Quantitative Assessment of the Echogenicity of a Breast Tumor Predicts the Response to Neoadjuvant Chemotherapy
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Histology
2.3. Ultrasonic Data Registration
2.4. Quantitative Analysis of Ultrasound Data
2.5. Tumor Echogenicity
- Hypoechoic
- Hypo and isoechoic (mixed)
- Isoechoic
- Hyperechoic
2.6. Tumor Volume
2.7. Statistical Analysis
3. Results
3.1. Tumor Echogenicity
3.2. Tumor Size
3.3. The Kullback–Leibler Divergence Based Parameters
3.4. Correlation
3.5. Classification
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Parameter | 1st NAC Course | 2nd NAC Course | 3rd NAC Course | 4th NAC Course |
---|---|---|---|---|
ΔEcho | −0.29 (0.043) | −0.28 (0.051) | −0.40 (0.005) | −0.38 (0.009) |
ΔV | +0.11 (0.427) | +0.24 (0.096) | +0.28 (0.061) | +0.25 (0.102) |
KLD0 | +0.24 (0.095) | −0.23 (0.106) | −0.41 (0.004) | −0.36 (0.018) |
KLD1 | −0.36 (0.012) | −0.58 (2 × 10−5) | −0.51 (5 × 10−4) | |
ΔKLD | −0.56 (3 × 10−5) | −0.62 (4 × 10−6) | −0.65 (3 × 10−6) |
Stage of Treatment | Parameter | AUC | Sensitivity | Specificity | Accuracy | PPV | NPV | |
---|---|---|---|---|---|---|---|---|
1st NAC course | ΔEcho | 0.62 | 0.73 0.5 | 0.36 | 0.91 | 0.6 | 0.83 | 0.53 |
ΔV | 0.65 | 0.79 0.49 | 0.64 | 0.73 | 0.68 | 0.75 | 0.62 | |
ΔV & ΔEcho | 0.68 | 0.82 0.52 | 0.71 | 0.68 | 0.7 | 0.74 | 0.65 | |
KLD0 | 0.69 | 0.82 0.53 | 0.54 | 0.86 | 0.68 | 0.83 | 0.59 | |
KLD1 | - | - - | - | - | - | - | - | |
ΔKLD | - | - - | - | - | - | - | - | |
ΔKLD & ΔEcho | - | - - | - | - | - | - | - | |
2nd NAC course | ΔEcho | 0.55 | 0.69 0.4 | 0.61 | 0.45 | 0.54 | 0.59 | 0.48 |
ΔV | 0.66 | 0.8 0.5 | 0.61 | 0.68 | 0.64 | 0.71 | 0.58 | |
ΔV & ΔEcho | 0.62 | 0.76 0.45 | 0.61 | 0.64 | 0.62 | 0.68 | 0.56 | |
KLD0 | 0.57 | 0.73 0.4 | 0.57 | 0.62 | 0.59 | 0.67 | 0.52 | |
KLD1 | 0.67 | 0.82 0.51 | 0.64 | 0.71 | 0.67 | 0.75 | 0.6 | |
ΔKLD | 0.84 | 0.94 0.71 | 0.79 | 0.86 | 0.82 | 0.88 | 0.75 | |
ΔKLD & ΔEcho | 0.81 | 0.92 0.66 | 0.79 | 0.81 | 0.8 | 0.85 | 0.74 | |
3rd NAC course | ΔEcho | 0.68 | 0.8 0.53 | 0.33 | 0.95 | 0.6 | 0.9 | 0.51 |
ΔV | 0.68 | 0.82 0.51 | 0.74 | 0.6 | 0.68 | 0.71 | 0.63 | |
ΔV & ΔEcho | 0.72 | 0.85 0.55 | 0.74 | 0.65 | 0.7 | 0.74 | 0.65 | |
KLD0 | 0.66 | 0.81 0.49 | 0.85 | 0.5 | 0.7 | 0.7 | 0.71 | |
KLD1 | 0.79 | 0.9 0.63 | 0.74 | 0.75 | 0.74 | 0.8 | 0.68 | |
ΔKLD | 0.84 | 0.94 0.7 | 0.93 | 0.7 | 0.83 | 0.81 | 0.88 | |
ΔKLD & ΔEcho | 0.84 | 0.94 0.7 | 0.81 | 0.75 | 0.79 | 0.81 | 0.75 | |
4th NAC course | ΔEcho | 0.73 | 0.85 0.58 | 0.5 | 0.76 | 0.62 | 0.71 | 0.57 |
ΔV | 0.62 | 0.78 0.44 | 0.75 | 0.48 | 0.62 | 0.62 | 0.63 | |
ΔV & ΔEcho | 0.64 | 0.79 0.46 | 0.58 | 0.67 | 0.62 | 0.67 | 0.58 | |
KLD0 | 0.68 | 0.83 0.5 | 0.83 | 0.55 | 0.7 | 0.68 | 0.73 | |
KLD1 | 0.76 | 0.88 0.6 | 0.78 | 0.65 | 0.72 | 0.72 | 0.72 | |
ΔKLD | 0.88 | 0.96 0.75 | 0.91 | 0.75 | 0.84 | 0.81 | 0.88 | |
ΔKLD & ΔEcho | 0.87 | 0.95 0.74 | 0.83 | 0.8 | 0.81 | 0.83 | 0.8 |
Stage of treatment | Parameter | AUC | Sensitivity | Specificity | Accuracy | PPV | NPV | |
---|---|---|---|---|---|---|---|---|
1st NAC course | ΔEcho | 0.6 | 0.7 0.48 | 0.92 | 0.3 | 0.46 | 0.32 | 0.92 |
ΔV | 0.6 | 0.77 0.43 | 0.69 | 0.62 | 0.64 | 0.39 | 0.85 | |
ΔV & ΔEcho | 0.62 | 0.78 0.45 | 0.69 | 0.68 | 0.68 | 0.43 | 0.86 | |
KLD0 | 0.67 | 0.8 0.5 | 0.92 | 0.51 | 0.62 | 0.4 | 0.95 | |
KLD1 | - | - - | - | - | - | - | - | |
ΔKLD | - | - - | - | - | - | - | - | |
ΔKLD & ΔEcho | - | - - | - | - | - | - | - | |
2nd NAC course | ΔEcho | 0.6 | 0.74 0.45 | 0.54 | 0.62 | 0.6 | 0.33 | 0.79 |
ΔV | 0.57 | 0.73 0.38 | 0.62 | 0.57 | 0.58 | 0.33 | 0.81 | |
ΔV & ΔEcho | 0.52 | 0.69 0.35 | 0.62 | 0.43 | 0.48 | 0.28 | 0.76 | |
KLD0 | 0.61 | 0.79 0.41 | 0.62 | 0.64 | 0.63 | 0.38 | 0.82 | |
KLD1 | 0.72 | 0.87 0.54 | 0.69 | 0.81 | 0.78 | 0.56 | 0.88 | |
ΔKLD | 0.85 | 0.96 0.68 | 0.85 | 0.83 | 0.84 | 0.65 | 0.94 | |
ΔKLD & ΔEcho | 0.84 | 0.97 0.65 | 0.85 | 0.83 | 0.84 | 0.65 | 0.94 | |
3rd NAC course | ΔEcho | 0.81 | 0.92 0.67 | 0.64 | 0.86 | 0.81 | 0.58 | 0.89 |
ΔV | 0.63 | 0.8 0.42 | 0.73 | 0.5 | 0.55 | 0.31 | 0.86 | |
ΔV & ΔEcho | 0.8 | 0.94 0.62 | 0.64 | 0.94 | 0.87 | 0.78 | 0.89 | |
KLD0 | 0.68 | 0.86 0.47 | 0.55 | 0.92 | 0.83 | 0.67 | 0.87 | |
KLD1 | 0.82 | 0.95 0.64 | 0.82 | 0.86 | 0.85 | 0.64 | 0.94 | |
ΔKLD | 0.9 | 0.99 0.75 | 0.82 | 0.94 | 0.91 | 0.82 | 0.94 | |
ΔKLD & ΔEcho | 0.92 | 1 0.76 | 0.91 | 0.92 | 0.91 | 0.77 | 0.97 | |
4th NAC course | ΔEcho | 0.79 | 0.92 0.61 | 0.58 | 0.94 | 0.84 | 0.78 | 0.86 |
ΔV | 0.7 | 0.88 0.48 | 0.67 | 0.73 | 0.71 | 0.47 | 0.86 | |
ΔV & ΔEcho | 0.77 | 0.92 0.56 | 0.83 | 0.76 | 0.78 | 0.56 | 0.93 | |
KLD0 | 0.66 | 0.84 0.43 | 0.55 | 0.88 | 0.79 | 0.6 | 0.85 | |
KLD1 | 0.81 | 0.95 0.62 | 0.73 | 0.78 | 0.77 | 0.53 | 0.89 | |
ΔKLD | 0.89 | 0.98 0.73 | 0.82 | 0.91 | 0.88 | 0.75 | 0.94 | |
ΔKLD & ΔEcho | 0.86 | 0.98 0.66 | 0.82 | 0.94 | 0.91 | 0.82 | 0.94 |
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Category | Characteristic | Count/Value |
---|---|---|
Patients | Number of patients | 39 |
Mean age (years) | 57 | |
Age range (years) | 32–83 | |
Tumor histology | Invasive ductal carcinoma (IDC) | 50 |
IDC with ductal carcinoma in situ | 20 | |
Receptor status | Luminal A | 9 |
Luminal B | 24 | |
TNBC | 9 | |
HER 2+ | 8 | |
Pathological response (RMC%) | 0 | 14 |
≤30 | 28 | |
31–69 | 9 | |
≥70 | 13 | |
Surgical treatment | Mastectomy | 37 |
Surgical treatment | BCT | 2 |
Echogenicity | Pre-Treatment | 1st NAC Course | 2nd NAC Course | 3rd NAC Course | 4th NAC Course | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n | μRMC | σRMC | n | μRMC | σRMC | n | μRMC | σRMC | n | μRMC | σRMC | n | μRMC | σRMC | |
Echo = 1 | 47 | 35 | 37 | 37 | 40 | 37 | 20 | 41 | 39 | 11 | 57 | 45 | 9 | 76 | 34 |
Echo = 2 | 3 | 37 | 40 | 11 | 26 | 32 | 24 | 38 | 36 | 26 | 34 | 32 | 18 | 28 | 31 |
Echo = 3 | 0 | - | - | 2 | 0 | 0 | 6 | 8 | 20 | 8 | 13 | 18 | 15 | 28 | 30 |
Echo = 4 | 0 | - | - | 0 | - | - | 0 | - | - | 2 | 0 | 0 | 3 | 10 | 16 |
All | 50 | 35 | 36 | 50 | 35 | 36 | 50 | 35 | 36 | 47 | 34 | 36 | 45 | 37 | 36 |
Measure of Performance | 2nd NAC Course | 3rd NAC Course | 4th NAC Course | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
ΔEcho | ΔV | ΔKLD | ΔEcho | ΔV | ΔKLD | ΔEcho | ΔV | ΔKLD | ||||||||||
AUC | 0.60 | 0.75 | 0.57 | 0.74 | 0.85 | 0.96 | 0.81 | 0.91 | 0.63 | 0.80 | 0.90 | 0.99 | 0.79 | 0.92 | 0.70 | 0.88 | 0.89 | 0.99 |
0.46 | 0.37 | 0.69 | 0.66 | 0.42 | 0.75 | 0.60 | 0.48 | 0.73 | ||||||||||
Sensitivity | 0.54 | 0.62 | 0.85 | 0.64 | 0.73 | 0.82 | 0.58 | 0.67 | 0.82 | |||||||||
Specificity | 0.62 | 0.57 | 0.83 | 0.86 | 0.50 | 0.94 | 0.94 | 0.73 | 0.91 | |||||||||
Accuracy | 0.60 | 0.58 | 0.84 | 0.81 | 0.55 | 0.91 | 0.84 | 0.71 | 0.88 | |||||||||
PPV | 0.33 | 0.33 | 0.65 | 0.58 | 0.31 | 0.82 | 0.78 | 0.47 | 0.75 | |||||||||
NPV | 0.79 | 0.81 | 0.94 | 0.89 | 0.86 | 0.94 | 0.86 | 0.86 | 0.94 |
Measure of Performance | 2nd NAC Course | 3rd NAC Course | 4th NAC Course | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
ΔEcho | ΔV | ΔKLD | ΔEcho | ΔV | ΔKLD | ΔEcho | ΔV | ΔKLD | ||||||||||
AUC | 0.55 | 0.69 | 0.66 | 0.8 | 0.84 | 0.93 | 0.68 | 0.8 | 0.68 | 0.82 | 0.84 | 0.94 | 0.73 | 0.85 | 0.62 | 0.78 | 0.88 | 0.96 |
0.4 | 0.5 | 0.71 | 0.53 | 0.51 | 0.71 | 0.57 | 0.44 | 0.75 | ||||||||||
Sensitivity | 0.61 | 0.61 | 0.79 | 0.33 | 0.74 | 0.93 | 0.5 | 0.75 | 0.91 | |||||||||
Specificity | 0.45 | 0.68 | 0.86 | 0.95 | 0.6 | 0.7 | 0.76 | 0.48 | 0.75 | |||||||||
Accuracy | 0.54 | 0.64 | 0.82 | 0.6 | 0.68 | 0.83 | 0.62 | 0.62 | 0.84 | |||||||||
PPV | 0.59 | 0.71 | 0.88 | 0.9 | 0.71 | 0.81 | 0.71 | 0.62 | 0.81 | |||||||||
NPV | 0.48 | 0.58 | 0.75 | 0.51 | 0.63 | 0.88 | 0.57 | 0.63 | 0.88 |
RMC ≥ 70% | 1st NAC Course | 2nd NAC Course | 3rd NAC Course | 4th NAC Course |
---|---|---|---|---|
AUC | 0.62 | 0.52 | 0.8 | 0.77 |
Sensitivity | 0.69 | 0.62 | 0.64 | 0.83 |
Specificity | 0.68 | 0.43 | 0.94 | 0.76 |
Accuracy | 0.68 | 0.48 | 0.87 | 0.78 |
PPV | 0.43 | 0.28 | 0.78 | 0.56 |
NPV | 0.86 | 0.76 | 0.89 | 0.93 |
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Dobruch-Sobczak, K.S.; Piotrzkowska-Wróblewska, H.; Karwat, P.; Klimonda, Z.; Markiewicz-Grodzicka, E.; Litniewski, J. Quantitative Assessment of the Echogenicity of a Breast Tumor Predicts the Response to Neoadjuvant Chemotherapy. Cancers 2021, 13, 3546. https://doi.org/10.3390/cancers13143546
Dobruch-Sobczak KS, Piotrzkowska-Wróblewska H, Karwat P, Klimonda Z, Markiewicz-Grodzicka E, Litniewski J. Quantitative Assessment of the Echogenicity of a Breast Tumor Predicts the Response to Neoadjuvant Chemotherapy. Cancers. 2021; 13(14):3546. https://doi.org/10.3390/cancers13143546
Chicago/Turabian StyleDobruch-Sobczak, Katarzyna Sylwia, Hanna Piotrzkowska-Wróblewska, Piotr Karwat, Ziemowit Klimonda, Ewa Markiewicz-Grodzicka, and Jerzy Litniewski. 2021. "Quantitative Assessment of the Echogenicity of a Breast Tumor Predicts the Response to Neoadjuvant Chemotherapy" Cancers 13, no. 14: 3546. https://doi.org/10.3390/cancers13143546