Keywords:
Breast, Oncology, Ultrasound, Ultrasound-Colour Doppler, Elastography, Chemotherapy, Technology assessment, Cancer, Neoplasia
Authors:
K. S. Dobruch-Sobczak, H. Piotrzkowska-Wróblewska, Z. Klimonda, M. E. Gumowska, J. Litniewski; Warsaw/PL
DOI:
10.26044/ecr2019/C-1007
Methods and materials
Prospective US analysis was performed on 42 malignant tumors in 40 patients,
prior to NAC treatment and 7 days after the first four courses of NAC. All women were qualified for NAC at the Oncology Clinic.
NAC was administered according to guidelines in the protocol: AC (doxorubicin,
cyclophosphamide).B-mode US examinations with breast SE were performed at the Department of Ultrasound,
Institute of Fundamental Technological Research Polish Academy of Science in Warsaw,
using an USscanner (Ultrasonix Sonix Touch-Research,
Ultrasonix Medical Corporation,
Richmond,
BC,
Canada) with a linear array transducer L14-5/38 and the transmitted frequency set at 10 MHz.Tumors echogenicity was assessed in comparison with fat tissue in the preglandular zones.
The following echogenicity levels were assigned to each tumor image: hypoechoic,
hypo- and isoechoic (mixed) and
Isoechoic.
The 5-point Tsukuba scale has been used to assess the stiffness of the lesions.
The Tsukuba scale is a 5-point scale of classification,
ranging from Tsukuba 1,
when strain is presented in the entire lesion,
to Tsukuba 5,
when no strain is measured in the lesion or surrounding tissue.
Tumor vascularization was assessed using color Doppler technique using the following levels: lack of vascularity,
peripheral vascularity and central and peripheral vascularity.
Changes in volume of the tumor after the nth dose of NAC with respect the volume before NAC were calculated.
All patients underwent a simple mastectomy with lymphadenectomy. After surgery, information on tumor response to treatment,
including cellularity (percentage of the resistant malignant cells [RMC],
from 0% to 100%) was assessed by a pathologist.
Echogenicity,
volume,
vascularity,
and sonoelastography of the breast tumors were measured and compared with posttreatment pathological results.
In histopathological examination after NAC,
tumors were classified into two categories: responding tumors (RT) and non-responding (N-RT).
In our study,
RT included tumors with a reduction in tumor cellularity >30% (<70% RMC),
which represented pathological partial response and pCR.
N-RT included tumors with a reduction in tumor cellularity <30% (persisting over 70% RMC).
The correlation analysis and a logistic regression model were used in statistical analysis.