The Potential Role of Lung Ultrasound B-Lines for Detection of Lung Radio-Induced Toxicity in Breast Cancer Patients after Radiation Therapy.
OBJECTIVE
Breast cancer patients exposed to doses of radiation after radiotherapy could develop toxicity to lung. Lung ultrasound (LUS) is able to detect interstitial lung disease by the evaluation of B-lines. The aim of our study was to assess the number of B-lines to diagnose lung involvement after chest radiotherapy.


METHODS
We measured LUS B-lines in the treated and contralateral lung of 20 breast cancer patients, 1-3 months after the end of radiotherapy and 1 year after previous LUS. The sum of the B-lines number in the 72 sites on anterior and posterior chest yielded a global B-lines score.


RESULTS
B-lines were more numerous in treated (median: 21; 1st-3rd quartiles: 11-31) versus untreated hemithorax (median: 3; 1st-3rd quartiles: 1-5) in both examination at T1-3 months (Kolmogorov-Smirnov test P < 0.001) and T1 year (median: 21; 1st-3rd quartiles: 12-28 vs. median: 4; 1st-3rd quartiles: 1-10; Kolmogorov-Smirnov test P < 0.01). Within the treated hemithorax, B-lines were more frequent in the anterior than in the posterior chest in both examination at T1-3 months (Kolmogorov-Smirnov test: P < 0.0001) and T1 year (Kolmogorov-Smirnov test: P < 0.01). Abnormal scores (B-lines>5) were present in 17/20 treated versus 7/20 untreated hemithoraxes (85.0 vs. 35.0%, P < 0.01) in the first LUS and likewise in 16/17 treated versus 7/17 in untreated hemithorax (94.1% vs. 41.2%, P < 0.01) after 1-year follow-up.


CONCLUSIONS
Among women receiving radiotherapy after breast cancer, B-lines are present predominantly in the irradiated lung. These data suggest that B-lines by LUS could provide, at a subclinical stage, a radiation-free biomarker of radiotherapy-induced lung damage.
Department of Radiation Oncology, "Perrino Hospital,", Brindisi, Italy.|Department of Interdisciplinary Medicine, Section of Diagnostic Imaging and Radiotherapy, University "Aldo Moro,", Bari, Italy.
Maria Fonte
http://orcid.org/0000-0003-4783-7097
MF
Petruzzelli
Oncologic Ultrasonography Unit, "F. Jaia Hospital", Conversano, Bari, Italy.
Maria Pia
MP
Vasti
Department of Radiation Oncology, "Perrino Hospital,", Brindisi, Italy.
Francesco
F
Tramacere
Department of Laboratory Medicine, "Perrino Hospital,", Brindisi, Italy.
Maria Patrizia
MP
D'Errico
Institute of Clinical Physiology, National Research Council, Pisa-Lecce, Italy.|Institute for Medical Biometrics, Epidemiology, and Informatics, Johannes Gutenberg-Universität Mainz, Mainz, Germany.
Emilio A L
EA
Gianicolo
Institute of Clinical Physiology, National Research Council, Pisa-Lecce, Italy.
Maria Grazia
MG
Andreassi
Institute of Clinical Physiology, National Research Council, Pisa-Lecce, Italy.
Eugenio
E
Picano
Department of Radiation Oncology, "Perrino Hospital,", Brindisi, Italy. brimapo@gmail.com.|Institute of Clinical Physiology, National Research Council, Pisa-Lecce, Italy. brimapo@gmail.com.
Maurizio
M
Portaluri
D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D017564:Radiation Pneumonitis / Q000000981:diagnostic imaging* / Q000209:etiology*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods*
breast cancer; lung toxicity; lung ultrasound methodology; radiation; ultrasound imaging