Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil.
Division of Gynecologic and Breast Oncology, Women's Hospital (CAISM), Unicamp, Campinas, São Paulo, Brazil.
PLoS One. 2024 Jun 4;19(6):e0302527. doi: 10.1371/journal.pone.0302527. eCollection 2024.
Neoadjuvant chemotherapy (NACT) is a treatment option for breast cancer patients that allows for the assessment of tumor response during treatment. This information can be used to adjust treatment and improve outcomes. However, the optimal imaging modalities and parameters for assessing tumor response to NACT are not well established.
This study included 173 breast cancer patients who underwent NACT. Patients were imaged with ultrasound (US), mammography (MMG), and magnetic resonance imaging (MRI) at baseline, after two cycles of NACT, and before breast surgery. US parameters included lesion morphology, Doppler variables, and elastography measurements. MMG and MRI were evaluated for the presence of nodules and tumor dimensions. The pathological response to NACT was determined using the residual cancer burden (RCB) classification.
The US parameter with the highest power for predicting pathological complete response (pCR) was shear wave elastography (SWE) maximum speed inside the tumor at baseline. For nonluminal tumors, the end diastolic velocity measured by US after two cycles of NACT showed the highest predictive value for pCR. Similarly, SWE maximum speed after two cycles of NACT had the highest discriminating power for predicting RCB-III in luminal tumors, while the same parameter measured at baseline was most predictive for nonluminal tumors.
This study provides evidence that mid-treatment Doppler US and other imaging modalities can be used to predict the response to NACT in breast cancer patients. Functional parameters, such as blood flow velocities and SWE measurements, demonstrated superior predictive value for pCR, while morphological parameters had limited value. These findings have implications for personalized treatment strategies and may contribute to improved outcomes in the management of breast cancer.
新辅助化疗（NACT）是一种治疗乳腺癌患者的方法，可以在治疗过程中评估肿瘤的反应。这些信息可用于调整治疗方案，改善治疗效果。然而，评估 NACT 对肿瘤反应的最佳成像方式和参数尚未得到充分确立。
本研究纳入了 173 例接受 NACT 的乳腺癌患者。患者在基线时、接受 2 个周期 NACT 后以及接受乳房手术前，分别接受了超声（US）、乳腺钼靶（MMG）和磁共振成像（MRI）检查。US 参数包括病变形态、多普勒变量和弹性成像测量值。MMG 和 MRI 评估了结节的存在和肿瘤的大小。使用残余肿瘤负担（RCB）分类来确定 NACT 的病理反应。
预测病理完全缓解（pCR）的最高效 US 参数是基线时肿瘤内剪切波弹性成像（SWE）最大速度。对于非腔隙性肿瘤，2 个周期 NACT 后 US 测量的舒张末期速度对 pCR 的预测价值最高。同样，2 个周期 NACT 后 SWE 最大速度对预测腔隙性肿瘤的 RCB-III 具有最高的判别能力，而在非腔隙性肿瘤中，基线时测量的相同参数最具预测价值。
本研究表明，治疗中期的多普勒 US 及其他成像方式可用于预测乳腺癌患者对 NACT 的反应。功能参数，如血流速度和 SWE 测量值，对 pCR 的预测价值优于形态参数。这些发现对个体化治疗策略具有重要意义，并可能有助于改善乳腺癌的管理效果。
