Prediction of pathological complete response in breast cancer patients during neoadjuvant chemotherapy: Is shear wave elastography a useful tool in clinical routine?

Prediction of pathological complete response in breast cancer patients during neoadjuvant chemotherapy: Is shear wave elastography a useful tool in clinical routine?

Maier Anna Marie; Heil Jorg; Harcos Aba; Rauch Geraldine; Uhlmann Lorenz; Gomez Christina; Stieber Anne; Funk Annika; Barr Richard G; Hennigs Andre; Riedel Fabian; Schafgen Benedikt; Hug Sarah; Marme Frederik; Sohn Christof; Golatta Michael

European journal of radiology

2020

2020-05-01

OBJECTIVE: To compare the validity of Shear Wave Elastography (SWE) for the preoperative assessment of pathological complete response (pCR) to standard clinical assessment in breast cancer patients undergoing neoadjuvant chemotherapy (NACT). MATERIALS AND METHODS: This prospective, consecutive clinical trial was conducted under routine clinical practice. Analysis included 134 patients. SWE served as index test, final pathology from surgical specimen as reference standard. PCR (ypT0) was defined as primary endpoint. Elasticity changes were compared for the pCR- vs. non-pCR group. To determine the validity of shear wave velocity (Vs), ROC analyses and diagnostic accuracy parameters were calculated and compared to the final standard clinical assessment by physical examination, mammography and B-mode ultrasound (ycT+vs. ycT0). RESULTS: Vs was significantly reduced in pCR and non-pCR groups during NACT (pCR: DeltaVs(abs)=3.90m/s, p<0.001; non-pCR: DeltaVs(abs)=3.10m/s, p<0.001). The pCR-group showed significant lower Vs for all control visits (t1,2,END: p<0.001). ROC analysis of Vs yielded moderate AUCs for the total population (t0: 0.613, t1: 0.745, t2: 0.685, tEND: 0.718). Compared to standard clinical assessment, Vs(tEND) (cut-off: </=3.35m/s) was superior in sensitivity (79.6 % vs. 54.5 %), NPV (86.4 % vs. 77.5 %), FNR (20.4 % vs. 45.5 %), inferior in specificity (58.6 % vs. 77.5 %), PPV (46.3 % vs. 54.5 %), FPR (41.4 % vs. 22.5 %). CONCLUSION: SWE measures significant differences in tumour elasticity changes in pCR vs. non-pCR cases. SWE shows improved sensitivity compared to standard clinical assessment, high NPV and low FNR, but failed in specificity in order to predict pCR under routine conditions.

2D shear wave imaging; Breast neoplasms; Elasticity imaging techniques; Neoadjuvant therapy

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journalArticle

109025

128

1872-7727 0720-048X

NEOMED College of Medicine

Department of Radiology

June 2020 Update II