title: Ultrasound assessment of residual abnormalities following primary chemotherapy for breast cancer.
abstract: The purpose of this study was to assess the usefulness of ultrasonography (US) in the assessment of the breast following primary medical therapy (PMT) of large operable breast cancer. A total of 52 patients were studied; all had invasive breast cancer, confirmed by core biopsy, with initial size > 4 cm by palpation, T2-3, N0-1, M0. PMT was with epirubicin, cisplatin and continuous infusional 5-fluorouracil, as previously described (Jones et al, 1994, J Clin Oncol 12: 1259-1265). Independent clinical and US assessments were made during PMT before surgery or biopsy. A total of 31 (60%) patients achieved complete clinical response (cCR), but in only five of these was the post-treatment ultrasound normal. Post-treatment sonographic findings of diffuse parenchymal distortion or a mass lesion without Doppler signal were associated with more favourable histology (pathological CR, non-invasive or microinvasive carcinoma), whereas a mass with Doppler positivity was more often associated with residual macroscopic invasive carcinoma. Patients who did not achieve cCR had a high incidence of residual macroscopic carcinoma (71%) regardless of the sonographic characteristics. With median follow-up of 27 months (range 12-43), ten (19%) patients have relapsed and six (12%) have died, but only one relapse has occurred within treated breast. Ultrasonography is a sensitive technique for assessing the response to PMT, particularly in patients who achieve cCR. It may be helpful in selecting those patients who do not require post-PMT surgery and in localizing abnormalities in those who do, particularly in those with cCR. However, clinicians should be aware that a residual US abnormality is by no means pathognomonic of residual cancer.
authors.affiliation: Department of Medicine, The Royal Marsden Hospital, London, UK.
authors.forename: M T
authors.initials: MT
authors.lastname: Seymour
authors.forename: E C
authors.initials: EC
authors.lastname: Moskovic
authors.forename: G
authors.initials: G
authors.lastname: Walsh
authors.forename: P
authors.initials: P
authors.lastname: Trott
authors.forename: I E
authors.initials: IE
authors.lastname: Smith
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000098:blood supply / Q000175:diagnosis* / Q000188:drug therapy; D002277:Carcinoma / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D012039:Regional Blood Flow; D014463:Ultrasonography