The utilization of CEUS and SWE for predicting pathological complete response to neoadjuvant chemotherapy for invasive breast cancer

To evaluate the potential value of combining contrast-enhanced ultrasound (CEUS) with shear wave elastography (SWE) for predicting pathological complete response (pCR) in patients with breast cancer receiving neoadjuvant chemotherapy (NAC). Ultrasound (US), CEUS and SWE examinations were performed before and after NAC. The maximum tumor diameter on US (D_US) and CEUS (D_CEUS), the maximum stiffness of SWE (Emax), their changes and consistency with the postoperative pathological analysis were evaluated, and their predictive value was compared using the receiver operating characteristic (ROC) curve. 60 patients were included among whom 28 (46.7%) achieved pCR and 32 (53.3%) exhibited non-pCR. The changes in D_CEUS and Emax were significantly correlated with pCR (p < 0.005). ΔD_CEUS% differed significantly between pCR and non-pCR groups across all molecular subtypes. However, ΔEmax% differed significantly in ER negative, PR negative and Her-2 negative breast cancer after NAC. The combination of ΔD_CEUS% and ΔEmax% demonstrated superior predictive ability for NAC response, with an area under the curve (AUC) of 0.906, outperforming ΔD_CEUS% (AUC 0.871) or ΔEmax% (AUC 0.722) alone. CEUS combined with SWE shows promise for predicting pCR in invasive breast cancer undergoing NAC.