Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea.
Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea.
Eur J Radiol. 2024 Jun;175:111432. doi: 10.1016/j.ejrad.2024.111432. Epub 2024 Mar 21.
To investigate whether multiparametric parameters of pretreatment breast ultrasound (US) and clinicopathologic factors are associated with pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) for breast cancer.
Between November 2018 and September 2022, 88 patients who underwent NAC and subsequent surgery were included in this study (median age, 55 years; interquartile range [IQR], 45, 59.3). Multiparametric breast US including grayscale, shear wave elastography (SWE) and superb microvascular imaging (SMI) of pathologically proven invasive breast cancers were retrospectively reviewed. Clinicopathological and multiparametric parameters of breast US, including size, SWEmax, SWEratio and vascular index on SMI (SMI) were compared between the groups. Univariate and multivariate logistic regression analyses were performed to determine factors predicting pCR after NAC. AUROC curve analysis was performed to determine the predictors' optimal cut-off values and diagnostic performance.
The pCR group (n = 24) showed a significantly smaller tumor size, lower SWEmax, higher Ki-67 index, higher hormone receptor negativity and negative axillary lymph node metastasis compared to the non-pCR group (n = 64). Multivariate regression analysis showed that SWEmax (adjusted odds ratio[aOR] = 0.956, 95 % confidence interval [CI] = 0.919-0.994, P = 0.025) and Ki-67 index (aOR = 1.083, 95 % CI = 1.012-1.159, P = 0.021) were independently associated with pathologically complete response. The optimal cut-off values for predicting pCR were 27.5 % for Ki-67 with an AUC of 0.743 and 134.8 kPa for SWEmax with an AUC of 0.779. A combination model including clinical factors and SWEmax showed the best diagnostic performance with an AUC of 0.876.
A higher Ki-67 index and lower SWEmax measured on pretreatment breast US were independently associated with pCR in invasive breast cancer after NAC.
探讨新辅助化疗（NAC）前后乳腺超声（US）的多参数指标与临床病理因素是否与乳腺癌患者的病理完全缓解（pCR）相关。
本研究纳入了 2018 年 11 月至 2022 年 9 月间接受 NAC 及后续手术的 88 例患者（中位年龄 55 岁；四分位距 [IQR]，45，59.3）。回顾性分析经病理证实的浸润性乳腺癌的多参数乳腺 US，包括灰阶、剪切波弹性成像（SWE）和超级微血管成像（SMI）。比较两组患者的临床病理和乳腺 US 多参数指标，包括大小、SWEmax、SWEratio 和 SMI 上的血管指数（SMI）。采用单因素和多因素逻辑回归分析确定预测 NAC 后 pCR 的因素。采用 AUROC 曲线分析确定预测因子的最佳截断值和诊断性能。
pCR 组（n=24）的肿瘤大小明显较小，SWEmax 较低，Ki-67 指数较高，激素受体阴性率和腋窝淋巴结阴性转移率均低于非 pCR 组（n=64）。多因素回归分析显示，SWEmax（调整后比值比[aOR] = 0.956，95%置信区间 [CI] = 0.919-0.994，P=0.025）和 Ki-67 指数（aOR=1.083，95%CI=1.012-1.159，P=0.021）与病理完全缓解独立相关。预测 pCR 的最佳截断值为 Ki-67 为 27.5%，AUC 为 0.743，SWEmax 为 134.8kPa，AUC 为 0.779。包含临床因素和 SWEmax 的联合模型具有最佳诊断效能，AUC 为 0.876。
NAC 前后乳腺 US 测量的 Ki-67 指数较高和 SWEmax 较低与浸润性乳腺癌患者的 pCR 独立相关。
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