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Color-doppler using contrast medium in evaluating the response to neoadjuvant treatment in patients with locally
Paolo Vallone1, Roberto D'Angelo, Salvatore Filice
1Department of Diagnostic and Interventional Radiology, National Cancer Institute - Naples, Italy. vallone.paolo@libero.it
Background:
The aim of our study was to assess the color-Doppler ultrasound (CDU) pattern in the analysis of neoadjuvant preoperative treatment of patients with locally advanced breast carcinoma, improvement after injection of contrast medium (Levovist) and possible correlations between morphological and vascular aspects of the neoplasm and postoperative histopathological findings.
Materials And Methods:
We studied 50 patients affected by locally advanced breast carcinoma (T3a e b-T4), using CDU before and after injection of Levovist, prior to and after neoadjuvant chemotherapeutic treatment.
Results:
The use of Levovist for ultrasound examinations prior to treatment revealed a higher number of vascular signals in 94% of the lesions compared to the basic color-Doppler examination; in only 3 cases (6%) were no modifications observed after injection of the contrast medium. This finding was also evident after neoadjuvant treatment, as a greater number of vessels in 28 lesions were observed, in addition to residual vascularization in 9 patients in whom the basic color-Doppler examination demonstrated substantial avascularity. Histopathology revealed that this method was more sensitive in disclosing the presence of active neoplastic tissue.
Conclusion:
Color-Doppler ultrasound is the first step in assessing the efficacy of neochemotherapeutic treatment in patients affected by locally advanced breast carcinoma. Levovist increases sensitivity and improves the diagnostic precision, thus allowing for a better image of the vessels, which is an important index of the biological activity of the neoplasm, compared to the basic color-Doppler examination.