title: Breast cancer: assessing response to neoadjuvant chemotherapy by using US-guided near-infrared tomography.
abstract: OBJECTIVE
  To assess initial breast tumor hemoglobin (Hb) content before the initiation of neoadjuvant chemotherapy, monitor the Hb changes at the end of each treatment cycle, and correlate these findings with tumor pathologic response.
  
  
  METHODS
  The HIPAA-compliant study protocol was approved by the institutional review boards of both institutions. Written informed consent was obtained from all patients. Patients who were eligible for neoadjuvant chemotherapy were recruited between December 2007 and May 2011, and their tumor Hb content was assessed by using a near-infrared imager coupled with an ultrasonography (US) system. Thirty-two women (mean age, 48 years; range, 32-82 years) were imaged before treatment, at the end of every treatment cycle, and before definitive surgery. The patients were graded in terms of their final pathologic response on the basis of the Miller-Payne system as nonresponders and partial responders (grades 1-3) and near-complete and complete responders (grades 4 and 5). Tumor vascularity was assessed from total Hb (tHb), oxygenated Hb (oxyHb), and deoxygenated Hb (deoxyHb) concentrations. Tumor vascularity changes during treatment were assessed from percentage tHb normalized to the pretreatment level. A two-sample two-sided t test was used to calculate the P value and to evaluate statistical significance between groups. Bonferroni-Holm correction was applied to obtain the corrected P value for multiple comparisons.
  
  
  RESULTS
  There were 20 Miller-Payne grade 1-3 tumors and 14 grade 4 or 5 tumors. Mean maximum pretreatment tHb, oxyHb, and deoxyHb levels were significantly higher in grade 4 and 5 tumors than in grade 1-3 tumors (P = .005, P = .008, and P = .017, respectively). The mean percentage tHb changes were significantly higher in grade 4 or 5 tumors than in grade 1-3 tumors at the end of treatment cycles 1-3 (P = .009 and corrected P = .009, P = .002 and corrected P = .004, and P < .001 and corrected P < .001, respectively).
  
  
  CONCLUSIONS
  These findings indicate that initial tumor Hb content is a strong predictor of final pathologic response. Additionally, the tHb changes during early treatment cycles can further predict final pathologic response.
authors.affiliation: Biomedical Engineering Program, Electrical and Computer Engineering Department, University of Connecticut, 371 Fairfield Rd, U2157, Storrs, CT 06269, USA. zhu@engr.uconn.edu
authors.forename: Quing
authors.initials: Q
authors.lastname: Zhu
authors.forename: Patricia A
authors.initials: PA
authors.lastname: DeFusco
authors.forename: Andrew
authors.initials: A
authors.lastname: Ricci
authors.forename: Edward B
authors.initials: EB
authors.lastname: Cronin
authors.forename: Poornima U
authors.initials: PU
authors.lastname: Hegde
authors.forename: Mark
authors.initials: M
authors.lastname: Kane
authors.forename: Behnoosh
authors.initials: B
authors.lastname: Tavakoli
authors.forename: Yan
authors.initials: Y
authors.lastname: Xu
authors.forename: Jesse
authors.initials: J
authors.lastname: Hart
authors.forename: Susan H
authors.initials: SH
authors.lastname: Tannenbaum
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab; D001706:Biopsy; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology*; D000069287:Capecitabine; D016190:Carboplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology*; D017239:Paclitaxel / Q000008:administration & dosage; D012372:ROC Curve; D019265:Spectroscopy, Near-Infrared; D000068878:Trastuzumab; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D003841:Deoxycytidine; D000068258:Bevacizumab; D000069287:Capecitabine; D004317:Doxorubicin; D003520:Cyclophosphamide; D016190:Carboplatin; D000068878:Trastuzumab; D017239:Paclitaxel; D005472:Fluorouracil