Utilization of ultrasound combined with Ki-67 and CESM quantitative parameters to predict pathological complete...

To evaluate the predictive value of ultrasound parameters combined with Ki-67 and contrast-enhanced spectral mammography (CESM) for assessing pathological complete response (pCR) following neoadjuvant chemotherapy (NAC) in triple-negative breast cancer (TNBC).

This retrospective study included 78 TNBC patients who underwent surgery after NAC and were stratified into pCR and non-pCR (nPCR) groups based on postoperative pathology. Baseline ultrasound imaging was conducted upon admission. Primary tumor ultrasound features and change rates in tumor longest diameter (△D2, △D4) after 2 and 4 NAC cycles were analyzed. CESM was performed pre-treatment and after two cycles to calculate △CNR (percentage reduction in relative enhancement grayscale value). Univariate and multivariate logistic regression analyses were employed to identify independent predictors of pCR.

Univariate analysis revealed significant differences in △D2, △D4, retromammary space disappearance, Ki-67 expression, and △CNR between the pCR and nPCR groups following 2 and 4 cycles (P< 0.05). Variables with P< 0.05 were included in multivariate binary logistic regression. △D4, △CNR, and Ki-67 were identified as independent predictors of pCR in TNBC (OR=1.064, P= 0.041; OR=1.081, P= 0.016; OR=0.140, P= 0.005, respectively). The combined predictive model yielded an AUC of 0.869 (95 % CI: 0.774-0.963), with a sensitivity of 84.0 % and specificity of 84.9 %.

The integration of △D4, △CNR, and Ki-67 offers clinical utility in predicting NAC response in TNBC.