Skip to main content
Erschienen in: Annals of Surgical Oncology 3/2015

01.12.2015 | Breast Oncology

Shear-Wave Elastography for the Detection of Residual Breast Cancer After Neoadjuvant Chemotherapy

verfasst von: Su Hyun Lee, Jung Min Chang, Wonshik Han, Hyeong-Gon Moon, Hye Ryoung Koo, Hye Mi Gweon, Won Hwa Kim, Dong-Young Noh, Woo Kyung Moon

Erschienen in: Annals of Surgical Oncology | Sonderheft 3/2015

Einloggen, um Zugang zu erhalten

Abstract

Objective

This study was designed to evaluate the accuracy of shear-wave elastography (SWE) in the detection of residual breast cancer after neoadjuvant chemotherapy (NAC).

Methods

Seventy-one women with stage II-III breast cancers who underwent B-mode ultrasound (US), SWE, and magnetic resonance imaging (MRI) after NAC were included. The presence of residual cancer was determined on B-mode US and MRI, and the maximum elasticity of residual lesions was assessed on SWE. The sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) of B-mode US, SWE, and MRI were compared.

Results

Sixty-one of 71 women (86 %) had residual cancer and showed higher maximum elasticity values (mean 116.0 ± 74.1 kPa) than those without residual cancer (26.4 ± 21.0 kPa; p < 0.001). B-mode US showed 72.1 % (44/61) sensitivity, 50.0 % (5/10) specificity, and 69.0 % (49/71) accuracy. The sensitivity, specificity, and accuracy of SWE were 83.6 % (51/61), 80.0 % (8/10), and 83.1 % (59/71) when a maximum elasticity value of >30 kPa was considered to indicate the presence of residual cancer. The combined AUC of B-mode US and SWE (0.877) was significantly higher than that of B-mode US (0.702) (p = 0.014) and comparable to that of MRI (0.939) (p = 0.147).

Conclusions

SWE allowed relatively accurate assessment for the presence of residual lesion after NAC and improved the diagnostic performance of B-mode US.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Charfare H, Limongelli S, Purushotham AD. Neoadjuvant chemotherapy in breast cancer. Br J Surg. 2005;92:14–23.PubMedCrossRef Charfare H, Limongelli S, Purushotham AD. Neoadjuvant chemotherapy in breast cancer. Br J Surg. 2005;92:14–23.PubMedCrossRef
2.
Zurück zum Zitat Kaufmann M, Hortobagyi GN, Goldhirsch A, et al. Recommendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer: an update. J Clin Oncol. 2006;24:1940–9.PubMedCrossRef Kaufmann M, Hortobagyi GN, Goldhirsch A, et al. Recommendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer: an update. J Clin Oncol. 2006;24:1940–9.PubMedCrossRef
3.
Zurück zum Zitat Buchholz TA, Lehman CD, Harris JR, et al. Statement of the science concerning locoregional treatments after preoperative chemotherapy for breast cancer: a National Cancer Institute conference. J Clin Oncol. 2008;26:791–7.PubMedCrossRef Buchholz TA, Lehman CD, Harris JR, et al. Statement of the science concerning locoregional treatments after preoperative chemotherapy for breast cancer: a National Cancer Institute conference. J Clin Oncol. 2008;26:791–7.PubMedCrossRef
4.
Zurück zum Zitat Gralow JR, Burstein HJ, Wood W, et al. Preoperative therapy in invasive breast cancer: pathologic assessment and systemic therapy issues in operable disease. J Clin Oncol. 2008;26:814–9.PubMedCrossRef Gralow JR, Burstein HJ, Wood W, et al. Preoperative therapy in invasive breast cancer: pathologic assessment and systemic therapy issues in operable disease. J Clin Oncol. 2008;26:814–9.PubMedCrossRef
5.
Zurück zum Zitat von Minckwitz G, Untch M, Blohmer JU, et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012;30:1796–804.CrossRef von Minckwitz G, Untch M, Blohmer JU, et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012;30:1796–804.CrossRef
6.
Zurück zum Zitat Symmans WF, Peintinger F, Hatzis C, et al. Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy. J Clin Oncol. 2007;25:4414–22.PubMedCrossRef Symmans WF, Peintinger F, Hatzis C, et al. Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy. J Clin Oncol. 2007;25:4414–22.PubMedCrossRef
7.
Zurück zum Zitat Jeruss JS, Mittendorf EA, Tucker SL, et al. Combined use of clinical and pathologic staging variables to define outcomes for breast cancer patients treated with neoadjuvant therapy. J Clin Oncol. 2008;26:246–52.PubMedCrossRef Jeruss JS, Mittendorf EA, Tucker SL, et al. Combined use of clinical and pathologic staging variables to define outcomes for breast cancer patients treated with neoadjuvant therapy. J Clin Oncol. 2008;26:246–52.PubMedCrossRef
8.
Zurück zum Zitat Rastogi P, Anderson SJ, Bear HD, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol. 2008;26:778–85.PubMedCrossRef Rastogi P, Anderson SJ, Bear HD, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol. 2008;26:778–85.PubMedCrossRef
9.
Zurück zum Zitat Balu-Maestro C, Chapellier C, Bleuse A, Chanalet I, Chauvel C, Largillier R. Imaging in evaluation of response to neoadjuvant breast cancer treatment benefits of MRI. Breast Cancer Res Treat. 2002;72:145–52.PubMedCrossRef Balu-Maestro C, Chapellier C, Bleuse A, Chanalet I, Chauvel C, Largillier R. Imaging in evaluation of response to neoadjuvant breast cancer treatment benefits of MRI. Breast Cancer Res Treat. 2002;72:145–52.PubMedCrossRef
10.
Zurück zum Zitat Rieber A, Brambs HJ, Gabelmann A, Heilmann V, Kreienberg R, Kuhn T. Breast MRI for monitoring response of primary breast cancer to neo-adjuvant chemotherapy. Eur Radiol. 2002;12:1711–9.PubMedCrossRef Rieber A, Brambs HJ, Gabelmann A, Heilmann V, Kreienberg R, Kuhn T. Breast MRI for monitoring response of primary breast cancer to neo-adjuvant chemotherapy. Eur Radiol. 2002;12:1711–9.PubMedCrossRef
11.
Zurück zum Zitat Rosen EL, Blackwell KL, Baker JA, et al. Accuracy of MRI in the detection of residual breast cancer after neoadjuvant chemotherapy. AJR Am J Roentgenol. 2003;181:1275–82.PubMedCrossRef Rosen EL, Blackwell KL, Baker JA, et al. Accuracy of MRI in the detection of residual breast cancer after neoadjuvant chemotherapy. AJR Am J Roentgenol. 2003;181:1275–82.PubMedCrossRef
12.
Zurück zum Zitat Bodini M, Berruti A, Bottini A, et al. Magnetic resonance imaging in comparison to clinical palpation in assessing the response of breast cancer to epirubicin primary chemotherapy. Breast Cancer Res Treat. 2004;85:211–8.PubMedCrossRef Bodini M, Berruti A, Bottini A, et al. Magnetic resonance imaging in comparison to clinical palpation in assessing the response of breast cancer to epirubicin primary chemotherapy. Breast Cancer Res Treat. 2004;85:211–8.PubMedCrossRef
13.
Zurück zum Zitat Nakamura S. Present role and future perspectives of the evaluation of the effect of primary chemotherapy by breast imaging. Breast Cancer. 2004;11:134–8.PubMedCrossRef Nakamura S. Present role and future perspectives of the evaluation of the effect of primary chemotherapy by breast imaging. Breast Cancer. 2004;11:134–8.PubMedCrossRef
14.
Zurück zum Zitat Hylton N. MR imaging for assessment of breast cancer response to neoadjuvant chemotherapy. Magn Reson Imaging Clin N Am. 2006;14:383–9, vii.PubMedCrossRef Hylton N. MR imaging for assessment of breast cancer response to neoadjuvant chemotherapy. Magn Reson Imaging Clin N Am. 2006;14:383–9, vii.PubMedCrossRef
15.
Zurück zum Zitat Chang JM, Moon WK, Cho N, et al. Clinical application of shear wave elastography (SWE) in the diagnosis of benign and malignant breast diseases. Breast Cancer Res Treat. 2011;129:89–97.PubMedCrossRef Chang JM, Moon WK, Cho N, et al. Clinical application of shear wave elastography (SWE) in the diagnosis of benign and malignant breast diseases. Breast Cancer Res Treat. 2011;129:89–97.PubMedCrossRef
16.
Zurück zum Zitat Evans A, Whelehan P, Thomson K, et al. Invasive breast cancer: relationship between shear-wave elastographic findings and histologic prognostic factors. Radiology. 2012;263:673–7.PubMedCrossRef Evans A, Whelehan P, Thomson K, et al. Invasive breast cancer: relationship between shear-wave elastographic findings and histologic prognostic factors. Radiology. 2012;263:673–7.PubMedCrossRef
17.
Zurück zum Zitat Chang JM, Park IA, Lee SH, et al. Stiffness of tumours measured by shear-wave elastography correlated with subtypes of breast cancer. Eur Radiol. 2013;23:2450–8.PubMedCrossRef Chang JM, Park IA, Lee SH, et al. Stiffness of tumours measured by shear-wave elastography correlated with subtypes of breast cancer. Eur Radiol. 2013;23:2450–8.PubMedCrossRef
18.
Zurück zum Zitat Berg WA, Cosgrove DO, Dore CJ, et al. Shear-wave elastography improves the specificity of breast US: the BE1 multinational study of 939 masses. Radiology. 2012;262:435–49.PubMedCrossRef Berg WA, Cosgrove DO, Dore CJ, et al. Shear-wave elastography improves the specificity of breast US: the BE1 multinational study of 939 masses. Radiology. 2012;262:435–49.PubMedCrossRef
19.
Zurück zum Zitat Hayashi M, Yamamoto Y, Ibusuki M, et al. Evaluation of tumor stiffness by elastography is predictive for pathologic complete response to neoadjuvant chemotherapy in patients with breast cancer. Ann Surg Oncol. 2012;19:3042–9.PubMedCrossRef Hayashi M, Yamamoto Y, Ibusuki M, et al. Evaluation of tumor stiffness by elastography is predictive for pathologic complete response to neoadjuvant chemotherapy in patients with breast cancer. Ann Surg Oncol. 2012;19:3042–9.PubMedCrossRef
20.
Zurück zum Zitat Evans A, Armstrong S, Whelehan P, et al. Can shear-wave elastography predict response to neoadjuvant chemotherapy in women with invasive breast cancer? Br J Cancer. 2013;109:2798–802.PubMedPubMedCentralCrossRef Evans A, Armstrong S, Whelehan P, et al. Can shear-wave elastography predict response to neoadjuvant chemotherapy in women with invasive breast cancer? Br J Cancer. 2013;109:2798–802.PubMedPubMedCentralCrossRef
21.
Zurück zum Zitat Montemurro F, Martincich L, De Rosa G, et al. Dynamic contrast-enhanced MRI and sonography in patients receiving primary chemotherapy for breast cancer. Eur Radiol. 2005;15:1224–33.PubMedCrossRef Montemurro F, Martincich L, De Rosa G, et al. Dynamic contrast-enhanced MRI and sonography in patients receiving primary chemotherapy for breast cancer. Eur Radiol. 2005;15:1224–33.PubMedCrossRef
22.
Zurück zum Zitat Yeh E, Slanetz P, Kopans DB, et al. Prospective comparison of mammography, sonography, and MRI in patients undergoing neoadjuvant chemotherapy for palpable breast cancer. AJR Am J Roentgenol. 2005;184:868–77.PubMedCrossRef Yeh E, Slanetz P, Kopans DB, et al. Prospective comparison of mammography, sonography, and MRI in patients undergoing neoadjuvant chemotherapy for palpable breast cancer. AJR Am J Roentgenol. 2005;184:868–77.PubMedCrossRef
23.
Zurück zum Zitat Bhattacharyya M, Ryan D, Carpenter R, Vinnicombe S, Gallagher CJ. Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer. Br J Cancer. 2008;98:289–93.PubMedPubMedCentralCrossRef Bhattacharyya M, Ryan D, Carpenter R, Vinnicombe S, Gallagher CJ. Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer. Br J Cancer. 2008;98:289–93.PubMedPubMedCentralCrossRef
24.
Zurück zum Zitat Schulz-Wendtland R. Neoadjuvant chemotherapy–monitoring: clinical examination, ultrasound, mammography, MRI, elastography: only one, only few or all? Eur J Radiol. 2012;81 Suppl 1:S147–8.PubMedCrossRef Schulz-Wendtland R. Neoadjuvant chemotherapy–monitoring: clinical examination, ultrasound, mammography, MRI, elastography: only one, only few or all? Eur J Radiol. 2012;81 Suppl 1:S147–8.PubMedCrossRef
25.
Zurück zum Zitat Marinovich ML, Houssami N, Macaskill P, et al. Meta-analysis of magnetic resonance imaging in detecting residual breast cancer after neoadjuvant therapy. J Natl Cancer Inst. 2013;105:321–33.PubMedCrossRef Marinovich ML, Houssami N, Macaskill P, et al. Meta-analysis of magnetic resonance imaging in detecting residual breast cancer after neoadjuvant therapy. J Natl Cancer Inst. 2013;105:321–33.PubMedCrossRef
26.
Zurück zum Zitat Londero V, Bazzocchi M, Del Frate C, et al. Locally advanced breast cancer: comparison of mammography, sonography and MR imaging in evaluation of residual disease in women receiving neoadjuvant chemotherapy. Eur Radiol. 2004;14:1371–9.PubMedCrossRef Londero V, Bazzocchi M, Del Frate C, et al. Locally advanced breast cancer: comparison of mammography, sonography and MR imaging in evaluation of residual disease in women receiving neoadjuvant chemotherapy. Eur Radiol. 2004;14:1371–9.PubMedCrossRef
27.
Zurück zum Zitat Chagpar AB, Middleton LP, Sahin AA, et al. Accuracy of physical examination, ultrasonography, and mammography in predicting residual pathologic tumor size in patients treated with neoadjuvant chemotherapy. Ann Surg. 2006;243:257–64.PubMedPubMedCentralCrossRef Chagpar AB, Middleton LP, Sahin AA, et al. Accuracy of physical examination, ultrasonography, and mammography in predicting residual pathologic tumor size in patients treated with neoadjuvant chemotherapy. Ann Surg. 2006;243:257–64.PubMedPubMedCentralCrossRef
28.
Zurück zum Zitat Aktepe F, Kapucuoglu N, Pak I. The effects of chemotherapy on breast cancer tissue in locally advanced breast cancer. Histopathology. 1996;29:63–7.PubMedCrossRef Aktepe F, Kapucuoglu N, Pak I. The effects of chemotherapy on breast cancer tissue in locally advanced breast cancer. Histopathology. 1996;29:63–7.PubMedCrossRef
29.
Zurück zum Zitat Honkoop AH, Pinedo HM, De Jong JS, et al. Effects of chemotherapy on pathologic and biologic characteristics of locally advanced breast cancer. Am J Clin Pathol. 1997;107:211–8.PubMed Honkoop AH, Pinedo HM, De Jong JS, et al. Effects of chemotherapy on pathologic and biologic characteristics of locally advanced breast cancer. Am J Clin Pathol. 1997;107:211–8.PubMed
30.
Zurück zum Zitat Rajan R, Poniecka A, Smith TL, et al. Change in tumor cellularity of breast carcinoma after neoadjuvant chemotherapy as a variable in the pathologic assessment of response. Cancer. 2004;100:1365–73.PubMedCrossRef Rajan R, Poniecka A, Smith TL, et al. Change in tumor cellularity of breast carcinoma after neoadjuvant chemotherapy as a variable in the pathologic assessment of response. Cancer. 2004;100:1365–73.PubMedCrossRef
31.
Zurück zum Zitat Sahoo S, Lester SC. Pathology of breast carcinomas after neoadjuvant chemotherapy: an overview with recommendations on specimen processing and reporting. Arch Pathol Lab Med. 2009;133:633–42.PubMed Sahoo S, Lester SC. Pathology of breast carcinomas after neoadjuvant chemotherapy: an overview with recommendations on specimen processing and reporting. Arch Pathol Lab Med. 2009;133:633–42.PubMed
32.
Zurück zum Zitat Tozaki M, Uno S, Kobayashi T, et al. Histologic breast cancer extent after neoadjuvant chemotherapy: comparison with multidetector-row CT and dynamic MRI. Radiat Med. 2004;22:246–53.PubMed Tozaki M, Uno S, Kobayashi T, et al. Histologic breast cancer extent after neoadjuvant chemotherapy: comparison with multidetector-row CT and dynamic MRI. Radiat Med. 2004;22:246–53.PubMed
33.
Zurück zum Zitat Woodhams R, Kakita S, Hata H, et al. Identification of residual breast carcinoma following neoadjuvant chemotherapy: diffusion-weighted imaging–comparison with contrast-enhanced MR imaging and pathologic findings. Radiology. 2010;254:357–66.PubMedCrossRef Woodhams R, Kakita S, Hata H, et al. Identification of residual breast carcinoma following neoadjuvant chemotherapy: diffusion-weighted imaging–comparison with contrast-enhanced MR imaging and pathologic findings. Radiology. 2010;254:357–66.PubMedCrossRef
34.
Zurück zum Zitat Lee SH, Cho N, Chang JM, et al. Two-view versus single-view shear-wave elastography: comparison of observer performance in differentiating benign from malignant breast masses. Radiology. 2014;270:344–53.PubMedCrossRef Lee SH, Cho N, Chang JM, et al. Two-view versus single-view shear-wave elastography: comparison of observer performance in differentiating benign from malignant breast masses. Radiology. 2014;270:344–53.PubMedCrossRef
35.
Zurück zum Zitat Lee SH, Chang JM, Kim WH, et al. Differentiation of benign from malignant solid breast masses: comparison of two-dimensional and three-dimensional shear-wave elastography. Eur Radiol. 2013;23:1015–26.PubMedCrossRef Lee SH, Chang JM, Kim WH, et al. Differentiation of benign from malignant solid breast masses: comparison of two-dimensional and three-dimensional shear-wave elastography. Eur Radiol. 2013;23:1015–26.PubMedCrossRef
Metadaten
Titel
Shear-Wave Elastography for the Detection of Residual Breast Cancer After Neoadjuvant Chemotherapy
verfasst von
Su Hyun Lee
Jung Min Chang
Wonshik Han
Hyeong-Gon Moon
Hye Ryoung Koo
Hye Mi Gweon
Won Hwa Kim
Dong-Young Noh
Woo Kyung Moon
Publikationsdatum
01.12.2015
Verlag
Springer US
Erschienen in
Annals of Surgical Oncology / Ausgabe Sonderheft 3/2015
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4828-1

Weitere Artikel der Sonderheft 3/2015

Annals of Surgical Oncology 3/2015 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.