specificity of US as well as false negative rate (FNR), negative predictive value (NPV) and positive predictive value (PPV) were analysed for receptor subtypes. A multivariable logistic regression model assessed the influence of patient- and tumor-associated covariates as predictors for pCR.Results50 patients (40.3%) achieved pCR, 39 (78.0%) had a corresponding cCR. Overall sensitivity was 60.8% and specificity 78.0% for US-predicted remission. NPV and FNR differed substantially between subtypes. NPV was highest (75.0%) in triple negative (TN) subtype, while FNR was low (37.5%). Therefore, pathological response was most accurately predicted for TN cancers. NPV for human-epidermal-growth-factor-receptor-2-positive/hormone-receptor-positive (HER2+/HR+) was 55.6%, for HER2+/HR- 64.3% and for HER2-/HR+ 16.7%, FNRs were 40.0%, 71.4% and 32.3%, respectively. Receptor subtypes impacted pCR significantly (p-value: 0.0033), cCR correlated positively with pCR (p-value: 0.0026).ConclusionUS imaging is insufficient to predict pCR with adequate accuracy. Receptor subtypes, however, affect diagnostic precision of US and pathologic outcome. |
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| Keywords: | Breast cancer Breast ultrasound Neoadjuvant chemotherapy Pathologic response Receptor subtypes |
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