Early Prediction of Response to Neoadjuvant Chemotherapy Using Quantitative Parameters on Automated Breast Ultrasound Combined with Contrast-Enhanced Ultrasound in Breast Cancer

Application of Contrast-Enhanced Ultrasound Parameters of Metastatic Axillary Lymph Nodes in Breast Cancer Patients in Predicting the Efficacy of Neoadjuvant Chemotherapy in Early Stage

BACKGROUND

To investigate the performance of contrast-enhanced ultrasound(CEUS) parameters of metastatic axillary lymph nodes (ALNs) before and after two courses of neoadjuvant chemotherapy (NAC) in breast cancer patients in predicting the efficacy of NAC.

METHODS

A total of 41 postoperative breast cancer patients were selected. All patients underwent NAC, and ALN biopsy was positive before chemotherapy. Metastatic ALN was examined by CEUS before and after two courses of NAC. The CEUS parameters of metastatic ALNs before and after two courses of NAC were analyzed to determine the performance of CEUS parameters in predicting the efficacy of NAC in early stage.

RESULTS

The NAC was effective for 28 cases and ineffective for 13 cases. There were no statistically significant differences in the CEUS parameters between effective NAC and ineffective NAC individuals before and after two courses of NAC. But, there were statistically significant differences in long diameter (LD), short diameter (SD), Peak intensity (Peak%) and area under the curve (AUC) between the effective and ineffective NAC patients after two courses of NAC. Receiver operating characteristic curve (ROC) analysis suggested the drop-out value of LD, SD, Peak% and AUC after two courses of NAC can be used as important indicators to evaluate the efficacy of NAC (p < 0.05).

CONCLUSIONS

CEUS parameters of metastatic axillary lymph nodes (ALNs) before and after two courses of neoadjuvant chemotherapy (NAC) in breast cancer patients can predict the efficacy of NAC in early stage.

Automated Breast Ultrasound for Evaluating Response to Neoadjuvant Therapy: A Comparison with Magnetic Resonance Imaging

Background: Neoadjuvant chemotherapy (NAC) is currently used for treating breast cancer in selected cases. Our study aims to evaluate the role of automated breast ultrasound (ABUS) in the assessment of response to NAC and compare the ABUS results with MRI. Methods: A total of 52 consecutive patients were included in this study. ABUS and MRI sensitivity (SE), specificity (SP), diagnostic accuracy (DA), positive predictive value (PPV), and negative predictive value (NPV) were calculated and represented using Area Under ROC Curve (ROC) analysis, searching for any significant difference (p < 0.05). The McNemar test was used searching for any significant difference in terms of sensitivity by comparing the ABUS and MRI results. The inter-observer agreement between the readers in evaluating the response to NAC for both MRI and ABUS was calculated using Cohen's kappa k coefficient. Results: A total of 35 cases of complete response and 17 cases of persistent disease were found. MRI showed SE, SP, DA, PPV, and NPV values of 100%, 88%, 92%, 81%, and 100%, respectively, with an AUC value of 0.943 (p < 0.0001). ABUS showed SE, SP, DA, PPV, and NPV values of 88%, 94%, 92%, 89%, and 94%, respectively, with an AUC of 0.913 (p < 0.0001). The McNemar test revealed no significant difference (p = 0.1250). The inter-observer agreement between the two readers in evaluating the response to NAC for MRI and ABUS was, respectively, 0.88 and 0.89. Conclusions: Automatic breast ultrasound represents a new accurate, tri-dimensional and operator-independent tool for evaluating patients referred to NAC.

Ultrasonographic and clinicopathological features of pelvic yolk sac tumors in women: a single-center retrospective analysis

Objectives

Yolk sac tumors (YSTs) are rare and highly malignant ovarian malignancies that have a very poor prognosis. The aim of this study is to delineate the ultrasound and clinicopathological features of female pelvic YSTs to better understand the disease.

Methods

This study was a retrospective analysis of the clinicopathological and ultrasound imaging data from 16 YST patients who received treatment at our hospital between January 2012 and August 2023. Then, the ultrasound imaging characteristics were compared with pathological findings.

Results

Among the 16 patients, various degrees of serum AFP increase were observed, and CA125 levels increased in 58.33% (7 out of 12) of patients. Thirteen patients (81.25%) had tumors located in ovary, two patients (12.5%) had tumors located in the sacrococcygeal region, and one patient (6.25%) had tumors located in the mesentery. Pathologically, nine patients presented with simple yolk sac tumors and seven with mixed germ cell tumors. According to the ultrasound manifestations, YST lesions can be classified into three types. (1) the cystic type, was diagnosed in two patients who presented with a large cystic mass with regular morphology and clear boundary and dense liquid within the cyst; and (2) the cystic-solid mixed type, was diagnosed in 4 patients. On 2D ultrasound, the lesions showed a cystic-solid mixed echo, and color Doppler showed a rich blood flow signal in the solid region and cystic separation. made up of four cases. (3) In ten patients with the solid type, 2D ultrasound showed solid uniform echoes with clear boundaries. The "fissure sign" was observed in the lesion. Color Doppler displayed rich blood flow in the solid part, and PW showed low to moderate resistance index of artery (RI:0.21-0.63). On contrast-enhanced ultrasound (CEUS), rapid and high enhancement in the solid part and cystic separation was observed in 2 patients.

Conclusions

Combining ultrasound features with clinical information and tumor markers provides reliable clues for the diagnosis of YST. The application of two-dimensional ultrasound and CEUS combined with patient tumor marker levels can provide a robust reference for determining the necessity of fertility-preserving surgery and postoperative chemotherapy, which can improve clinical decision-making and patient consultation.

A systematic review and meta-analysis comparing the diagnostic capability of automated breast ultrasound and contrast-enhanced ultrasound in breast cancer

Objective

To compare the diagnostic performance of automated breast ultrasound (ABUS) and contrast-enhanced ultrasound (CEUS) in breast cancer.

Methods

Published studies were collected by systematically searching the databases PubMed, Embase, Cochrane Library and Web of Science. The sensitivities, specificities, likelihood ratios and diagnostic odds ratio (DOR) were confirmed. The symmetric receiver operator characteristic curve (SROC) was used to assess the threshold of ABUS and CEUS. Fagan's nomogram was drawn. Meta-regression and subgroup analyses were applied to search for sources of heterogeneity among the included studies.

Results

A total of 16 studies were included, comprising 4115 participants. The combined sensitivity of ABUS was 0.88 [95% CI (0.73-0.95)], specificity was 0.93 [95% CI (0.82-0.97)], area under the SROC curve (AUC) was 0.96 [95% CI (0.94-0.96)] and DOR was 89. The combined sensitivity of CEUS was 0.88 [95% CI (0.84-0.91)], specificity was 0.76 [95% CI (0.66-0.84)], AUC was 0.89 [95% CI (0.86-0.92)] and DOR was 24. The Deeks' funnel plot showed no existing publication bias. The prospective design, partial verification bias and blinding contributed to the heterogeneity in specificity, while no sources contributed to the heterogeneity in sensitivity. The post-test probability of ABUS in BC was 75%, and the post-test probability of CEUS in breast cancer was 48%.

Conclusion

Compared with CEUS, ABUS showed higher specificity and DOR for detecting breast cancer. ABUS is expected to further improve the accuracy of BC diagnosis.