Annina Baumgartner1, Christoph Tausch2, Stefanie Hosch2, Bärbel Papassotiropoulos2, Zsuzsanna Varga3, Christoph Rageth2, Astrid Baege4. 1. University of Zurich, Faculty of Medicine, Rämistrasse 71, 8008 Zurich, Switzerland. 2. Breast Center Zurich, Seefeldstrasse 214, 8008 Zurich, Switzerland. 3. University Hospital Zurich, Department of Pathology and Molecular Pathology, Rämistrasse 100, 8091 Zurich, Switzerland. 4. Breast Center Zurich, Seefeldstrasse 214, 8008 Zurich, Switzerland; University Hospital Zurich, Department of Gynecology, Frauenklinikstrasse 10, 8091 Zurich, Switzerland. Electronic address: a.baege@brust-zentrum.ch.
Abstract
BACKGROUND: Accuracy in predicting pathologic response to neoadjuvant chemotherapy (NACT) in breast cancer is essential for the determination of therapeutic efficacy and surgical planning. This study aimed to assess the precision of ultrasound (US) for predicting pathologic complete response (pCR = ypT0) after NACT. METHODS: This retrospective mono-center study included 124 invasive breast cancer patients treated with NACT. Patients received US before and after NACT with documentation of clinical partial response (cPR) and clinical complete response (cCR). Post-operatively, the pathologic response was defined as absence of tumor cells (ypT0), presence of non-invasive tumor cells (ypTis) or invasive tumor cells (ypTinv). Sensitivity and specificity of US as well as false negative rate (FNR), negative predictive value (NPV) and positive predictive value (PPV) were analysed for receptor subtypes. A multivariable logistic regression model assessed the influence of patient- and tumor-associated covariates as predictors for pCR. RESULTS: 50 patients (40.3%) achieved pCR, 39 (78.0%) had a corresponding cCR. Overall sensitivity was 60.8% and specificity 78.0% for US-predicted remission. NPV and FNR differed substantially between subtypes. NPV was highest (75.0%) in triple negative (TN) subtype, while FNR was low (37.5%). Therefore, pathological response was most accurately predicted for TN cancers. NPV for human-epidermal-growth-factor-receptor-2-positive/hormone-receptor-positive (HER2+/HR+) was 55.6%, for HER2+/HR- 64.3% and for HER2-/HR+ 16.7%, FNRs were 40.0%, 71.4% and 32.3%, respectively. Receptor subtypes impacted pCR significantly (p-value: 0.0033), cCR correlated positively with pCR (p-value: 0.0026). CONCLUSION: US imaging is insufficient to predict pCR with adequate accuracy. Receptor subtypes, however, affect diagnostic precision of US and pathologic outcome.
BACKGROUND: Accuracy in predicting pathologic response to neoadjuvant chemotherapy (NACT) in breast cancer is essential for the determination of therapeutic efficacy and surgical planning. This study aimed to assess the precision of ultrasound (US) for predicting pathologic complete response (pCR = ypT0) after NACT. METHODS: This retrospective mono-center study included 124 invasive breast cancerpatients treated with NACT. Patients received US before and after NACT with documentation of clinical partial response (cPR) and clinical complete response (cCR). Post-operatively, the pathologic response was defined as absence of tumor cells (ypT0), presence of non-invasive tumor cells (ypTis) or invasive tumor cells (ypTinv). Sensitivity and specificity of US as well as false negative rate (FNR), negative predictive value (NPV) and positive predictive value (PPV) were analysed for receptor subtypes. A multivariable logistic regression model assessed the influence of patient- and tumor-associated covariates as predictors for pCR. RESULTS: 50 patients (40.3%) achieved pCR, 39 (78.0%) had a corresponding cCR. Overall sensitivity was 60.8% and specificity 78.0% for US-predicted remission. NPV and FNR differed substantially between subtypes. NPV was highest (75.0%) in triple negative (TN) subtype, while FNR was low (37.5%). Therefore, pathological response was most accurately predicted for TN cancers. NPV for human-epidermal-growth-factor-receptor-2-positive/hormone-receptor-positive (HER2+/HR+) was 55.6%, for HER2+/HR- 64.3% and for HER2-/HR+ 16.7%, FNRs were 40.0%, 71.4% and 32.3%, respectively. Receptor subtypes impacted pCR significantly (p-value: 0.0033), cCR correlated positively with pCR (p-value: 0.0026). CONCLUSION: US imaging is insufficient to predict pCR with adequate accuracy. Receptor subtypes, however, affect diagnostic precision of US and pathologic outcome.
Authors: Rosalind P Candelaria; Beatriz E Adrada; Deanna L Lane; Gaiane M Rauch; Stacy L Moulder; Alastair M Thompson; Roland L Bassett; Elsa M Arribas; Huong T Le-Petross; Jessica W T Leung; David A Spak; Elizabeth E Ravenberg; Jason B White; Vicente Valero; Wei T Yang Journal: Ultrasound Med Biol Date: 2022-03-14 Impact factor: 2.998
Authors: Quing Zhu; Foluso O Ademuyiwa; Catherine Young; Catherine Appleton; Matthew F Covington; Cynthia Ma; Souzan Sanati; Ian S Hagemann; Atahar Mostafa; K M Shihab Uddin; Isabella Grigsby; Ashley E Frith; Leonel F Hernandez-Aya; Steven S Poplack Journal: Breast Cancer Res Treat Date: 2021-05-10 Impact factor: 4.872
Authors: Beatriz E Adrada; Rosalind Candelaria; Stacy Moulder; Alastair Thompson; Peng Wei; Gary J Whitman; Vicente Valero; Jennifer K Litton; Lumarie Santiago; Marion E Scoggins; Tanya W Moseley; Jason B White; Elizabeth E Ravenberg; Wei T Yang; Gaiane M Rauch Journal: Cancer Date: 2021-04-20 Impact factor: 6.921