Ultrasound-based prediction of pathologic response to neoadjuvant chemotherapy in breast cancer patients
Ultrasound-based prediction of pathologic response to neoadjuvant chemotherapy in breast cancer patients
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DOI：
10.1016/j.breast.2018.02.028
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发表时间：
2018-06-01
期刊：
影响因子：
3.9
通讯作者：
Baege, Astrid
中科院分区：
文献类型：
--
作者：
Baumgartner, Annina;Tausch, Christoph;Baege, Astrid
背景资料：准确预测乳腺癌新辅助化疗（NACT）的病理反应对于确定治疗效果和手术计划至关重要。本研究旨在评估超声（US）预测NACT后病理完全缓解（pCR = ypT 0）的准确性。方法：本回顾性单中心研究纳入124例浸润性乳腺癌患者接受NACT治疗。患者在NACT前后接受US治疗，记录临床部分缓解（cPR）和临床完全缓解（cCR）。术后，病理学反应定义为不存在肿瘤细胞（ypT 0）、存在非侵袭性肿瘤细胞（ypTis）或侵袭性肿瘤细胞（ypTinv）。分析超声对受体亚型的敏感性、特异性以及假阴性率（FNR）、阴性预测值（NPV）和阳性预测值（PPV）。结果：pCR 50例（40.3%），cCR 39例（78.0%）。US预测缓解的总体敏感性为60.8%，特异性为78.0%。NPV和FNR在亚型之间差异很大。三阴性（TN）亚型NPV最高（75.0%），FNR最低（37.5%）。因此，TN癌症的病理学反应预测最准确。人表皮生长因子受体2阳性/表皮受体阳性（HER 2 +/HR+）的NPV为55.6%，HER 2 +/HR- 64.3%和HER 2-/HR+16.7%，FNR分别为40.0%、71.4%和32.3%。受体亚型对pCR有显著影响（p值：0.0033），cCR与pCR呈正相关（p值：0.0026）。结论：超声显像不足以准确预测pCR。然而，受体亚型影响超声诊断的准确性和病理结果。(C)2018爱思唯尔有限公司版权所有
Background: Accuracy in predicting pathologic response to neoadjuvant chemotherapy (NACT) in breast cancer is essential for the determination of therapeutic efficacy and surgical planning. This study aimed to assess the precision of ultrasound (US) for predicting pathologic complete response (pCR = ypT0) after NACT.Methods: This retrospective mono-center study included 124 invasive breast cancer patients treated with NACT. Patients received US before and after NACT with documentation of clinical partial response (cPR) and clinical complete response (cCR). Post-operatively, the pathologic response was defined as absence of tumor cells (ypT0), presence of non-invasive tumor cells (ypTis) or invasive tumor cells (ypTinv). Sensitivity and specificity of US as well as false negative rate (FNR), negative predictive value (NPV) and positive predictive value (PPV) were analysed for receptor subtypes. A multivariable logistic regression model assessed the influence of patient-and tumor-associated covariates as predictors for pCR.Results: 50 patients (40.3%) achieved pCR, 39 (78.0%) had a corresponding cCR. Overall sensitivity was 60.8% and specificity 78.0% for US-predicted remission. NPV and FNR differed substantially between subtypes. NPV was highest (75.0%) in triple negative (TN) subtype, while FNR was low (37.5%). Therefore, pathological response was most accurately predicted for TN cancers. NPV for human-epidermal-growth-factor-receptor-2-positive/hormone-receptor-positive (HER2+/HR+) was 55.6%, for HER2+/HR- 64.3% and for HER2-/HR+ 16.7%, FNRs were 40.0%, 71.4% and 32.3%, respectively. Receptor subtypes impacted pCR significantly (p-value: 0.0033), cCR correlated positively with pCR (p-value: 0.0026).Conclusion: US imaging is insufficient to predict pCR with adequate accuracy. Receptor subtypes, however, affect diagnostic precision of US and pathologic outcome. (C) 2018 Elsevier Ltd. All rights reserved.