Institute of Fundamental Technological Research

A 22 year-old woman with no family history of breast cancer developed a painful breast tumor in the inner lower quadrant of the left breast. After surgical consultation, ultrasound examination was advised. On ultrasound,the mass demonstrated malignant features such as non-parallel orientation, hypoechogenicity, spiculated margins, posterior shadowing, peripheral vessels on color Doppler and increased stiffness in the tissue surrounding the tumor. Before biopsy, mammography was performed. The mass had higher density than fibroglandular tissue, margins were ill-defined (spiculated) and had no microcalcification. BIRADS 5 category was pre-assigned. Core biopsy revealed granular cell tumor (GCT). The patient is undergoing regular follow-up. Granular cell tumor is rare and generally benign, however, it typically demonstrates malignant features clinically and on obtained diagnostic images. This article highlights the variety of imaging features accompanying benign breast tumors.

Breast Cancer,Breast Ultrasound,Granular Cell Tumor

Background: Neoadjuvant chemotherapy (NAC) is used in patients with breast cancer to reduce tumor focus, metastatic risk, and patient mortality. Monitoring NAC effects is necessary to capture resistant patients and stop or change treatment. The existing methods for evaluating NAC results have some limitations. The aim of this study was to assess the tumor response at an early stage, after the first doses of the NAC, based on the variability of the backscattered ultrasound energy, and backscatter statistics. The backscatter statistics has not previously been used to monitor NAC effects. Methods: The B-mode ultrasound images and raw radio frequency data from breast tumors were obtained using an ultrasound scanner before chemotherapy and 1 week after each NAC cycle. The study included twenty-four malignant breast cancers diagnosed in sixteen patients and qualified for neoadjuvant treatment before surgery. The shape parameter of the homodyned K distribution and integrated backscatter, along with the tumor size in the longest dimension, were determined based on ultrasound data and used as markers for NAC response. Cancer tumors were assigned to responding and non-responding groups, according to histopathological evaluation, which was a reference in assessing the utility of markers. Statistical analysis was performed to rate the ability of markers to predict the final NAC response based on data obtained after subsequent therapeutic doses. Results: Statistically significant differences (p<0.05) between groups were obtained after 2, 3, 4, and 5 doses of NAC for quantitative ultrasound markers and after 5 doses for the assessment based on maximum tumor dimension. Statistical analysis showed that, after the second and third NAC courses the classification based on integrated backscatter marker was characterized by an AUC of 0.69 and 0.82, respectively. The introduction of the second quantitative marker describing the statistical properties of scattering increased the corresponding AUC values to 0.82 and 0.91. Conclusions: Quantitative ultrasound information can characterize the tumor's pathological response better and at an earlier stage of therapy than the assessment of the reduction of its dimensions. The introduction of statistical parameters of ultrasonic backscatter to monitor the effects of chemotherapy can increase the effectiveness of monitoring and contribute to a better personalization of NAC therapy.

The presented study demonstrates the effectiveness of quantitative ultrasound imaging (H-scan ultrasound) in monitoring the breast cancer response to neoadjuvant chemotherapy and predicting pathological response. A group of 40 patients (51 breast tumors) participated in the study. The results showed that QUS imaging was able to distinguish between breast cancer patients responding and not responding to chemotherapy early in the course of treatment. Analysis of the percentage changes in red in the parametric images showed that this parameter can predict the response to treatment of patients with the area under the receiver operational characteristics (ROC) curve of 0.61, 0.70, 0.83, and 0.86, respectively, one week after 1st 2nd , 3rd and 4th dose of treatment.

breast cancer, neoadjuvant chemotherapy, ultrasound, H-scan ultrasounds.