Predictive Value of Ultrasound Doppler Parameters in the Neoadjuvant Chemotherapy Response of Breast Cancer: Prospective Comparison with Magnetic Resonance and Mammography

Abstract

Abstract Background: Neoadjuvant chemotherapy (NACT) is a treatment option for breast cancer patients who allows for the assessment of tumor response during treatment. This information can be used to adjust treatment and improve outcomes. However, the optimal imaging modalities and parameters for assessing tumor response to NACT are not well established. Methods: This study included 173 breast cancer patients who underwent NACT. Patients were imaged with ultrasound, mammography, and MRI at baseline, after two cycles of NACT, and before breast surgery. Ultrasound parameters included lesion morphology, Doppler variables, and elastography measurements. Mammography and MRI were evaluated for the presence of nodules and tumor dimensions. The pathological response to NACT was determined using the residual cancer burden (RCB) classification. Results: The ultrasound parameter with the highest power for predicting pathological complete response (PCR) was shear wave elastography (SWE) maximum speed inside the tumor at baseline. For nonluminal tumors, the end diastolic velocity measured by ultrasound after two cycles of NACT showed the highest predictive value for pCR. Similarly, SWE maximum speed after two cycles of NACT had the highest discriminating power for predicting RCB-III in luminal tumors, while the same parameter measured at baseline was most predictive for nonluminal tumors. Conclusions: This study provides evidence that mid-treatment Doppler ultrasound and other imaging modalities can be used to predict the response to NACT in breast cancer patients. Functional parameters, such as blood flow velocities and SWE measurements, demonstrated superior predictive value for PCR, while morphological parameters had limited value. These findings have implications for personalized treatment strategies and may contribute to improved outcomes in the management of breast cancer.