Prediction of Pathological Complete Response to Neoadjuvant Chemotherapy for Primary Breast Cancer Comparing Interim Ultrasound, Shear Wave Elastography and MRI

Andrew Evans, Patsy Whelehan, Alastair Thompson, Colin Purdie, Lee Jordan, Jane Macaskill, Shelley Waugh, Frances Fuller-Pace, Katrin Brauer, Sarah Vinnicombe

Research output: Contribution to journalArticle

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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 kPa; 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 kPa gave the best prediction of pCR with pCR seen in 10 of 14 (71 %) cancers with an interim stiffness of ≤ 50 kPa, compared to 7 of 50 (14 %) of cancers with an interim stiffness of > 50 kPa, (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.

Original languageEnglish
Pages (from-to)422-431
Number of pages10
JournalEuropean Journal of Ultrasound
Volume39
Issue number04
Early online date21 Sep 2017
DOIs
Publication statusPublished - Aug 2018

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Elasticity Imaging Techniques
Magnetic Resonance Imaging
Breast Neoplasms
Drug Therapy
Sensitivity and Specificity
Axilla
Chi-Square Distribution
ROC Curve
Neoplasms
Breast
Ultrasonic Waves

Keywords

  • ultrawave
  • shear wave elastography
  • breast cancer
  • neoadjuvant chemotherapy
  • MR imaging

Cite this

Evans, Andrew ; Whelehan, Patsy ; Thompson, Alastair ; Purdie, Colin ; Jordan, Lee ; Macaskill, Jane ; Waugh, Shelley ; Fuller-Pace, Frances ; Brauer, Katrin ; Vinnicombe, Sarah. / Prediction of Pathological Complete Response to Neoadjuvant Chemotherapy for Primary Breast Cancer Comparing Interim Ultrasound, Shear Wave Elastography and MRI. In: European Journal of Ultrasound. 2018 ; Vol. 39, No. 04. pp. 422-431.
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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 kPa; 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 kPa gave the best prediction of pCR with pCR seen in 10 of 14 (71 {\%}) cancers with an interim stiffness of ≤ 50 kPa, compared to 7 of 50 (14 {\%}) of cancers with an interim stiffness of > 50 kPa, (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.",
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Prediction of Pathological Complete Response to Neoadjuvant Chemotherapy for Primary Breast Cancer Comparing Interim Ultrasound, Shear Wave Elastography and MRI. / Evans, Andrew; Whelehan, Patsy; Thompson, Alastair; Purdie, Colin; Jordan, Lee; Macaskill, Jane; Waugh, Shelley; Fuller-Pace, Frances; Brauer, Katrin; Vinnicombe, Sarah.

In: European Journal of Ultrasound, Vol. 39, No. 04, 08.2018, p. 422-431.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prediction of Pathological Complete Response to Neoadjuvant Chemotherapy for Primary Breast Cancer Comparing Interim Ultrasound, Shear Wave Elastography and MRI

AU - Evans, Andrew

AU - Whelehan, Patsy

AU - Thompson, Alastair

AU - Purdie, Colin

AU - Jordan, Lee

AU - Macaskill, Jane

AU - Waugh, Shelley

AU - Fuller-Pace, Frances

AU - Brauer, Katrin

AU - Vinnicombe, Sarah

N1 - No funding info

PY - 2018/8

Y1 - 2018/8

N2 - 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 kPa; 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 kPa gave the best prediction of pCR with pCR seen in 10 of 14 (71 %) cancers with an interim stiffness of ≤ 50 kPa, compared to 7 of 50 (14 %) of cancers with an interim stiffness of > 50 kPa, (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.

AB - 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 kPa; 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 kPa gave the best prediction of pCR with pCR seen in 10 of 14 (71 %) cancers with an interim stiffness of ≤ 50 kPa, compared to 7 of 50 (14 %) of cancers with an interim stiffness of > 50 kPa, (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.

KW - ultrawave

KW - shear wave elastography

KW - breast cancer

KW - neoadjuvant chemotherapy

KW - MR imaging

U2 - 10.1055/s-0043-111589

DO - 10.1055/s-0043-111589

M3 - Article

C2 - 28934812

VL - 39

SP - 422

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JO - European Journal of Ultrasound

JF - European Journal of Ultrasound

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