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1.Piotrzkowska-Wróblewska H., Dobruch-Sobczak K., Klimonda Z., Karwat P., Roszkowska-Purska K., Gumowska M., Litniewski J., Monitoring breast cancer response to neoadjuvant chemotherapy with ultrasound signal statistics and integrated backscatter , PLOS ONE, ISSN: 1932-6203, DOI: 10.1371/journal.pone.0213749 , Vol.14, No.3, pp.1-15, 2019
Piotrzkowska-Wróblewska H., Dobruch-Sobczak K., Klimonda Z., Karwat P., Roszkowska-Purska K., Gumowska M., Litniewski J., Monitoring breast cancer response to neoadjuvant chemotherapy with ultrasound signal statistics and integrated backscatter , PLOS ONE, ISSN: 1932-6203, DOI: 10.1371/journal.pone.0213749 , Vol.14, No.3, pp.1-15, 2019

Abstract:
Background Neoadjuvant chemotherapy (NAC) is used in patients with breast cancer to reduce tumor focus, metastatic risk, and patient mortality. Monitoring NAC effects is necessary to capture resistant patients and stop or change treatment. The existing methods for evaluating NAC results have some limitations. The aim of this study was to assess the tumor response at an early stage, after the first doses of the NAC, based on the variability of the backscattered ultrasound energy, and backscatter statistics. The backscatter statistics has not previously been used to monitor NAC effects. Methods The B-mode ultrasound images and raw radio frequency data from breast tumors were obtained using an ultrasound scanner before chemotherapy and 1 week after each NAC cycle. The study included twenty-four malignant breast cancers diagnosed in sixteen patients and qualified for neoadjuvant treatment before surgery. The shape parameter of the homodyned K distribution and integrated backscatter, along with the tumor size in the longest dimension, were determined based on ultrasound data and used as markers for NAC response. Cancer tumors were assigned to responding and non-responding groups, according to histopathological evaluation, which was a reference in assessing the utility of markers. Statistical analysis was performed to rate the ability of markers to predict the final NAC response based on data obtained after subsequent therapeutic doses. Results Statistically significant differences (p<0.05) between groups were obtained after 2, 3, 4, and 5 doses of NAC for quantitative ultrasound markers and after 5 doses for the assessment based on maximum tumor dimension. Statistical analysis showed that, after the second and third NAC courses the classification based on integrated backscatter marker was characterized by an AUC of 0.69 and 0.82, respectively. The introduction of the second quantitative marker describing the statistical properties of scattering increased the corresponding AUC values to 0.82 and 0.91. Conclusions Quantitative ultrasound information can characterize the tumor's pathological response better and at an earlier stage of therapy than the assessment of the reduction of its dimensions. The introduction of statistical parameters of ultrasonic backscatter to monitor the effects of chemotherapy can increase the effectiveness of monitoring and contribute to a better personalization of NAC therapy.

2.Dobruch-Sobczak K., Piotrzkowska-Wróblewska H., Klimonda Z., Roszkowska-Purska K., Litniewski J., Ultrasound echogenicity reveals the response of breast cancer to chemotherapy , Clinical Imaging , ISSN: 0899-7071, DOI: 10.1016/j.clinimag.2019.01.021, Vol.55, pp.41-46, 2019
Dobruch-Sobczak K., Piotrzkowska-Wróblewska H., Klimonda Z., Roszkowska-Purska K., Litniewski J., Ultrasound echogenicity reveals the response of breast cancer to chemotherapy , Clinical Imaging , ISSN: 0899-7071, DOI: 10.1016/j.clinimag.2019.01.021, Vol.55, pp.41-46, 2019

Abstract:
Purpose: To evaluate the ultrasound (US) response in patients with breast cancer (BC) during neoadjuvant chemotherapy (NAC). Methods: Prospective US analysis was performed on 19 malignant tumors prior to NAC treatment and 7days after each first four courses of NAC in 13 patients (median age=57years). Echogenicity, size, vascularity, and sonoelastography were measured and compared with posttreatment scores of residual cancers burden. Results: Changes in the echogenicity of tumors after 3 courses of NAC had the most statistically strong correlation with the percentage of residual malignant cells used in histopathology to assess the response to treatment (odds ratio=60, p < 0.05). Changes in lesion size and elasticity were also significant (p < 0.05). Conclusions: There is a statistically significant relationship between breast tumors' echogenicity in US, neoplasm size, and stiffness and the response to NAC. In particular, our results show that the change in tumor echogenicity could predict a pathological response with satisfactory accuracy and may be considered in NAC monitoring.

Keywords:
Breast ultrasonography, Neoadjuvant chemotherapy, Clinical response, Breast cancer, Sonoelastography