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Accuracy of morphologic change measurements by ultrasound in predicting pathological response to neoadjuvant chemotherapy in triple-negative and HER2-positive breast cancer

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Abstract

Background

Neoadjuvant chemotherapy (NAC) is standard therapy in triple-negative breast cancer (TNBC) and HER2-positive breast cancer (HER2 + ve BC). There are concerns about the accurate imaging modalities to measure residual tumor during or after NAC. Up to now no standard imaging method for monitoring the efficacy of NAC has been established, and few reports showed ultrasonographic change. We aimed to assess the echogenicity in ultrasonography (US) as the predictive marker of pathological complete response (pCR) for not only TNBC, but also HER2 + ve BC. Furthermore, we also investigated the change in depth (D) and width (W) of the tumor as the predictive value of pCR.

Methods

We retrospectively reviewed a consecutive 59 patients with TNBC and 41 patients with HER2 + ve BC who received NAC. In all of 100 patients, echogenicity, D and W of the tumor were measured before (pre-NAC) and after NAC (post-NAC). The tumor echogenicity was measured at representative region of interest (ROI), and calculated as the relative comparative assessment with fat echogenicity (ROI ratio).

Results

pCR was significantly associated with higher post-NAC ROI ratio in TNBC (p = 0.010), while there was no association in HER2 + ve BC (p = 0.885). pCR was significantly associated with smaller sizes of post-NAC D and W in TNBC (p = 0.001, 0.003), while no trend was observed in HER2 + ve BC (p = 0.259, 0.435). The area under the curve (AUC) for post-NAC ROI ratio and D were 0.701, 0.755, respectively. Combined with them, AUC became higher up to 0.762.

Conclusion

TNBC and HER2 + ve BC showed different morphologic features of residual disease. Echogenicity and tumor size after NAC were both useful to predict pCR for TNBC, but not HER2 + ve BC. In future, radiological imaging needs to be analyzed in terms of breast cancer subtypes.

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Acknowledgements

The authors thank all the staff from the departments of Breast Surgical Oncology, Radiology and Pathology, St. Luke’s International Hospital, for their support in collecting the clinical data. A part of this study has been presented at the 25th Annual Meeting of The Japanese Breast Cancer Society, 2018.

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Authors and Affiliations

  1. Departments of Breast Surgical Oncology, St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan

    Tomohiro Ochi, Naoko Matsuda & Hideko Yamauchi

  2. Departments of Radiology, St. Luke’s International Hospital, Tokyo, Japan

    Hiroko Tsunoda

  3. Departments of Pathology, St. Luke’s International Hospital, Tokyo, Japan

    Fumi Nozaki & Koyu Suzuki

  4. Department of Breast Surgery and Oncology, Nippon Medical School, Tokyo, Japan

    Tomohiro Ochi & Hiroyuki Takei

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  1. Tomohiro Ochi
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  2. Hiroko Tsunoda
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Correspondence to Tomohiro Ochi.

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All procedures involving human participants were in accordance with the ethical standards of the institutional research committee. Prior ethical approval was obtained from the Research Ethics Committee of St. Luke’s International Hospital.

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Ochi, T., Tsunoda, H., Matsuda, N. et al. Accuracy of morphologic change measurements by ultrasound in predicting pathological response to neoadjuvant chemotherapy in triple-negative and HER2-positive breast cancer. Breast Cancer 28, 838–847 (2021). https://doi.org/10.1007/s12282-021-01220-5

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  • DOI: https://doi.org/10.1007/s12282-021-01220-5

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