Efficacy of shear-wave elastography versus dynamic optical breast imaging for predicting the pathological response to neoadjuvant chemotherapy in breast cancer
Introduction
Neoadjuvant chemotherapy (NACT) is currently the standard treatment for patients with locally advanced or inflammatory breast cancer (BC). Pathological complete response (pCR) can be used as a surrogate prognostic marker for long-term disease-free survival after NACT in BC patients [1]. Several clinical studies have shown good results, with an objective response rate of approximately 70 % and a pCR rate of up to 30 % [1,2]. However, certain risk factors are associated with a higher likelihood of acquiring resistance to chemotherapy [3]. Therefore, the ability to predict the NACT response early in BC patients is critical.
Among the common clinicopathological markers, the ability of Ki-67, ER, PR, and HER2 to predict the NACT response in BC seems to be insufficient [4,5]. Studies to date have focused on the application of imaging modalities to predict and evaluate the NACT response [2,[6], [7], [8], [9], [10], [11], [12], [13], [14]]. Magnetic resonance imaging (MRI) is widely available and serves as an important tool for monitoring NACT and predicting its pathologic outcome [[7], [8], [9], [10]]. However, MRI has practical constraints for some patients [13,14]. Ultrasound (US) is a first-line non-invasive modality for breast disease; however, grey-scale US does not perform well in early prediction of the NACT response [15]. To date, there is still no overall satisfactory imaging modality for predicting the NACT response.
Shear-wave elastography (SWE) is a non-invasive ultrasound imaging method that can visualize and quantify tissue stiffness in vivo, and its usefulness for differentiating benign from malignant breast masses has been verified. SWE is an important complement to grey-scale US [16,17]. High stiffness on SWE is associated with chemotherapy resistance in BC, although this finding has been reported in relatively few studies [6,18,19].
Optical imaging, based on different absorption coefficients in the near-infrared region of blood hemoglobin (Hb), oxygenated hemoglobin (oxy-Hb), and deoxygenated hemoglobin (deoxy-Hb) can be used to detect breast vasculature and tumor microvasculature, owing to the inherent capability to differentiate hypoxic from normally oxygenated tissue [12,[20], [21], [22]]. Several dynamic optical imaging features acquired within 10 days to 2 weeks of NACT initiation were recently shown capable of early identification of BC patients with a pCR to NACT [[12], [13], [14]]. Dynamic optical breast imaging (DOBI) is a non-invasive optical imaging method. It can help distinguish breast regions with abnormal blood volume and oxygen saturation (which are suspected for malignancy) from normal tissue [21,23].
Optical imaging and ultrasonic elastography are potentially capable of early prediction of the NACT response [[12], [13], [14],18,19]. To the best of our knowledge, the power of the two non-invasive imaging modalities for predicting NACT responses has not been compared. Here, we examined 91 BC patients receiving NACT to compare the performance of SWE stiffness, optical imaging features, and tumor size for early prediction of the NACT response.
Section snippets
Patients
Ninety-seven eligible women were enrolled between April 2014 and September 2019. All patients were diagnosed with invasive BC by ultrasound-guided core needle biopsy and received NACT and subsequent surgical intervention. Six patients were excluded: three whose treatment plans changed and three with unqualified images (lesion maximum diameter ≥10 cm and/or deeper than 4 cm on US). The chemotherapy regimens are shown in Supplementary material 1. The study was conducted with the approval of the
Patient and lesion characteristics
The STARD flow diagram of patient inclusion is presented in Fig. 1. The baseline characteristics are shown in Table 1. Of the 91 patients, 19 (21 %) showed a favorable response (pCR and RCB-I), 43 (47 %) showed a moderate response (RCB-II), and 29 (32 %) showed NACT resistance (RCB-III). There were significant differences among the three RCB groups (P < 0.05) in most clinical indicators, except for age, HER2 positivity in ‘Immunohistochemical marker’ and Grade.
Tumor size and SWE evaluation
Interobserver reliability of
Discussion
A salient feature of grey-scale US in evaluating the NACT response is that the dynamic change in the echo, shape, and size of BC can be monitored. However, in our study, no differences in tumor size and relative change rate were observed among the groups, except for the parameters at t6. This indicates that the dynamic change of tumor size is not a sensitive indicator to differentiate between responders and non-responders, which is consistent with previous studies [15,27]. Grey-scale US can
Conclusions
SWE, OS, and BS exhibited excellent and similar performances for the early prediction of a favorable response, and SWE showed a better diagnostic performance than BS and OS for the early prediction of NACT resistance. ΔEmean (t2) showed a particularly impressing potential for the early prediction of NACT resistance. The results of this study may help guide the formulation of individualized treatment schemes for BC patients undergoing NACT.
CRediT authorship contribution statement
Jing Zhang: Conceptualization, Methodology, Software, Writing - original draft. Xueying Tan: Data curation, Formal analysis. Xintong Zhang: Visualization, Investigation. Ye Kang: Writing - review & editing. Jianyi Li: Resources. Weidong Ren: Resources. Yan Ma: Supervision, Validation, Project administration, Funding acquisition.
Declaration of Competing Interest
The authors declare that they have no conflicts of interest.
Acknowledgments
This work was supported by National Natural Science Foundation of China (81801710, 81571686), Science and Technology Project Funds from Education Department of Liaoning Province (LK2016022, LK2016021).
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