The Value Of SMI Combined With SWE For Early Prediction Of Pathological Response After Neoadjuvant Chemotherapy For Breast Cancer

Objective To evaluate the value of conventional ultrasound,shear wave elastography（SWE）and superb microvascular imaging（SMI）in the early prediction of pathological response after neoadjuvant chemotherapy（NAC）in breast cancer patients.Methods Sixty-eight patients with breast cancer diagnosed by core needle biopsy at the General Hospital of Ningxia Medical University from October 2021 to October 2022 and proposed for NAC were recruited,all of whom underwent surgery after chemotherapy and were divided into pathological response group（grade III-V）and non-response group（grade I and II）according to the density change of tumor cells before and after chemotherapy（Miller-Payne classification）.All patients underwent routine ultrasound,SMI and SWE before NAC and after early chemotherapy（second cycle）,and the maximum tumor diameters（Dmax）,maximum tumor elasticity（Emax）,and vasoconstriction period were recorded before NAC and after the second cycle of chemotherapy.The peak systolic velocity（PSV）and resistance index（RI）were calculated.The change rates of each parameter were calculated and recorded asΔDmax,ΔEmax,ΔPSV andΔRI.T-test was used to compare the differences of parameters between the two groups before NAC and after the 2^nd cycle of chemotherapy.Binary Logistic regression analysis was used to obtain variables and their risk ratios（OR）independently related to pathological response and establish a prediction model.The receiver operating characteristic（ROC）curve was drawn to analyze the efficacy of each parameter and its combined model in early prediction of pathological response after NAC.Results 1.After NAC,there were 53 cases in the pathological response group and 15cases in the non-response group.2.There was no significant difference in age,menopausal status,pathological type,histological grade,molecular typing,ER status,PR status,Her-2 status,ki67 and lymph node metastasis between the two groups before NAC（P>0.05）.3.There was no significant difference in Dmax,Emax,PSV and RI between the two groups before NAC（P>0.05）.After two cycles of NAC treatment,the relative values ofΔPSV,ΔRI andΔEmax in the response group were higher than those in the non-response group（P<0.05）.4.Logistic regression showed thatΔEmax（OR 0.797,95%CI 0.683-0.929,P=0.004）,ΔPSV（OR 0.926,95%CI 0.860-0.998,P=0.045）andΔRI（OR 0.841,95%CI 0.736-0.960,P=0.010）after the 2^ndcycle of NAC were independently associated with the pathological response of breast cancer after NAC.The combined prediction model was model=-（ΔEmax*0.228+ΔPSV*0.076+ΔRI*0.173+8.757）.The Hosmer-Lemeshow test results showed that the P value of the model was greater than 0.10（0.587）.5.The ROC curves showed that the area under curve（AUC）ofΔEmax,ΔPSV andΔRI were 0.878,0.716 and 0.801,respectively,and the AUC value of the joint predictive efficiency of the rate of change of each parameter was 0.945 with a sensitivity of 94.3%and specificity of 86.7%.Conclusion SMI combined with SWE technology can better predict the pathological reactivity of BC patients after NAC,which is helpful to improve the clinical application value of NAC.The combination of the two methods may provide imaging basis for personalized diagnosis and treatment of BC patients on the basis of timely diagnosis.