Prediction of pathological complete response in breast cancer patients during neoadjuvant chemotherapy: Is shear wave elastography a useful tool in clinical routine?. Issue 128 (July 2020)

• Record Type: Journal Article
• Authors: Maier, Anna Marie; Heil, Jörg; Harcos, Aba; Sinn, Hans-Peter; Rauch, Geraldine; Uhlmann, Lorenz; Gomez, Christina; Stieber, Anne; Funk, Annika; Barr, Richard G.; Hennigs, André; Riedel, Fabian; Schäfgen, Benedikt; Hug, Sarah; Marmé, Frederik; Sohn, Christof; Golatta, Michael
• Is Part Of: European journal of radiology. Issue 128(2020)
• Publication Date: 2020-07
• Subjects: Breast neoplasms -- Elasticity imaging techniques -- 2D shear wave imaging -- Neoadjuvant therapy; ACT Adjuvant chemotherapy -- ANOVA Analysis of variance -- AUC Area under the curve -- BC Breast cancer -- BCT Breast conserving therapy -- CCB Core-cut biopsy -- cCR Clinical complete response -- FNR False negative rate -- FPR False positive rate -- HER2 Human epidermal growth factor receptor 2 -- HR Hormone receptor -- ME Mastectomy -- MG Mammography -- MRI Magnetic resonance imaging -- NACT Neoadjuvant chemotherapy -- NPV Negative predictive value -- pCR Pathological complete response -- PPV Positive predictive value -- QM Quality map -- ROC Receiver operating characteristic curve -- ROI Region of interest -- SWE Shear wave elastography -- TNBC Triple negative breast cancer -- Vs Shear wave velocity -- VTIQ™ Virtual Touch Tissue Imaging Quantification™; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2020.109025
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Clinical trial of SWE during clinical routine for prediction of pCR in BC patients. SWE monitors reduced tumour stiffness during neoadjuvant chemotherapy in BC. pCR cases show higher reduction in shear wave velocity after only two NACT cycles. SWE shows improved sensitivity, high NPV, low FNR compared to standard assessment. SWE failed in specificity in order to predict pCR under routine conditions. Abstract: 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: ΔVs (abs) = 3.90 m/s, p < 0.001; non-pCR: ΔVs (abs) = 3.10 m/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: ≤3.35 m/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.