3D breast ultrasound: a significant predictor in breast cancer reduction under pre-operative chemotherapy.

2011 
Background: The objective was the investigation of a possible predictive quantitative impact of initial tumor sphericity, measured by 3D sonography, on response to pre- operative chemotherapy. Patients and Methods: This 3D ultrasound study was conducted on 41 consecutive primary breast cancer patients who received pre-operative epirubicin and paclitaxel chemotherapy; the tumors were measured by 3D sonography and by pathology after chemotherapy. Sphericity was defined as the ratio of the smallest to the largest extent by 3D sonography. Results: A predictive impact of initial tumor sphericity on response to pre-operative chemotherapy was quantitatively identified for the first time. Sphericity was a significant predictor of pathological complete remission with a rank difference of 0.34 or about 1/3 i.e., spherical tumors were more likely to show successful remission. Conclusion: Tumor sphericity as defined from 3D sonography could be predictive of response to pre-operative chemotherapy regimens; prospective investigation is suggested. Using ultrasound as a noninvasive method to predict the possible outcome of a given treatment regimen would greatly benefit any patient collective while resulting in virtually no additional patient discomfort. This however, requires a thorough ultrasound analysis of response to pre-operative chemotherapy in breast cancer patients. Evidence points to at least equal long-term survival for pre-operative versus adjuvant administration of chemotherapy regimens (1, 2). The quality of life benefits accruing from the known (3-8) increase in the breast conserving surgery rate due to pre- operative therapy is substantial. Therefore, treatment individualization and optimization by identifying specific patient subgroups with different potential pre-operative response profiles is becoming more and more important. The noninvasive and readily available method of 3D ultrasound is already a fundamental part of clinical practice and may yield additional information about tumor response to preoperative chemotherapy. Two tumors with the same volume can obviously have different degrees of asymmetry when considered as three- dimensional structures. Malignant tumors are significantly associated (9, 10) with a ratio of length to depth >1 (OR=2.5); here, the "depth" refers to the tumor dimension perpendicular to the skin surface, whereas the "length" refers to the larger of the two remaining dimensions. These findings provide an example of a wide relationship between morphology and tumor malignancy. It was thus an intriguing inquiry whether or not morphology might also be a predictive factor for response to pre-operative chemotherapy. Therefore, this investigation proposed and tested the hypothesis that predictive information might be provided by the three-dimensional character of sonographic measurements, in particular the degree of equality of all three dimensions, which were defined and refered to as "sphericity".
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