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Xue M, Li S, Zhu Q. Improving diffuse optical tomography imaging quality using APU-Net: an attention-based physical U-Net model. JOURNAL OF BIOMEDICAL OPTICS 2024; 29:086001. [PMID: 39070721 PMCID: PMC11272096 DOI: 10.1117/1.jbo.29.8.086001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/28/2024] [Accepted: 07/01/2024] [Indexed: 07/30/2024]
Abstract
Significance Traditional diffuse optical tomography (DOT) reconstructions are hampered by image artifacts arising from factors such as DOT sources being closer to shallow lesions, poor optode-tissue coupling, tissue heterogeneity, and large high-contrast lesions lacking information in deeper regions (known as shadowing effect). Addressing these challenges is crucial for improving the quality of DOT images and obtaining robust lesion diagnosis. Aim We address the limitations of current DOT imaging reconstruction by introducing an attention-based U-Net (APU-Net) model to enhance the image quality of DOT reconstruction, ultimately improving lesion diagnostic accuracy. Approach We designed an APU-Net model incorporating a contextual transformer attention module to enhance DOT reconstruction. The model was trained on simulation and phantom data, focusing on challenges such as artifact-induced distortions and lesion-shadowing effects. The model was then evaluated by the clinical data. Results Transitioning from simulation and phantom data to clinical patients' data, our APU-Net model effectively reduced artifacts with an average artifact contrast decrease of 26.83% and improved image quality. In addition, statistical analyses revealed significant contrast improvements in depth profile with an average contrast increase of 20.28% and 45.31% for the second and third target layers, respectively. These results highlighted the efficacy of our approach in breast cancer diagnosis. Conclusions The APU-Net model improves the image quality of DOT reconstruction by reducing DOT image artifacts and improving the target depth profile.
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Affiliation(s)
- Minghao Xue
- Washington University in St. Louis, Biomedical Engineering Department, St. Louis, Missouri, United States
| | - Shuying Li
- Boston University, Electrical and Computer Engineering Department, Boston, Massachusetts, United States
| | - Quing Zhu
- Washington University in St. Louis, Biomedical Engineering Department, St. Louis, Missouri, United States
- Washington University in St. Louis, Radiology Department, St. Louis, Missouri, United States
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Zou Y, Xue M, Hossain MI, Zhu Q. Ultrasound and diffuse optical tomography-transformer model for assessing pathological complete response to neoadjuvant chemotherapy in breast cancer. JOURNAL OF BIOMEDICAL OPTICS 2024; 29:076007. [PMID: 39050779 PMCID: PMC11268382 DOI: 10.1117/1.jbo.29.7.076007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/27/2024]
Abstract
Significance We evaluate the efficiency of integrating ultrasound (US) and diffuse optical tomography (DOT) images for predicting pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) in breast cancer patients. The ultrasound-diffuse optical tomography (USDOT)-Transformer model represents a significant step toward accurate prediction of pCR, which is critical for personalized treatment planning. Aim We aim to develop and assess the performance of the USDOT-Transformer model, which combines US and DOT images with tumor receptor biomarkers to predict the pCR of breast cancer patients under NAC. Approach We developed the USDOT-Transformer model using a dual-input transformer to process co-registered US and DOT images along with tumor receptor biomarkers. Our dataset comprised imaging data from 60 patients at multiple time points during their chemotherapy treatment. We used fivefold cross-validation to assess the model's performance, comparing its results against a single modality of US or DOT. Results The USDOT-Transformer model demonstrated excellent predictive performance, with a mean area under the receiving characteristic curve of 0.96 (95%CI: 0.93 to 0.99) across the fivefold cross-validation. The integration of US and DOT images significantly enhanced the model's ability to predict pCR, outperforming models that relied on a single imaging modality (0.87 for US and 0.82 for DOT). This performance indicates the potential of advanced deep learning techniques and multimodal imaging data for improving the accuracy (ACC) of pCR prediction. Conclusion The USDOT-Transformer model offers a promising non-invasive approach for predicting pCR to NAC in breast cancer patients. By leveraging the structural and functional information from US and DOT images, the model offers a faster and more reliable tool for personalized treatment planning. Future work will focus on expanding the dataset and refining the model to further improve its accuracy and generalizability.
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Affiliation(s)
- Yun Zou
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri, United States
| | - Minghao Xue
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri, United States
| | - Md Iqbal Hossain
- Washington University in St. Louis, Imaging Science, St. Louis, Missouri, United States
| | - Quing Zhu
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri, United States
- Washington University School of Medicine, Department of Radiology, St. Louis, Missouri, United States
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Zheng G, Hou J, Shu Z, Peng J, Han L, Yuan Z, He X, Gong X. Prediction of neoadjuvant chemotherapy pathological complete response for breast cancer based on radiomics nomogram of intratumoral and derived tissue. BMC Med Imaging 2024; 24:22. [PMID: 38245712 PMCID: PMC10800060 DOI: 10.1186/s12880-024-01198-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 01/10/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Non-invasive identification of breast cancer (BCa) patients with pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) is critical to determine appropriate surgical strategies and guide the resection range of tumor. This study aimed to examine the effectiveness of a nomogram created by combining radiomics signatures from both intratumoral and derived tissues with clinical characteristics for predicting pCR after NACT. METHODS The clinical data of 133 BCa patients were analyzed retrospectively and divided into training and validation sets. The radiomics features for Intratumoral, peritumoral, and background parenchymal enhancement (BPE) in the training set were dimensionalized. Logistic regression analysis was used to select the optimal feature set, and a radiomics signature was constructed using a decision tree. The signature was combined with clinical features to build joint models and generate nomograms. The area under curve (AUC) value of receiver operating characteristic (ROC) curve was then used to assess the performance of the nomogram and independent predictors. RESULTS Among single region, intratumoral had the best predictive value. The diagnostic performance of the intratumoral improved after adding the BPE features. The AUC values of the radiomics signature were 0.822 and 0.82 in the training and validation sets. Multivariate logistic regression analysis revealed that age, ER, PR, Ki-67, and radiomics signature were independent predictors of pCR in constructing a nomogram. The AUC of the nomogram in the training and validation sets were 0.947 and 0.933. The DeLong test showed that the nomogram had statistically significant differences compared to other independent predictors in both the training and validation sets (P < 0.05). CONCLUSION BPE has value in predicting the efficacy of neoadjuvant chemotherapy, thereby revealing the potential impact of tumor growth environment on the efficacy of neoadjuvant chemotherapy.
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Affiliation(s)
- Guangying Zheng
- Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Jie Hou
- Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Zhenyu Shu
- Cancer Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, No. 158 Shangtang Road, Hangzhou City, Zhejiang Province, China
| | - Jiaxuan Peng
- Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Lu Han
- Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Zhongyu Yuan
- Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Xiaodong He
- Cancer Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, No. 158 Shangtang Road, Hangzhou City, Zhejiang Province, China
| | - Xiangyang Gong
- Cancer Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, No. 158 Shangtang Road, Hangzhou City, Zhejiang Province, China.
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Xue M, Zhang M, Li S, Zou Y, Zhu Q. Automated pipeline for breast cancer diagnosis using US assisted diffuse optical tomography. BIOMEDICAL OPTICS EXPRESS 2023; 14:6072-6087. [PMID: 38021111 PMCID: PMC10659805 DOI: 10.1364/boe.502244] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023]
Abstract
Ultrasound (US)-guided diffuse optical tomography (DOT) is a portable and non-invasive imaging modality for breast cancer diagnosis and treatment response monitoring. However, DOT data pre-processing and imaging reconstruction often require labor intensive manual processing which hampers real-time diagnosis. In this study, we aim at providing an automated US-assisted DOT pre-processing, imaging and diagnosis pipeline to achieve near real-time diagnosis. We have developed an automated DOT pre-processing method including motion detection, mismatch classification using deep-learning approach, and outlier removal. US-lesion information needed for DOT reconstruction was extracted by a semi-automated lesion segmentation approach combined with a US reading algorithm. A deep learning model was used to evaluate the quality of the reconstructed DOT images and a two-step deep-learning model developed earlier is implemented to provide final diagnosis based on US imaging features and DOT measurements and imaging results. The presented US-assisted DOT pipeline accurately processed the DOT measurements and reconstruction and reduced the procedure time to 2 to 3 minutes while maintained a comparable classification result with manually processed dataset.
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Affiliation(s)
- Minghao Xue
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Menghao Zhang
- Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Shuying Li
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Yun Zou
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Quing Zhu
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
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Ma J, Deng Y, Chen D, Li X, Yu Z, Wang H, Zhong L, Li Y, Wang C, Li X, Yu J, Zhang Q. Spatial immunophenotypes orchestrate prognosis in triple-negative breast cancer with Miller-Payne grade 4 following neoadjuvant chemotherapy. NPJ Breast Cancer 2023; 9:57. [PMID: 37438419 DOI: 10.1038/s41523-023-00565-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/26/2023] [Indexed: 07/14/2023] Open
Abstract
Some triple-negative breast cancer (TNBC) patients evaluated as Miller-Payne 4 with ypN0 after neoadjuvant chemotherapy (NACT) who have better prognoses should avoid escalation of therapy. We aim to identify these patients by evaluating pretherapeutic spatial distributions of immunophenotypes. Our retrospective study in patients with TNBC assessed as Miller-Payne grade 4/5 with ypN0 showed that Miller-Payne 4 with ypN0 group had poorer 5-year disease-free survival (DFS, 63.8% vs. 83.0%, p = 0.003) and the 5-year overall survival (OS, 71.0% vs. 85.5%, p = 0.007) than Miller-Payne 5 with ypN0 group. High TILs were significantly associated with better DFS and OS in patients with Miller-Payne 4 and ypN0 (both p = 0.016). Spatially, detected by multiplexed ion beam imaging by the time of flight combined with proteomics, tumors assessed as Miller-Payne 4 and ypN0 with good prognosis exhibited an inflamed phenotype, with dominant CD8+ T cells on tumor center, few scattered CD68+ myeloid-derived cells far away from T cells, and deposit of increased activated molecules of lymphocyte. While those with poor prognoses presented excluded phenotypes, with few CD8+ T cells restricted to invasive margins and a high density of CD14+CD68+CD11c+ myeloid cells. A good classifier model based on 29 spatial immunophenotypes was established by the random forest algorithm (AUC = 0.975), for identifying patients with Miller-Payne 4 and ypN0 who had favorable prognoses. We also observed similar signatures in patients with Miller-Payne 5 and ypN0. Taken together, spatial immunophenotypes may assess the prognosis in TNBC patients with Miller-Payne 4 and ypN0 after NACT.
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Affiliation(s)
- Jianli Ma
- Department of Radiation Oncology, Shandong University Cancer Center, 440 Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China
| | - Yuwei Deng
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Dawei Chen
- Department of Radiation Oncology, Shandong University Cancer Center, 440 Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China
| | - Xiaomei Li
- Department of Pathology, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Zhiyong Yu
- Department of Breast Cancer Center, Shandong University Cancer Center, 440 Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China
| | - Haibo Wang
- Department of Breast Disease Center, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, Shandong, 266003, P.R. China
| | - Lei Zhong
- Department of Breast Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Yingjie Li
- Department of Pathology, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Chengqin Wang
- Department of Pathology, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, People's Republic of China
| | - Xiang Li
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong University Cancer Center, 440 Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China.
| | - Qingyuan Zhang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Heilongjiang Cancer Institute, Harbin, 150081, Heilongjiang Province, People's Republic of China.
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Wang X, Hua H, Han J, Zhong X, Liu J, Chen J. Evaluation of Multiparametric MRI Radiomics-Based Nomogram in Prediction of Response to Neoadjuvant Chemotherapy in Breast Cancer: A Two-Center study. Clin Breast Cancer 2023:S1526-8209(23)00134-9. [PMID: 37321954 DOI: 10.1016/j.clbc.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/20/2023] [Accepted: 05/21/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION This study evaluated the performance of primary foci of breast cancer on multiparametric magnetic resonance imaging (MRI) contributing to establish and validate radiomics-based nomograms for predicting the different pathological outcome of breast cancer patients after neoadjuvant chemotherapy (NAC). MATERIALS AND METHODS Retrospectively collected 387 patients with locally advanced breast cancer, all treated with NAC and received breast dynamic contrast-enhanced MRI (DCE-MRI) before NAC. Radiomics signatures were extracted from region of interest (ROI) on multiparametric MRI to build rad score. Clinical-pathologic data and radiological features established the clinical model. The comprehensive model featured rad-score, predictive clinical-pathologic data and radiological features, which was ultimately displayed as a nomogram. Patients were grouped in 2 different ways in accordance with the Miller-Payne (MP) grading of surgical specimens. The first grouping method: 181 patients with pathological reaction grades Ⅳ∼Ⅴ were included in the significant remission group, while 206 patients with pathological reaction grades Ⅰ∼Ⅲ were included in the nonsignificant remission group. The second grouping method: 117 patients with pathological complete response (pCR) were assigned to the pCR group, and 270 patients who failed to meet pCR were assigned to in the non-pCR group. Two combined nomograms are created from 2 grouped data for predicting different pathological responses to NAC. The area under the curves (AUC) of the receiver operating characteristic curves (ROC) were used to evaluate the performance of each model. While decision curve analysis (DCA) and calibration curves were used for estimating the clinical application value of the nomogram. RESULTS Two combined nomograms embodying rad score and clinical-pathologic data outperformed, showing good calibrations for predicting response to NAC. The combined nomogram predicting pCR showed the best performance with the AUC values of 0.97, 0.90 and 0.86 in the training, testing, and external validation cohorts respectively. The AUC values of another combined nomogram predicting significant remission: 0.98, 0.88 0.80 in the training, testing and external validation cohorts. DCA showed the comprehensive model nomogram obtained the most clinical benefit. CONCLUSIONS The combined nomogram could preoperatively predict significant remission or even pCR to NAC in breast cancer based on multiparametric MRI and clinical-pathologic data.
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Affiliation(s)
- Xiaolin Wang
- Department of Breast Imaging, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hui Hua
- Department of Thyroid Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Junqi Han
- Department of Breast Imaging, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xin Zhong
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jingjing Liu
- Department of Breast Imaging, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jingjing Chen
- Department of Breast Imaging, The Affiliated Hospital of Qingdao University, Qingdao, China.
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Pavlov MV, Bavrina AP, Plekhanov VI, Golubyatnikov GY, Orlova AG, Subochev PV, Davydova DA, Turchin IV, Maslennikova AV. Changes in the tumor oxygenation but not in the tumor volume and tumor vascularization reflect early response of breast cancer to neoadjuvant chemotherapy. Breast Cancer Res 2023; 25:12. [PMID: 36717842 PMCID: PMC9887770 DOI: 10.1186/s13058-023-01607-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/17/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Breast cancer neoadjuvant chemotherapy (NACT) allows for assessing tumor sensitivity to systemic treatment, planning adjuvant treatment and follow-up. However, a sufficiently large number of patients fail to achieve the desired level of pathological tumor response while optimal early response assessment methods have not been established now. In our study, we simultaneously assessed the early chemotherapy-induced changes in the tumor volume by ultrasound (US), the tumor oxygenation by diffuse optical spectroscopy imaging (DOSI), and the state of the tumor vascular bed by Doppler US to elaborate the predictive criteria of breast tumor response to treatment. METHODS A total of 133 patients with a confirmed diagnosis of invasive breast cancer stage II to III admitted to NACT following definitive breast surgery were enrolled, of those 103 were included in the final analysis. Tumor oxygenation by DOSI, tumor volume by US, and tumor vascularization by Doppler US were determined before the first and second cycle of NACT. After NACT completion, patients underwent surgery followed by pathological examination and assessment of the pathological tumor response. On the basis of these, data regression predictive models were created. RESULTS We observed changes in all three parameters 3 weeks after the start of the treatment. However, a high predictive potential for early assessment of tumor sensitivity to NACT demonstrated only the level of oxygenation, ΔStO2, (ρ = 0.802, p ≤ 0.01). The regression model predicts the tumor response with a high probability of a correct conclusion (89.3%). The "Tumor volume" model and the "Vascularization index" model did not accurately predict the absence of a pathological tumor response to treatment (60.9% and 58.7%, respectively), while predicting a positive response to treatment was relatively better (78.9% and 75.4%, respectively). CONCLUSIONS Diffuse optical spectroscopy imaging appeared to be a robust tool for early predicting breast cancer response to chemotherapy. It may help identify patients who need additional molecular genetic study of the tumor in order to find the source of resistance to treatment, as well as to correct the treatment regimen.
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Affiliation(s)
- Mikhail V. Pavlov
- Nizhny Novgorod Regional Clinical Oncology Dispensary, Delovaya St., 11/1, Nizhny Novgorod, Russia 603126
| | - Anna P. Bavrina
- grid.416347.30000 0004 0386 1631Privolzhsky Research Medical University, Minina Square, 10/1, Nizhny Novgorod, Russia 603950
| | - Vladimir I. Plekhanov
- grid.410472.40000 0004 0638 0147Institute of Applied Physics RAS, Ul’yanov Street, 46, Nizhny Novgorod, Russia 603950
| | - German Yu. Golubyatnikov
- grid.410472.40000 0004 0638 0147Institute of Applied Physics RAS, Ul’yanov Street, 46, Nizhny Novgorod, Russia 603950
| | - Anna G. Orlova
- grid.410472.40000 0004 0638 0147Institute of Applied Physics RAS, Ul’yanov Street, 46, Nizhny Novgorod, Russia 603950
| | - Pavel V. Subochev
- grid.410472.40000 0004 0638 0147Institute of Applied Physics RAS, Ul’yanov Street, 46, Nizhny Novgorod, Russia 603950
| | - Diana A. Davydova
- Nizhny Novgorod Regional Clinical Oncology Dispensary, Delovaya St., 11/1, Nizhny Novgorod, Russia 603126
| | - Ilya V. Turchin
- grid.410472.40000 0004 0638 0147Institute of Applied Physics RAS, Ul’yanov Street, 46, Nizhny Novgorod, Russia 603950
| | - Anna V. Maslennikova
- grid.416347.30000 0004 0386 1631Privolzhsky Research Medical University, Minina Square, 10/1, Nizhny Novgorod, Russia 603950 ,grid.28171.3d0000 0001 0344 908XNational Research Lobachevsky State University of Nizhny Novgorod, Gagarin Ave., 23, Nizhny Novgorod, Russia 603022
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Wang Y, Li S, Wang Y, Yan Q, Wang X, Shen Y, Li Z, Kang F, Cao X, Zhu S. Compact fiber-free parallel-plane multi-wavelength diffuse optical tomography system for breast imaging. OPTICS EXPRESS 2022; 30:6469-6486. [PMID: 35299431 DOI: 10.1364/oe.448874] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/05/2022] [Indexed: 06/14/2023]
Abstract
To facilitate the clinical applicability of the diffuse optical inspection device, a compact multi-wavelength diffuse optical tomography system for breast imaging (compact-DOTB) with a fiber-free parallel-plane structure was designed and fabricated for acquiring three-dimensional optical properties of the breast in continuous-wave mode. The source array consists of 56 surface-mounted micro light-emitting diodes (LEDs), each integrating three wavelengths (660, 750, and 840 nm). The detector array is arranged with 56 miniaturized surface-mounted optical sensors, each encapsulating a high-sensitivity photodiode (PD) and a low-noise current amplifier with a gain of 24×. The system provides 3,136 pairs of source-detector measurements at each wavelength, and the fiber-free design largely ensures consistency between source/detection channels while effectively reducing the complexity of system operation and maintenance. We have evaluated the compact-DOTB system's characteristics and demonstrated its performance in terms of reconstruction positioning accuracy and recovery contrast with breast-sized phantom experiments. Furthermore, the breast cancer patient studies have been carried out, and the quantitative results indicate that the compact-DOTB system is able to observe the changes in the functional tissue components of the breast after receiving the neoadjuvant chemotherapy (NAC), demonstrating the great potential of the proposed compact system for clinical applications, while its cost and ease of operation are competitive with the existing breast-DOT devices.
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Zhu Q, Ademuyiwa FO, Young C, Appleton C, Covington MF, Ma C, Sanati S, Hagemann IS, Mostafa A, Uddin KMS, Grigsby I, Frith AE, Hernandez-Aya LF, Poplack SS. Early Assessment Window for Predicting Breast Cancer Neoadjuvant Therapy using Biomarkers, Ultrasound, and Diffuse Optical Tomography. Breast Cancer Res Treat 2021; 188:615-630. [PMID: 33970392 DOI: 10.1007/s10549-021-06239-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/20/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE The purpose of the study was to assess the utility of tumor biomarkers, ultrasound (US) and US-guided diffuse optical tomography (DOT) in early prediction of breast cancer response to neoadjuvant therapy (NAT). METHODS This prospective HIPAA compliant study was approved by the institutional review board. Forty one patients were imaged with US and US-guided DOT prior to NAT, at completion of the first three treatment cycles, and prior to definitive surgery from February 2017 to January 2020. Miller-Payne grading was used to assess pathologic response. Receiver operating characteristic curves (ROCs) were derived from logistic regression using independent variables, including: tumor biomarkers, US maximum diameter, percentage reduction of the diameter (%US), pretreatment maximum total hemoglobin concentration (HbT) and percentage reduction in HbT (%HbT) at different treatment time points. Resulting ROCs were compared using area under the curve (AUC). Statistical significance was tested using two-sided two-sample student t-test with P < 0.05 considered statistically significant. Logistic regression was used for ROC analysis. RESULTS Thirty-eight patients (mean age = 47, range 24-71 years) successfully completed the study, including 15 HER2 + of which 11 were ER + ; 12 ER + or PR + /HER2-, and 11 triple negative. The combination of HER2 and ER biomarkers, %HbT at the end of cycle 1 (EOC1) and %US (EOC1) provided the best early prediction, AUC = 0.941 (95% CI 0.869-1.0). Similarly an AUC of 0.910 (95% CI 0.810-1.0) with %US (EOC1) and %HbT (EOC1) can be achieved independent of HER2 and ER status. The most accurate prediction, AUC = 0.974 (95% CI 0.933-1.0), was achieved with %US at EOC1 and %HbT (EOC3) independent of biomarker status. CONCLUSION The combined use of tumor HER2 and ER status, US, and US-guided DOT may provide accurate prediction of NAT response as early as the completion of the first treatment cycle. CLINICAL TRIAL REGISTRATION NUMBER NCT02891681. https://clinicaltrials.gov/ct2/show/NCT02891681 , Registration time: September 7, 2016.
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Affiliation(s)
- Quing Zhu
- Biomedical Engineering and Radiology, Washington University in St Louis, One Brookings Drive, Mail Box 1097, Whitaker Hall 200F, St. Louis, MO, 63130, USA. .,Washington University School of Medicine in St Louis, St. Louis, USA.
| | - Foluso O Ademuyiwa
- Medical Oncology, Washington University School of Medicine in St Louis, St. Louis, USA
| | - Catherine Young
- Washington Baylor Scott & White Health, Medical Center, Texas, Dallas, USA
| | - Catherine Appleton
- Diagnostic Imaging Associates, Ltd. St. Luke's Hospital, Chesterfield, USA
| | - Matthew F Covington
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, USA
| | - Cynthia Ma
- Medical Oncology, Washington University School of Medicine in St Louis, St. Louis, USA
| | - Souzan Sanati
- Pathology, Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Ian S Hagemann
- Washington University School of Medicine in St Louis, St. Louis, USA
| | - Atahar Mostafa
- Biomedical Engineering and Radiology, Washington University in St Louis, One Brookings Drive, Mail Box 1097, Whitaker Hall 200F, St. Louis, MO, 63130, USA
| | - K M Shihab Uddin
- Biomedical Engineering and Radiology, Washington University in St Louis, One Brookings Drive, Mail Box 1097, Whitaker Hall 200F, St. Louis, MO, 63130, USA
| | - Isabella Grigsby
- Medical Oncology, Washington University School of Medicine in St Louis, St. Louis, USA
| | - Ashley E Frith
- Medical Oncology, Washington University School of Medicine in St Louis, St. Louis, USA
| | | | - Steven S Poplack
- Washington University School of Medicine in St Louis, St. Louis, USA.,Radiology, Stanford University, Stanford, USA
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Zhang J, Gao S, Zheng Q, Kang Y, Li J, Zhang S, Shang C, Tan X, Ren W, Ma Y. A Novel Model Incorporating Tumor Stiffness, Blood Flow Characteristics, and Ki-67 Expression to Predict Responses After Neoadjuvant Chemotherapy in Breast Cancer. Front Oncol 2020; 10:603574. [PMID: 33364197 PMCID: PMC7753215 DOI: 10.3389/fonc.2020.603574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/09/2020] [Indexed: 01/04/2023] Open
Abstract
Objective To investigate the ability of tumor stiffness, tumor blood flow, and Ki-67 expression alone or in combination in predicting the pathological response to neoadjuvant chemotherapy (NACT) in breast cancer. Patients and Methods This prospective cohort study included 145 breast cancer patients treated with NACT. Tumor stiffness (maximum stiffness (Emax), mean stiffness (Emean)), blood score (BS), and their relative changes, were evaluated before (t0), during (t1-t5), and at the end of NACT (t6) by shear-wave elastography and optical imaging. Ki-67 expression was quantitatively evaluated by immunohistochemistry using core biopsy specimens obtained before NACT. Pathological responses were evaluated by residual cancer burden. The ability of tumor stiffness, BS, Ki-67, and predRCB-which combined ΔEmean (t2) (the relative changes in Emean after the second NACT cycle), BS2 (BS after the second NACT cycle), and Ki-67-in predicting tumor responses was compared using receiver operating characteristic curves and the Z-test. Results Tumor stiffness and BS decreased during NACT. ΔEmean (t2), BS2, and Ki-67 had better predictive performance than other indexes in identifying a favorable response (AUC = 0.82, 0.81, and 0.80) and resistance responses (AUC = 0.85, 0.79, and 0.84), with no significant differences between the three (p > 0.05). PredRCB had better predictive performance than any parameter alone for a favorable response (AUC = 0.90) and resistance (AUC = 0.93). Conclusion Tumor stiffness, BS, and Ki-67 expression showed good and similar abilities for predicting the pathological response to NACT, and predRCB was a significantly better predictor than each index alone. These results may help design therapeutic strategies for breast cancer patients undergoing NACT.
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Affiliation(s)
- Jing Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Song Gao
- Department of Clinical Oncology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qiaojin Zheng
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ye Kang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jianyi Li
- Department of Breast Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shuo Zhang
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Cong Shang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xueying Tan
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yan Ma
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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11
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Sella T, Gelber SI, Poorvu PD, Kim HJ, Dominici L, Guzman-Arocho YD, Collins L, Ruddy KJ, Tamimi RM, Peppercorn JM, Schapira L, Borges VF, Come SE, Warner E, Snow C, Jakubowski DM, Russell CA, Winer EP, Rosenberg SM, Partridge AH. Response to neoadjuvant chemotherapy and the 21-gene Breast Recurrence Score test in young women with estrogen receptor-positive early breast cancer. Breast Cancer Res Treat 2020; 186:157-165. [PMID: 33150547 DOI: 10.1007/s10549-020-05989-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The 21-gene Breast Recurrence Score test predicts benefit from adjuvant chemotherapy in estrogen receptor-positive, HER2-negative (ER+/HER2-) breast cancer (BC). We examined whether the 21-gene assay predicts response to neoadjuvant chemotherapy (NCT). METHODS We identified patients with stage I-III ER+/HER2- BC treated with NCT from the Young Women's Breast Cancer Study, a prospective cohort of women diagnosed with BC at age ≤40 years. The 21-gene assay was performed on tumor specimens removed prior to NCT either as part of clinical care or retrospectively for research. Pathological complete response (pCR) was defined as ypT0/is ypN0. The relationship between Recurrence Score result and pCR was evaluated using logistic regression modeling. RESULTS 76 women received NCT for ER+/HER2- BC and were eligible for this analysis. Median age at diagnosis was 37 years (range 24-40). Scores ranged between 5 and 77 with 50% >25 and 5% <11. Median Recurrence Score result was significantly higher among tumors achieving pCR vs. non-pCR response (61.5 vs. 23, pwilcoxon = 0.0005). pCR rate in patients with scores >25 was 21% (8/38) vs. 5% in patients with scores <25 (2/38) (p = 0.09), with both pCRs in the <25 group in patients with scores between 21 and 25. In multivariable analysis, only Recurrence Score result was significantly associated with pCR (OR: 1.07, 95%CI 1.01-1.12, p = 0.01). CONCLUSIONS In young women with ER+/HER2- BC who received NCT, higher pretreatment Recurrence Score result was associated with an increased likelihood of pCR. Gene expression profile assays may have a role in decision making in young women in need of neoadjuvant therapy.
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Affiliation(s)
- Tal Sella
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Shari I Gelber
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Philip D Poorvu
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Laura Dominici
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Divison of Breast Surgery Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Yaileen D Guzman-Arocho
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Laura Collins
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Rulla M Tamimi
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Jeffrey M Peppercorn
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Steven E Come
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ellen Warner
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Craig Snow
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | | | | | - Eric P Winer
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Shoshana M Rosenberg
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Ann H Partridge
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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12
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Chen S, Shu Z, Li Y, Chen B, Tang L, Mo W, Shao G, Shao F. Machine Learning-Based Radiomics Nomogram Using Magnetic Resonance Images for Prediction of Neoadjuvant Chemotherapy Efficacy in Breast Cancer Patients. Front Oncol 2020; 10:1410. [PMID: 32923392 PMCID: PMC7456979 DOI: 10.3389/fonc.2020.01410] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 07/03/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose: The construction and validation of a radiomics nomogram based on machine learning using magnetic resonance image (MRI) for predicting the efficacy of neoadjuvant chemotherapy (NACT) in patients with breast cancer (BCa). Methods: This retrospective investigation consisted of 158 patients who were diagnosed with BCa and underwent MRI before NACT, of which 33 patients experienced pathological complete response (pCR) by the postoperative pathological examination. The patients with BCa were divided into the training set (n = 110) and test set (n = 48) randomly. The features were selected by the maximum relevance minimum redundancy (mRMR) and absolute shrinkage and selection operator (LASSO) algorithm in the training set. In return, the radiomics signature was established using machine learning. The predictive score of each patient was calculated using the radiomics signature formula. Finally, the predictive scores and clinical factors were used to perform the multivariate logistic regression and construct the nomogram. Receiver operating characteristics (ROC) analyses were used to assess and validate the diagnostic accuracy of the nomogram in the test set. Lastly, the usefulness of the nomogram was confirmed via decision curve analysis (DCA). Results: The radiomics signature was well-discriminated in the training set [AUC 0.835, specificity 71.32%, and sensitivity 82.61%], and test set (AUC 0.834, specificity 73.21%, and sensitivity 80%). Containing the radiomics signature and hormone status, the radiomics nomogram showed good calibration and discrimination in the training set [AUC 0.888, specificity 79.31%, and sensitivity 86.96%] and test set (AUC 0.879, specificity 82.19%, and sensitivity 83.57%). The decision curve indicated the clinical usefulness of our nomogram. Conclusion: Our radiomics nomogram showed good discrimination in patients with BCa who experience pCR after NACT. The model may aid physicians in predicting how specific patients may respond to BCa treatments in the future.
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Affiliation(s)
- Shujun Chen
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China.,Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Zhenyu Shu
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Yongfeng Li
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China.,Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, China
| | - Bo Chen
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China.,Department of Pathology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Lirong Tang
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China.,Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Wenju Mo
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China.,Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, China
| | - Guoliang Shao
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China.,Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Feng Shao
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China.,Department of Gynecological Oncology, Zhejiang Cancer Hospital, Hangzhou, China
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13
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Zhang J, Tan X, Zhang X, Kang Y, Li J, Ren W, Ma Y. Efficacy of shear-wave elastography versus dynamic optical breast imaging for predicting the pathological response to neoadjuvant chemotherapy in breast cancer. Eur J Radiol 2020; 129:109098. [PMID: 32559591 DOI: 10.1016/j.ejrad.2020.109098] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Explore the value of shear-wave elastography (SWE) parameters and dynamic optical breast imaging features for predicting pathological responses to neoadjuvant chemotherapy (NACT) in breast cancer (BC). METHOD This prospective cohort study included 91 BC patients receiving NACT. Tumor size, SWE (maximum stiffness [Emax] and mean stiffness [Emean]), blood score (BS), and oxygen score (OS) and their relative changes were collected before (t0), during (t1-t5), and after NACT (t6). The pathological response was classified according to the residual cancer burden. Relationships between tumor size, SWE stiffness, BS, and OS at t0-t6 were analyzed, and their predictive power was compared. RESULTS During six NACT cycles, tumor size, tumor stiffness, and BS decreased, and tumor OS increased. ΔEmean (t2), E2mean, BS2, and OS2 had a greater power than other indexes for predicting a favorable response (AUC = 0.79, 0.71, 0.77, 0.78) and a resistance response (0.86, 0.74, 0.71, 0.71). For the favorable response, predictive power did not differ significantly between ΔEmean (t2), E2mean, BS2, and OS2, whereas for the resistance response, ΔEmean (t2) showed better prediction than E2mean, BS2, and OS2. CONCLUSIONS SWE stiffness, BS, and OS exhibited good and similar performances in predicting a NACT favorable response, and SWE stiffness showed better performance than BS and OS in predicting NACT resistance. These results may provide an important reference for individualized treatment in BC patients receiving NACT.
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Affiliation(s)
- Jing Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Xueying Tan
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Xintong Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Ye Kang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Jianyi Li
- Department of Breast Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China.
| | - Yan Ma
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China.
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14
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Tank A, Peterson HM, Pera V, Tabassum S, Leproux A, O'Sullivan T, Jones E, Cabral H, Ko N, Mehta RS, Tromberg BJ, Roblyer D. Diffuse optical spectroscopic imaging reveals distinct early breast tumor hemodynamic responses to metronomic and maximum tolerated dose regimens. Breast Cancer Res 2020; 22:29. [PMID: 32169100 PMCID: PMC7071774 DOI: 10.1186/s13058-020-01262-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 02/11/2020] [Indexed: 12/13/2022] Open
Abstract
Background Breast cancer patients with early-stage disease are increasingly administered neoadjuvant chemotherapy (NAC) to downstage their tumors prior to surgery. In this setting, approximately 31% of patients fail to respond to therapy. This demonstrates the need for techniques capable of providing personalized feedback about treatment response at the earliest stages of therapy to identify patients likely to benefit from changing treatment. Diffuse optical spectroscopic imaging (DOSI) has emerged as a promising functional imaging technique for NAC monitoring. DOSI uses non-ionizing near-infrared light to provide non-invasive measures of absolute concentrations of tissue chromophores such as oxyhemoglobin. In 2011, we reported a new DOSI prognostic marker, oxyhemoglobin flare: a transient increase in oxyhemoglobin capable of discriminating NAC responders within the first day of treatment. In this follow-up study, DOSI was used to confirm the presence of the flare as well as to investigate whether DOSI markers of NAC response are regimen dependent. Methods This dual-center study examined 54 breast tumors receiving NAC measured with DOSI before therapy and the first week following chemotherapy administration. Patients were treated with either a standard of care maximum tolerated dose (MTD) regimen or an investigational metronomic (MET) regimen. Changes in tumor chromophores were tracked throughout the first week and compared to pathologic response and treatment regimen at specific days utilizing generalized estimating equations (GEE). Results Within patients receiving MTD therapy, the oxyhemoglobin flare was confirmed as a prognostic DOSI marker for response appearing as soon as day 1 with post hoc GEE analysis demonstrating a difference of 48.77% between responders and non-responders (p < 0.0001). Flare was not observed in patients receiving MET therapy. Within all responding patients, the specific treatment was a significant predictor of day 1 changes in oxyhemoglobin, showing a difference of 39.45% (p = 0.0010) between patients receiving MTD and MET regimens. Conclusions DOSI optical biomarkers are differentially sensitive to MTD and MET regimens at early timepoints suggesting the specific treatment regimen should be considered in future DOSI studies. Additionally, DOSI may help to identify regimen-specific responses in a more personalized manner, potentially providing critical feedback necessary to implement adaptive changes to the treatment strategy.
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Affiliation(s)
- Anup Tank
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA, 02215, USA
| | - Hannah M Peterson
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA, 02215, USA
| | - Vivian Pera
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA, 02215, USA
| | - Syeda Tabassum
- Department of Electrical Engineering, Boston University, Boston, MA, USA
| | - Anais Leproux
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, California, USA
| | - Thomas O'Sullivan
- Department of Electrical Engineering, University of Notre Dame, Notre Dame, IN, USA
| | - Eric Jones
- Department of Biostatistics, Boston University, Boston, MA, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University, Boston, MA, USA
| | - Naomi Ko
- Department of Hematology and Medical Oncology, Boston Medical Center, Boston, MA, USA
| | - Rita S Mehta
- Department of Medicine, University of California Irvine, Irvine, California, USA
| | - Bruce J Tromberg
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, California, USA
| | - Darren Roblyer
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA, 02215, USA.
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15
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Pomponio MK, Burkbauer L, Goldbach M, Nazarian SM, Xie F, Clark AS, Matro JM, Fox KR, Shulman LN, Keele LJ, Tchou J. Refining the indications for neoadjuvant chemotherapy for patients with HER2+ breast cancer: A single institution experience. J Surg Oncol 2020; 121:447-455. [PMID: 31919848 DOI: 10.1002/jso.25814] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 12/09/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND We aim to compare the clinical outcomes of patients with early-stage HER2+ breast cancer treated with adjuvant chemotherapy (AC) and neoadjuvant chemotherapy (NAC). METHODS Patients with non-metastatic HER2+ breast cancer treated from 2009 to 2018 at our institution comprised our study cohort (n = 1254). Pathologic complete response (pCR) was defined as the absence of invasive disease in the breast and axilla after NAC. Log-rank, Kaplan-Meier, and inverse probability of treatment weighting were used to assess differences in disease-free and overall survival between groups stratified by AC vs. NAC and pCR vs. non-pCR. RESULTS The majority received AC (n = 787 or 62.8%) while 467 (37.2%) patients received NAC. Median follow up for AC and NAC groups was 46 and 28 months, respectively. The crude disease-free survival and overall survival of our study cohort were 92.2% and 89.1% for AC, 89.1% and 82.2% for NAC pCR, and 68.1% and 60.0% for NAC non-pCR, respectively. For clinical stage ≥IIB patients, NAC conferred a positive but statistically nonsignificant treatment effect over AC in multivariate analysis. CONCLUSIONS After adjusting for imbalances in our subgroups, we found that, regardless of the sequence of chemotherapy (AC vs. NAC), patients with early-stage HER2+ breast cancer had excellent outcomes.
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Affiliation(s)
- Maria K Pomponio
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laura Burkbauer
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Macy Goldbach
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susanna M Nazarian
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fei Xie
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amy S Clark
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer M Matro
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin R Fox
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lawrence N Shulman
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Luke J Keele
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia Tchou
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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16
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Xiong Q, Zhou X, Liu Z, Lei C, Yang C, Yang M, Zhang L, Zhu T, Zhuang X, Liang C, Liu Z, Tian J, Wang K. Multiparametric MRI-based radiomics analysis for prediction of breast cancers insensitive to neoadjuvant chemotherapy. Clin Transl Oncol 2020; 22:50-59. [PMID: 30977048 DOI: 10.1007/s12094-019-02109-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/04/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the value of multiparametric magnetic resonance imaging (MRI) in pretreatment prediction of breast cancers insensitive to neoadjuvant chemotherapy (NAC). METHODS A total of 125 breast cancer patients (63 in the primary cohort and 62 in the validation cohort) who underwent MRI before receiving NAC were enrolled. All patients received surgical resection, and Miller-Payne grading system was applied to assess the response to NAC. Grade 1-2 cases were classified as insensitive to NAC. We extracted 1941 features in the primary cohort. After feature selection, the optimal feature set was used to construct a radiomic signature using machine learning. We built a combined prediction model incorporating the radiomic signature and independent clinical risk factors selected by multivariable logistic regression. The performance of the combined model was assessed with the results of independent validation. RESULTS Four features were selected for the construction of the radiomic signature based on the primary cohort. Combining with independent clinical factors, the combined prediction model for identifying the Grade 1-2 group reached a better discrimination power than the radiomic signature, with an area under the receiver operating characteristic curve of 0.935 (95% confidence interval 0.848-1) in the validation cohort, and its clinical utility was confirmed by the decision curve analysis. CONCLUSION The combined model based on radiomics and clinical variables has potential in predicting drug-insensitive breast cancers.
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Affiliation(s)
- Qianqian Xiong
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Xuezhi Zhou
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, 710126, Shaanxi, China
| | - Zhenyu Liu
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, 100190, No. 95 Zhongguancun East Road, Beijing, China
| | - Chuqian Lei
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Ciqiu Yang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Mei Yang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Liulu Zhang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Teng Zhu
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Xiaosheng Zhuang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
- Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Changhong Liang
- Department of Radiology, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Zaiyi Liu
- Department of Radiology, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Jie Tian
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, 710126, Shaanxi, China.
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, 100190, No. 95 Zhongguancun East Road, Beijing, China.
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, 100191, Beijing, China.
| | - Kun Wang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
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17
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Karrobi K, Tank A, Tabassum S, Pera V, Roblyer D. Diffuse and nonlinear imaging of multiscale vascular parameters for in vivo monitoring of preclinical mammary tumors. JOURNAL OF BIOPHOTONICS 2019; 12:e201800379. [PMID: 30706695 DOI: 10.1002/jbio.201800379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/25/2019] [Accepted: 01/29/2019] [Indexed: 06/09/2023]
Abstract
Diffuse optical imaging (DOI) techniques provide a wide-field or macro assessment of the functional tumor state and have shown substantial promise for monitoring treatment efficacy in cancer. Conversely, intravital microscopy provides a high-resolution view of the tumor state and has played a key role in characterizing treatment response in the preclinical setting. There has been little prior work in investigating how the macro and micro spatial scales can be combined to develop a more comprehensive and translational view of treatment response. To address this, a new multiscale preclinical imaging technique called diffuse and nonlinear imaging (DNI) was developed. DNI combines multiphoton microscopy with spatial frequency domain imaging (SFDI) to provide multiscale data sets of tumor microvascular architecture coregistered within wide-field hemodynamic maps. A novel method was developed to match the imaging depths of both modalities by utilizing informed SFDI spatial frequency selection. An in vivo DNI study of murine mammary tumors revealed multiscale relationships between tumor oxygen saturation and microvessel diameter, and tumor oxygen saturation and microvessel length (|Pearson's ρ| ≥ 0.5, P < 0.05). Going forward, DNI will be uniquely enabling for the investigation of multiscale relationships in tumors during treatment.
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Affiliation(s)
- Kavon Karrobi
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts
| | - Anup Tank
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts
| | - Syeda Tabassum
- Department of Electrical and Computer Engineering, Boston University, Boston, Massachusetts
| | - Vivian Pera
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts
| | - Darren Roblyer
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts
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18
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Vavadi H, Mostafa A, Zhou F, Uddin KMS, Althobaiti M, Xu C, Bansal R, Ademuyiwa F, Poplack S, Zhu Q. Compact ultrasound-guided diffuse optical tomography system for breast cancer imaging. JOURNAL OF BIOMEDICAL OPTICS 2018; 24:1-9. [PMID: 30350491 PMCID: PMC6197842 DOI: 10.1117/1.jbo.24.2.021203] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 09/19/2018] [Indexed: 05/02/2023]
Abstract
Near-infrared diffuse optical tomography (DOT) has demonstrated a great potential as an adjunct modality for differentiation of malignant and benign breast lesions and for monitoring treatment response in patients with locally advanced breast cancers. The path toward commercialization of DOT techniques depends upon the improvement of robustness and user-friendliness of this technique in hardware and software. In this study, we introduce our recently developed ultrasound-guided DOT system, which has been improved in system compactness, robustness, and user-friendliness by custom-designed electronics, automated data preprocessing, and implementation of a new two-step reconstruction algorithm. The system performance has been tested with several sets of solid and blood phantoms and the results show accuracy in reconstructed absorption coefficients as well as blood oxygen saturation. A clinical example of a breast cancer patient, who was undergoing neoadjuvant chemotherapy, is given to demonstrate the system performance.
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Affiliation(s)
- Hamed Vavadi
- University of Connecticut, BME and ECE Departments, Connecticut, United States
| | - Atahar Mostafa
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri, United States
| | - Feifei Zhou
- University of Connecticut, BME and ECE Departments, Connecticut, United States
| | - K. M. Shihab Uddin
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri, United States
| | - Murad Althobaiti
- University of Connecticut, BME and ECE Departments, Connecticut, United States
| | - Chen Xu
- New York City College of Technology, Brooklyn, New York, United States
| | - Rajeev Bansal
- University of Connecticut, BME and ECE Departments, Connecticut, United States
| | - Foluso Ademuyiwa
- Washington University School of Medicine, Department of Medical Oncology, St. Louis, Missouri, United States
| | - Steven Poplack
- Washington University School of Medicine, Department of Radiology, St. Louis, Missouri, United States
| | - Quing Zhu
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri, United States
- Washington University School of Medicine, Department of Radiology, St. Louis, Missouri, United States
- Address all correspondence to: Quing Zhu, E-mail:
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