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Senologie - Zeitschrift für Mammadiagnostik und -therapie 2018; 15(04): 229-237
DOI: 10.1055/a-0797-4532
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Prediction of pathological complete response to neoadjuvant chemotherapy for primary breast cancer comparing interim ultrasound, Shear Wave elastography and MRI

Prädiktion der pathologischen Komplettremission nach neoadjuvanter Chemotherapie bei primärem Mammakarzinom mittels Interim Ultraschall, Shearwave-Elastografie und MRT
Andrew Evans
1   Imaging and Technology, Dundee University, Dundee, United Kingdom of Great Britain and Northern Ireland
,
Patsy Whelehan
2   Breast Imaging, Ninewells Hospital, Dundee, United Kingdom of Great Britain and Northern Ireland
,
Alastair Thompson
3   Breast Surgery, University of Texas MD Anderson Cancer Center, Houston, United States
,
Colin Purdie
4   Pathology, Ninewells Hospital, Dundee, United Kingdom of Great Britain and Northern Ireland
,
Lee Jordan
4   Pathology, Ninewells Hospital, Dundee, United Kingdom of Great Britain and Northern Ireland
,
Jane Macaskill
5   Breast Surgery, Ninewells Hospital, Dundee, United Kingdom of Great Britain and Northern Ireland
,
Shelley Waugh
6   Medical Physics, Ninewells Hospital, Dundee, United Kingdom of Great Britain and Northern Ireland
,
Frances Fuller-Pace
7   Cancer, Dundee University, Dundee, United Kingdom of Great Britain and Northern Ireland
,
Katrin Brauer
2   Breast Imaging, Ninewells Hospital, Dundee, United Kingdom of Great Britain and Northern Ireland
,
Sarah Vinnicombe
1   Imaging and Technology, Dundee University, Dundee, United Kingdom of Great Britain and Northern Ireland
› Author Affiliations
Further Information

Publication History

Publication Date:
10 December 2018 (online)

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Abstract

Background Prediction of pathological complete response (pCR) of primary breast cancer to neoadjuvant chemotherapy (NACT) may influence planned surgical approaches in the breast and axilla. The aim of this project is to assess the value of interim shear wave elastography (SWE), ultrasound (US) and magnetic resonance imaging (MRI) after 3 cycles in predicting pCR.

Methods 64 patients receiving NACT had baseline and interim US, SWE and MRI examinations. The mean lesion stiffness at SWE, US and MRI diameter was measured at both time points. We compared four parameters with pCR status: a) Interim mean stiffness ≤ or > 50 kPat; b) Percentage stiffness reduction; c) Percentage US diameter reduction and d) Interim MRI response using RECIST criteria. The Chi square test was used to assess significance.

Results Interim stiffness of ≤ or > 50 kPat gave the best prediction of pCR with pCR seen in 10 of 14 (71 %) cancers with an interim stiffness of ≤ 50 kPat, compared to 7 of 50 (14 %) of cancers with an interim stiffness of > 50 kPat, (p < 0.0001) (sensitivity 59 %, specificity 91 %, PPV 71 %, NPV 86 % and diagnostic accuracy 83 %). Percentage reduction in stiffness was the next best parameter (sensitivity 59 %, specificity 85 %, p < 0.0004) followed by reduction in MRI diameter of > 30 % (sensitivity 50 % and specificity 79 %, p = 0.03) and % reduction in US diameter (sensitivity 47 %, specificity 81 %, p = 0.03). Similar results were obtained from ROC analysis.

Conclusion SWE stiffness of breast cancers after 3 cycles of NACT and changes in stiffness from baseline are strongly associated with pCR after 6 cycles.

Zusammenfassung

Hintergrund Die Prädiktion der pathologischen Komplettremission (pCR) bei primärem Mammakarzinom nach neoadjuvanter Chemotherapie (NACT) kann die geplante chirurgische Herangehensweise in Brust und Axilla beeinflussen. Ziel dieser Arbeit ist die Beurteilung des Wertes von Interim Shearwave-Elastografie (SWE), Ultraschall (US) und Magnetresonanztomografie (MRI) nach 3 Zyklen für die Vorhersage einer pCR.

Methoden Bei 64 Patienten mit NACT wurden Anfangs- und Interim-Untersuchungen mittels US, SWE und MRT durchgeführt. Die mittlere Steifigkeit der Läsion mittels SWE-, US- und MRT-Durchmesser wurde zu beiden Zeitpunkten bestimmt. Wir verglichen vier Parameter mit dem pCR-Status: a) Interim mittlere Steifigkeit ≤ oder > 50 kPat, b) prozentuale Reduktion der Steifigkeit, c) prozentuale Reduktion des US-Durchmessers und d) Interim MRT-Antwort mittels RECIST-Kriterien. Der Chi-Square-Test wurde zur Beurteilung der Signifikanz angewandt.

Ergebnisse Die Interim-Steifigkeit von ≤ oder > 50 kPat führte zur besten Prädiktion einer pCR, mit einer pCR bei 10 von 14 (71 %) Karzinomen mit einer Interim-Steifigkeit von ≤ 50 kPa im Vergleich zu 7 von 50 (14 %) Karzinomen mit einer Interim-Steifigkeit von > 50 kPat. (p < 0,0001) (Sensitivität 59 %, Spezifität 91 %, positiver Vorhersagewert 71 %, negativer Vorhersagewert 86 % und diagnostische Treffsicherheit 83 %). Die prozentuale Reduktion der Steifigkeit war der zweitbeste Parameter (Sensitivität 59 %, Spezifität 85 %, p < 0,0004) gefolgt der Reduktion des MRI-Durchmessers um > 30 % (Sensitivität 50 % und Spezifität 79 %, p = 0,03) und einer prozentualen Reduktion des US-Durchmessers (Sensitivität 47 %, Spezifität 81 %, p = 0,03). Ähnliche Ergebnisse wurden mittels ROC-Analyse erzielt.

Schlussfolgerung Die SWE-Steifigkeit von Mammakarzinomen nach 3 NACT-Zyklen und die Veränderungen der Steifigkeit im Bezug zum Anfangswert sind eng mit einer pCR nach 6 Zyklen assoziiert.

Key words

ultrasound - shear wave elastography - breast cancer - neoadjuvant chemotherapy - MR imaging
 

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