Ultrasound Automated Breast Volume Scanner(ABVS)in Evaluation Of Breast Lesions

Part Ⅰ Evaluation of response to neoadjuvant chemotherapy using ultrasound automatic breast volume scanner(ABVS)in breast cancerPurpose:Breast cancer is the most common malignancy in women with the highest incidence.Neoadjuvant chemotherapy(NAC)is increasingly used as standard therapy for locally advanced breast cancer.The clinical importance of NAC lies in the fact that it significantly downstages the primary tumor,enables greater breast conservation surgery(BCS)and improvement in long-term recurrence-free survival(RPS)and overall survival(OS)with those patients achieved pathological complete remission(pCR).Radiological methods for assessing the degree of response of the primary tumor to NAC may guide decisions about whether subsequent regimens should be tailored,or mastectomy or BCS should be attempted.Automated breast volume scanner(ABVS)is one of the emerging technology for evaluating breast lesions,which can reconstruct the cross-section images for 3D model,and achieve the standard diagnosis procedures.This study aims to assess the value of ABVS measurements of breast tumor size in predicting NAC efficiency and compare the predictive values with ultrasonography(US).Methods:The study included 25 patients undergoing NAC from Jan 2015 to Mar 2016 in Jinling Hospital.The longest diameters of breast tumors were measured on ABVS and US before NAC treatment,after first cycle,after second cycle and fourth cycle.The 3D model of the tumors were reconstructed and segment from ABVS data for measurement of tumor volume(MTV)using medical image software.Fisher exact test was used to compare the difference of clinical variables such as age,menopausal status,tumor pathological type and molecular subtype between pCR and non pathological complete remission(npCR)group,and between major histological response(MHR)and non-major histological response(nMHR)group.Tumor size of US,AIBVS and MTV at each time point and the percentage change was compared by using Independent sample t test(Mann-Whitney U test).Size correlations of US and ABVS were determined using Spearman rank correlation analysis.US,ABVS and pathologic measurements were also compared using weighted kappa statistics.The sensitivity,specificity,accuracy,positive preditive value(PPV)and negative predictive value(NPV)of US,ABVS and MTV for pCR and MHR were calculated.For a correct determination of pCR and MHR,the ROC-curves of US,ABVS and MTV for tumor size and percentage change were performed,and the statistical significant differences were tested.Results:Of the 25 patients,5 patients achieved pCR(Miller-Payne grade 5),and 20 patients had residual carcinomas with 8 patient in grade 1,2 patients in grade 2,4 patients in grade 3 and 6 patients in grade 4.11 patients in MHR and 14 patients in nMHR.Except for menopausal status,the rest clinical variables were not signigicant difference between groups.US,ABVS and MTV measurement showed tumor size was significant decreased after the second cycle(P<0.05).Of all measurements,ABVS was superior in predicting pCR with higher area under the ROC-curves(AUC:0.930)after second cycle.But no significant difference were found among the three methods.Tumors size of ABVS before surgery showed a stronger correlation with pathologic size of residual tumors(r=0.682,P=0.000 vs r 0.679,P=0.000)and higher agreement(κ=0.464 vs κ=0.234)than US.For predicting pCR,ABVS and MTV were superior to US with the sensitivity of 100%,specificity of 40%,accuracy of 88.00%,PPV of 86.96%and NPV of 100%.For predicting MHR,MTV was the best with sensitivity of 92.86%,specificity of 72.73%,accuracy of 84.00%,PPV of 81.25%and NPV of 88.89%.Conclusion:ABVS is a more reliable tool to evaluate the NAC efficiency.ABVS and MTV,can early predict the response fo NAC,differentiate the pCR from residual caicinoma,and differentiate the MHR for nMHR than US.Part Ⅱ Three-dimensional measurements of invasive ductal carcinoma with automated breast volume scanner(ABVS)predicts axillary lymph node metastasisPurpose:Automated breast volume scanner(ABVS)is highly sensitive and specific to tumors’ morphological characteristics,providing clear anatomical level for the determination of tumor size and boundary.This study aims to evaluate the three-dimensional characteristics of invasive ductal carcinomas with ABVS,and identify the predictive factors of axillary lymph node metastasis(ALNM),when compared with conventional ultrasound(US).Methods:Sixty-three patients with invasive ductal carcinoma underwent US and ABVS.The tumor’s largest diameter(LD)were measured,the tumor volume(TV)and surface area(TSA)were calculated by the formula of ellipse.The volumetric measurement(MTV)was also obtained from ABVS data using medical image software,which can used for tumor segment and 3D reconstructed.The differences between negative and positive axillary lymph node patients(age,menstrual status,clinical stage,tumor grade,molecular subtypes,the measurements of US and ABVS were sought using non-parametric t test or Chi-squared test/Fisher’s exact test.The above variables were combined and determined for the predictors of ALNM by univariate and multivariate analyses.ROC curve was used to determine the accuracy of variables for predicting N1-3 and N1 ALNM.Results:There were 32patients with ALNM,and 31 patients without ALNM.The age,menstrual status,tumor grade,ER,PR,HER2,Ki67 and molecular subtypes were no significant difference between two groups(P>0.05).The clinical stage,US(LD,TV and TSA),ABVS(LD,TV and TSA)and MTV were significant difference(P<0.05)in univariate regress;on analysis.Only MTV(P=0.049,OR=1.25,95%CI=1.00-1.55,AUC=0.761)remained the predictor of ALNM in multivariate analysis.US(TSA:P=049,OR=1.19,AUC=0.748)和 ABVS(LD:P=0.021,OR=1.16,AUC=0.789;TV:P=0.045,OR=1.26,AUC=0.737;TSA:P=0.038,OR=1.14,AUC=0.755)remained the predictors of ALNM in early N stage.Conclusions:When compared with LD,TV and TSA played the similar role on differer negative from positive lymph nodes and predict ALNM.When compared with US,ABVS may be a more reliable tool to evaluate the tumor morphological characteristics;The tumor segment and tumor volume measurement based on the ABVS images,can further differentiate the positive lymph node from negative one,and predict the risk of ALNM better,which can assist the treatment stratagem for the patients.However,further investigations are needed to confirm.