Prospective cohort study of CEUS quantitative parameters combined with immunohistochemistry in predicting NAC curative efficacy for breast cancer
10.3969/j.issn.1672-8270.2025.09.012
- VernacularTitle:超声造影定量参数联合免疫组织化学指标预测乳腺癌新辅助化疗疗效的前瞻性队列研究
- Author:
Qiqi SHEN
1
;
Wenjuan WU
1
;
Jing HUO
1
;
Ling CHEN
1
Author Information
1. 江南大学附属医院超声医学科 无锡 214000
- Publication Type:Journal Article
- Keywords:
Contrast enhanced ultrasound(CEUS);
Quantitative parameters;
Immunohistochemistry;
Breast cancer;
Adjuvant therapy;
Curative efficacy
- From:
China Medical Equipment
2025;22(9):56-61
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore application value of a constructed predictive model of quantitative parameters of contrast-enhanced ultrasound(CEUS)combined with immunohistochemical indicators in assessing the curative efficacy of neoadjuvant chemotherapy(NAC)for breast cancer,so as to provide objective basis for clinically individual treatment decisions.Methods:The CEUS quantitative parameters were used to combine with immunohistochemical indicators to construct predictive model,and this study adopted prospective cohort design.A total of 93 patients who were preliminarily diagnosed as breast cancer at Affiliated Hospital of Jiangnan University during June 2022 and June 2023 were included in this study.According to the pathologically relieve condition,they were divided into significant response group(41 cases)and non-significant response group(52 cases).All of them received NAC with docetaxel/doxorubicin/cyclophosphamide(TAC).Before treatment,the peak intensity(PI),time-to-peak(TTP),and wash-in rate(WIR)of them were obtained through CEUS,and all of patients underwent immunohistochemical examination to detect the expressions of immunohistochemical indicators included estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor 2(HER2)and Ki-67 proliferation index.The Miller-Payne grade G4-G5 was used as the standard of pathological complete response(pCR).Multivariate logistic regression was adopted to screen independent predictors,and construct a jointly predictive model,and verify effectiveness by Bootstrap resampling method.Results:The PI value of significant response group was(22.7±4.1)dB,which was significantly higher than(18.3±3.6)dB of non-significant response group,and the difference was significant(t=5.437,P<0.001).The TTP of significant response group was(14.2±2.8)s,which was shorter than(18.6±3.1)s of non-significant response group,and the difference was significant(t=7.152,P<0.05).The wash-in rate(WIR)of significant response group was(1.61±0.43)dB/s,which was significantly higher than(0.98±0.37)dB/s of non-significant response group,and the difference was significant(t=7.893,P<0.001).In the immunohistochemical indicators,the positive HER2 and high Ki-67 expression significantly correlated with pathological response.In the results of positive HER2,there were 17 cases(41.5%)in 41 patients of significant response group,and there were 9 cases(17.3%)in non-significant response group,and the positive HER2 of significant response group was higher than that of non-significant response group,and the difference was significant(x2=7.326,P<0.05).For patients whose Ki-67 were larger or equal to 20%,the positive rate of significant response group was 75.6%(31 cases),which was higher than 57.7%(30 cases)of non-significant response group.For patients whose Ki-67 were less than 20%,the positive rate of significant response group was 24.4%(10 cases),which was significantly higher than 42.3%(22 cases)of non-significant response group,and the difference was significant(x2=3.921,P<0.05).Multivariate analysis indicated that TTP≤15 s,WIR≥1.5 dB/s,and positive HER2 were respectively independent predictors(OR=4.23,3.76,2.91,P<0.05).The area under curve(AUC)value of receiver operating characteristic(ROC)curve of joint model was 0.89(95%CI:0.83-0.95),and the sensitivity and specificity of that were respectively 92.7%and 80.8%,which were significantly better than each single parameter.Decision curve analysis indicated that the net benefit value of joint model increased by 21.3%-28.6%than conventional strategy when threshold probabilities was 15%-60%.Conclusion:CEUS quantitative parameters(TTP,WIR)that combine with HER2 status can construct predictive model with high-precision and low-cost for NAC curative efficacy,which synergistic effect in dynamic perfusion assessment and molecularly pathological characteristic can provide new paradigm for precision treatment in breast cancer.This mode has excellent clinical applicability,and can effectively identify chemosensitive populations and optimize decision-making process of treatment.
