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Sonographic Evaluation of Early-Stage Breast Cancers That Undergo Neoadjuvant Chemotherapy

Departments of Radiology (M.A.R., G.L.L., J.B.F., P.L.C.) and Internal Medicine (A.F.S.), University of Michigan Health Systems, Ann Arbor, Michigan USA; University of Michigan School of Medicine, Ann Arbor, Michigan USA (B.B.); Department of Biostatistics, University of Michigan, Ann Arbor, Michigan USA (T.D.J.); Oakwood Healthcare System, Dearborn, Michigan USA (D.P.); and Primary Children’s Medical Center, Salt Lake City, Utah USA (S.P.G.).

Address correspondence to Marilyn A. Roubidoux, MD, Department of Radiology, University of Michigan Health Systems, 2910G Taubman Center, Ann Arbor, MI 48109-0326 USA.

Objective. We prospectively evaluated low-stage breast cancers treated with neoadjuvant chemotherapy using whole-volume sonography and color Doppler imaging. Methods. Thirty-four women with breast cancer (mean maximum size, 2.4 cm) received neoadjuvant chemotherapy with doxorubicin and docetaxel. Targeted whole-volume sonography of tumor sites was performed before and after chemotherapy to assess mass size, color pixel speed-weighted density, and American College of Radiology Breast Imaging Reporting and Data System sonographic characteristics. After chemotherapy, tumor sites were excised by lumpectomy or mastectomy. Results. Three (11.3%) of 34 patients had a complete histologic response. After chemotherapy, correlation was r = 0.716 between final histologic and sonographic sizes. Compared with histologic residual tumors, sonography had 4 false-negative results, 3 false-positive results, and 27 true-positive results (sensitivity, 87%), with no false-negative results among a subgroup of tumors of 7 mm and larger (sensitivity, 100%). The 3 cases with false-positive results were histologic fibrosis or biopsy changes. Mean speed-weighted density was 0.015 before and 0.0082 after chemotherapy (P = .03). After chemotherapy, vascularity was less common within (P = .06) or adjacent to (P = .009) masses or in tumor sites (P = .05). Prechemotherapy variables of gray scale characteristics and vascularity were compared with final histologic size, and all had P > .20. Conclusions. Postchemotherapy sensitivity of sonography was high for residual tumors of 7 mm or larger. Correlation was moderate between histologic and sonographic final tumor sizes. False-positive results were caused by fibrosis or biopsy-related changes. False-negative results occurred with residual tumor size of 6 mm or smaller. After chemotherapy, vascularity usually decreased, and this was not specific for complete response. Before chemotherapy, no vascular or gray scale feature at initial imaging predicted complete responders.

Key Words: breast cancer • breast sonography • neoadjuvant chemotherapy

Abbreviations: BIRADS, Breast Imaging Reporting and Data System • MRI, magnetic resonance imaging • PET, positron emission tomography • ROI, region of interest • SWD, speed-weighted pixel density • 3D, 3-dimensional

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