Related Experiment Video
Updated: Sep 2, 2026
Clinical Imaging of Microwave Mammography
Published on: November 14, 2025
Diagnostic Accuracy of Combined Ultrasonography and Mammography for Assessing Response to Neoadjuvant Chemotherapy in
Nasirudeen Oloko1, Zaid Al-Ishaq1, Suaad Ali Saleh Al Aghbari1
1Department of Surgical Oncology, University Medical City, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman.
Background:
Neoadjuvant chemotherapy (NACT) is commonly used in locally advanced, inflammatory, and biologically aggressive breast cancers to downstage tumors, facilitate breast-conserving surgery, and guide adjuvant treatment decisions. Response assessment after NACT relies on clinical examination and imaging modalities such as ultrasound, mammography, and MRI, with variable diagnostic accuracy. This study aimed to evaluate the accuracy of combined breast ultrasound and mammography in assessing response to NACT. Secondary objectives included determining the rates of pathological complete response (pCR) and radiological complete response (rCR), as well as the sensitivity, specificity, positive predictive value, and negative predictive value of combined imaging in predicting pCR.
Methodology:
A total of 145 consecutive patients diagnosed with breast cancer between January 2021 and June 2024 were retrospectively analyzed. All patients received neoadjuvant chemotherapy (NACT), followed by post-treatment breast ultrasonography and mammography performed 2-3 weeks after completion of NACT, depending on the chemotherapy regimen. Radiologic response was subsequently compared with final postoperative histopathology.
Results:
The combined use of breast ultrasound and mammography demonstrated an overall accuracy of 89.7% (95% CI: 83.6-94.1) in predicting pathological response, with a sensitivity of 81.8% (95% CI: 69.1-90.9) and specificity of 94.4% (95% CI: 87.5-98.2). The positive predictive value was 90.0% (95% CI: 78.2-96.7). However, subgroup analysis showed lower performance in the HR-/HER2+ subtype, with an accuracy of 68.2% (95% CI: 45.1-86.1) and a sensitivity of 63.1% (95% CI: 38.4-83.7).
Conclusion:
Combined breast ultrasonography and digital mammography demonstrated good accuracy in predicting pathologic response; however, variability across tumor subtypes underscores the need to integrate imaging findings with tumor biology and clinical context when planning surgical management.