Qi Jiaojiao, Wang Chenyu, Ma Yongxin, Wang Jiaxing, Yang Guangfei, Wu Yating, Wang Haiyan, Mi Chengrong
Department of Obstetrics and Gynecology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.
Ningxia Medical University, Yinchuan, Ningxia, China.
Front Oncol. 2023 Sep 8;13:1176141. doi: 10.3389/fonc.2023.1176141. eCollection 2023.
The potential role of shear wave elastography (SWE) and superb microvascular imaging (SMI) for early assessment of treatment response to neoadjuvant chemotherapy (NAC) in breast cancer remains unexplored. This study aimed to identify potential factors associated with the pathological response to NAC using these advanced ultrasound techniques.
Between August 2021 and October 2022, 68 patients with breast cancer undergoing NAC were recruited. Patients underwent conventional ultrasonography, SMI, and SWE examinations at baseline and post-2 cycle of NAC. Maximum tumor diameter (Dmax), maximum elastic value (Emax), peak systolic velocity (PSV), and resistance index (RI) at baseline and the rate of change of these parameters post-2 cycle were recorded. After chemotherapy, all patients underwent surgery. Using the Miller-Payne's grade, patients were categorized into response (grades 3, 4, or 5) and non-response (grades 1 or 2) group. Parameters were compared using t-tests at baseline and post-2 cycle. Binary logistic regression analysis was used to identify variables and their odds ratios (ORs) related to responses and a prediction model was established. ROC curves were drawn to analyze the efficacy of each parameter and their combined model for early NAC response prediction.
Among the 68 patients, 15(22.06%) were categorized into the non-response group, whereas 53(77.94%) were categorized into the response group. At baseline, no significant differences were observed between the two groups (>0.05). Post-2 cycle of NAC, rates of change of Emax, PSV and RI (ΔEmax, ΔPSV and ΔRI) were higher in responders than non-responders (<0.05). Binary logistic regression analysis revealed that ΔEmax (OR 0.797 95% CI, 0.683-0.929), ΔPSV (OR 0.926, 95%CI, 0.860-0.998), and ΔRI (OR 0.841, 95%CI, 0.736-0.960) were independently associated with the pathological response of breast cancer after NAC. The combined prediction model exhibited higher accuracy in the early evaluation of the response to NAC (AUC 0.945, 95%CI, 0.873-1.000).
SWE and SMI techniques enable early identification of tumor characteristics associated with the pathological response to NAC and may be potentially indicative of an effective response. These factors may eventually be used for the early assessment of NAC treatment for clinical management.
剪切波弹性成像（SWE）和超微血管成像（SMI）在乳腺癌新辅助化疗（NAC）治疗反应早期评估中的潜在作用仍未得到探索。本研究旨在利用这些先进的超声技术确定与NAC病理反应相关的潜在因素。
2021年8月至2022年10月，招募了68例接受NAC的乳腺癌患者。患者在基线时以及NAC第2周期后接受常规超声检查、SMI和SWE检查。记录基线时的最大肿瘤直径（Dmax）、最大弹性值（Emax）、收缩期峰值速度（PSV）和阻力指数（RI）以及第2周期后这些参数的变化率。化疗后，所有患者均接受手术。根据米勒-佩恩分级，将患者分为反应组（3、4或5级）和无反应组（1或2级）。在基线时和第2周期后使用t检验比较参数。采用二元逻辑回归分析确定与反应相关的变量及其比值比（OR），并建立预测模型。绘制ROC曲线以分析各参数及其联合模型对NAC早期反应预测的效能。
68例患者中，15例（22.06%）被归入无反应组，而53例（77.94%）被归入反应组。基线时，两组之间未观察到显著差异（>0.05）。NAC第2周期后，反应组的Emax、PSV和RI变化率（ΔEmax、ΔPSV和ΔRI）高于无反应组（<0.05）。二元逻辑回归分析显示，ΔEmax（OR 0.797，95%CI，0.683 - 0.929）、ΔPSV（OR 0.926，95%CI，0.860 - 0.998）和ΔRI（OR 0.841，95%CI，0.736 - 0.960）与NAC后乳腺癌的病理反应独立相关。联合预测模型在NAC反应早期评估中表现出更高的准确性（AUC 0.945，95%CI，0.873 - 1.000）。
SWE和SMI技术能够早期识别与NAC病理反应相关的肿瘤特征，可能潜在地提示有效反应。这些因素最终可用于NAC治疗的早期评估以指导临床管理。
