The use of breast ultrasound for prediction of pathologic complete response in different subtypes of early breast cancer within the WSG-ADAPT subtrials
Monika Graeser,
Nadia Harbeck,
Oleg Gluz,
Rachel Würstlein,
Christine zu Eulenburg,
Claudia Schumacher,
Eva-Maria Grischke,
Helmut Forstbauer,
Moritz Dimpfl,
Michael Braun,
Matthias Christgen,
Hans Heinrich Kreipe,
Jochem Potenberg,
Raquel von Schumann,
Bahriye Aktas,
Cornelia Kolberg-Liedtke,
Sherko Kümmel,
Ulrike Nitz
Affiliations
Monika Graeser
West German Study Group, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany; Breast Center Niederrhein, Ev. Hospital Bethesda, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany; Department of Gynecology, University Medical Center Hamburg, Martinistrasse 52, 20251, Hamburg, Germany; Corresponding author. Breast Center Niederrhein Bethesda Clinics, West German Study Group, Ludwig Weber Str. 15, 41061, Moenchengladbach, Germany.
Nadia Harbeck
West German Study Group, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany; Breast Center, Department of Gynecology and Obstetrics and CCCLMU, LMU University Hospital, Marchioninistrasse 15, 81377, Munich, Germany
Oleg Gluz
West German Study Group, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany; Breast Center Niederrhein, Ev. Hospital Bethesda, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany; University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
Rachel Würstlein
West German Study Group, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany; Breast Center, Department of Gynecology and Obstetrics and CCCLMU, LMU University Hospital, Marchioninistrasse 15, 81377, Munich, Germany
Christine zu Eulenburg
West German Study Group, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany
Claudia Schumacher
Breast Center, St. Elisabeth Hospital, Werthmannstrasse 1, 50935, Cologne, Germany
Eva-Maria Grischke
Women's Clinic, University Clinics Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
Helmut Forstbauer
Practice Network Troisdorf, Schlossstrasse 18, 53840, Troisdorf, Germany
Moritz Dimpfl
Breast Center, Department of Gynecology and Obstetrics and CCCLMU, LMU University Hospital, Marchioninistrasse 15, 81377, Munich, Germany
Michael Braun
Breast Center, Rotkreuz Clinics Munich, Nymphenburger Strasse 163, 80634, Munich, Germany
Matthias Christgen
Institute of Pathology, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
Hans Heinrich Kreipe
Institute of Pathology, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
Breast Center Niederrhein, Ev. Hospital Bethesda, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany
Bahriye Aktas
Women's Clinic, University Clinics Essen, Hufelandstrasse 55, 45147, Essen, Germany; Women's Clinic, University Clinics Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany
Cornelia Kolberg-Liedtke
Women's Clinic, University Clinics Essen, Hufelandstrasse 55, 45147, Essen, Germany; University Hospital Charité, Humboldt University, Chariteplatz 1, 10117, Berlin, Germany
Sherko Kümmel
West German Study Group, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany; University Hospital Charité, Humboldt University, Chariteplatz 1, 10117, Berlin, Germany; Breast Unit, Kliniken Essen-Mitte, Henricistrasse 92, 45136, Essen, Germany
Ulrike Nitz
West German Study Group, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany; Breast Center Niederrhein, Ev. Hospital Bethesda, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany
Objective: We assessed the value of breast ultrasound (US) performed at week 3 and 6 and at the end (EOT) of neoadjuvant therapy (NAT) for prediction of pathologic complete response (pCR, ypT0/is ypN0) in patients with HR+/HER2+, HR-/HER2-or HR-/HER2+ early breast cancer enrolled in the WSG-ADAPT subtrials. Methods: US was performed at week 3 and 6 of NAT and at EOT in 401, 517, and 553 patients, respectively. Tumors with complete or partial response by US (RECIST 1.1) were classified as responders and those with stable or progressive disease as non-responders. Results: pCR rate was higher in US responders than in non-responders. US tended to yield the highest positive predictive value in HR-/HER2+ (69%) and HR-/HER2-tumors (65%) at week 3, and the highest negative predictive value in HR+/HER2+ tumors at week 6 and at EOT (88.9% and 86.9%, respectively) and in HR-/HER2-tumors at EOT (87.9%). Multivariable analysis of patients with US at week 3 and 6 identified tumor subtype (HR-/HER2+ vs HR+/HER2+; odds ratio (OR) 2.77, 95%CI 1.45–5.29, and OR 4.17, 95%CI 2.26–7.68, respectively) and each 10% change in lesion dimension on US from baseline (OR 1.15, 95%CI 1.08–1.24, and OR 1.25, 95%CI 1.16–1.35, respectively) as parameters associated with pCR. Conclusions: Our data support the use of week 3 and EOT US for prediction of pCR in response-guided NAT and in planning of breast-conserving surgery. Change in tumor diameter on US as a continuous variable could be a valuable alternative to categorical RECIST 1.1 criteria.
