Role of Doppler US and elastography prior to biopsy to Identify candidates for avoidance of surgery following neoadjuvant chemotherapy for breast cancer
Soo-Yeon Kim , Han-Byoel Lee , Wonshik Han , Su Hyun Lee , Jung Min Chang , Nariya Cho
Seoul National University Hospital, Seoul, Korea
Corresponding Author: Nariya Cho ,Tel: 02-2072-2584, Fax: 743-6385, Email: river7774@gmail.com
Received: November 9, 2022;  Accepted: January 10, 2023.  Published online: January 16, 2023.
ABSTRACT
Purpose:
To evaluate the role of Doppler ultrasound (US) and elastography to identify residual breast cancer for patients showing near complete response following chemotherapy on MRI. Materials and
Methods:
Between September 2016 and January 2018, 40 breast cancer patients who showed near complete response (either tumor size ≤ 0.5 cm or lesion-to-background parenchymal signal enhancement ratio ≤ 1.6) on MRI following neoadjuvant chemotherapy were prospectively enrolled. After excluding seven women who did not undergo Doppler US and elastography, 33 women (median age, 49 years; ranges, 32-67) were analyzed. On the day of surgery, women underwent Doppler US and elastography for tumor bed prior to US-guided core needle biopsy. Histopathologic results of biopsy and surgery were evaluated. Negative predictive value (NPV) and false negative rate (FNR) of biopsy and the combined Doppler US and elastography were analyzed, respectively.
Results:
After surgery, nine women had residual cancers and 24 women had pathologic complete response. The NPV and FNR of biopsy were 92% (24 of 26) and 22% (2 of 9), respectively. The NPV and FNR of combined Doppler US and elastography were 100% (14 of 14) and 0% (0 of 9), respectively. All of nine women with residual cancers had positive vascularity or elasticity. Two women with false-negative biopsy results, having 0.3cm or 2.5cm ductal carcinoma in situ at surgery, showed positive vascularity or elasticity.
Conclusion:
Tumor bed showing positive vascularity or elasticity indicates residual breast cancer for patients showing near complete response on MRI following chemotherapy.
Keywords: Breast cancer; Neoadjuvant chemotherapy; Ultrasonography; Doppler; Elasticity imaging techniques; Biopsy
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