title: Using Flow Characteristics in Three-Dimensional Power Doppler Ultrasound Imaging to Predict Complete Responses in Patients Undergoing Neoadjuvant Chemotherapy.
abstract: OBJECTIVE
  Strategies are needed for the identification of a poor response to treatment and determination of appropriate chemotherapy strategies for patients in the early stages of neoadjuvant chemotherapy for breast cancer. We hypothesize that power Doppler ultrasound imaging can provide useful information on predicting response to neoadjuvant chemotherapy.
  
  
  METHODS
  The solid directional flow of vessels in breast tumors was used as a marker of pathologic complete responses (pCR) in patients undergoing neoadjuvant chemotherapy. Thirty-one breast cancer patients who received neoadjuvant chemotherapy and had tumors of 2 to 5 cm were recruited. Three-dimensional power Doppler ultrasound with high-definition flow imaging technology was used to acquire the indices of tumor blood flow/volume, and the chemotherapy response prediction was established, followed by support vector machine classification.
  
  
  RESULTS
  The accuracy of pCR prediction before the first chemotherapy treatment was 83.87% (area under the ROC curve [AUC] = 0.6957). After the second chemotherapy treatment, the accuracy of was 87.9% (AUC = 0.756). Trend analysis showed that good and poor responders exhibited different trends in vascular flow during chemotherapy.
  
  
  CONCLUSIONS
  This preliminary study demonstrates the feasibility of using the vascular flow in breast tumors to predict chemotherapeutic efficacy.
authors.affiliation: Cancer Research Center, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Wei-Chung
authors.initials: WC
authors.lastname: Shia
authors.affiliation: Department of Computer Science, Tunghai University, Taichung, Taiwan.
authors.forename: Yu-Len
authors.initials: YL
authors.lastname: Huang
authors.affiliation: Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Hwa-Koon
authors.initials: HK
authors.lastname: Wu
authors.affiliation: Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Dar-Ren
authors.initials: DR
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000098:blood supply / Q000000981:diagnostic imaging; D001943:Breast Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods*
keywords: Doppler ultrasound imaging; breast cancer; clinical prediction rule; neoadjuvant therapy