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Chinese Journal of Diagnostics(Electronic Edition) ›› 2025, Vol. 13 ›› Issue (02): 89-96. doi: 10.3877/cma.j.issn.2095-655X.2025.02.004

• Imaging Diagnostic Studies • Previous Articles    

The value of ultrasound features combined with clinicopathology for early prediction of the efficacy of neoadjuvant chemotherapy in breast cancer

Xinnian Pang1, Tian Jiang2, Beibei Xu1, Tianyao Yang3, Wei Li4, Lucou Chen1,()   

  1. 1. Department of Ultrasound, Tiantai County People′s Hospital, Tiantai 317200, China
    2. Graduate Training Base, Wenzhou Medical University, Hangzhou 310022, China
    3. Department of Thyroid and Breast Surgery,Tiantai County People′s Hospital, Tiantai 317200, China
    4. Department of Ultrasound, Zhejiang Cancer Hospital, Hangzhou 310022, China
  • Received:2025-02-13 Online:2025-05-26 Published:2025-06-20
  • Contact: Lucou Chen

Abstract:

Objective

To investigate the clinical utility of the combination of ultrasound features and clinicopathologic factors for the early prediction of pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in breast cancer patients.

Methods

A retrospective was conducted on imaging and clinical data from 304 breast cancer patients who received NAC at Zhejiang Cancer Hospital between October 2020 and March 2022. According to the postoperative pathological results, patients were divided into the pCR group and the non-pathologic complete response (non-pCR) group. The differences in ultrasound and clinical pathological characteristics between the 2 groups were compared. Binary Logistic regression analysis was performed to identify independent predictors of pCR. The diagnostic ability of each model for pCR was evaluated by receiver operating characteristics (ROC) curve. A nomogram model for predicting pCR was established using R software, and the goodness-of-fit was assessed with the Hosmer-Lemeshow test.

Results

There were statistically significant differences in the scores of lateral acoustic shadow, margin characteristics,calcification patterns and blood flow scores between the pCR group and the non-pCR group before NAC (χ2=12.001, 18.135, 12.991, 9.327, all P<0.05). The reduction rate of the maximum tumor diameter in the pCR group was greater than that in the non-pCR group after 2 cycles of NAC, and the difference was statistically significant (Z=4.182, P<0.01). Before NAC, there were statistically significant differences in clinical T stage, estrogen receptor (ER) expression, progesterone receptor (PR) expression and human epidermal grouth factor receptor 2 (HER2) expression between the 2 groups (χ2=8.553, 23.293, 30.333,38.384, all P<0.05). Binary Logistic regression analysis showed that lateral acoustic shadow (OR=2.782,95%CI:1.534-5.045), calcification (OR=0.395, 95%CI:0.170-0.920), margin (OR=0.244, 95%CI:0.104-0.572), blood flow score (OR=0.527, 95%CI:0.295-0.941), clinical T stage [T2OR=0.371,95%CI:0.153-0.902)、T3OR=0.212,95%CI:0.066-0.684)、 T4OR=0.146,95%CI:0.039-0.555)], maximum diameter reduction rate (OR=5.988, 95%CI: 1.923-18.645), and HER2 expression (OR=4.977, 95%CI:2.740-9.041) were independent predictors of pCR in breast cancer (all P<0.05). Based on the above factors, a combined model was constructed, and the area under the ROC curve for predicting pCR was 0.821 (95%CI: 0.796-0.872). A nomogram was also constructed, and the Hosmer-Lemeshow goodness-of-fit test showed that the nomogram model had a good fit (χ2=4.144, P>0.05).

Conclusion

Lateral acoustic shadows, calcifications, margins, blood flow scores, maximum diameter reduction rate, as well as clinical T stage and HER2 expression measured by ultrasound are independent predictors for obtaining pCR after NAC in patients with breast cancer, and ultrasound features combined with clinicopathology factors can provide an imaging basis for the development of clinical treatment plans for patients with breast cancer.

Key words: Ultrasonography, Breast neoplasms, Neoadjuvant chemotherapy, Pathologic complete response, Pathology

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