Abstract
OBJECTIVES: The prediction of pathological complete response (pCR) of primary breast cancer to neoadjuvant chemotherapy (NAC) is crucial for guiding surgical decisions. This study examined the effectiveness of shear wave elastography (SWE) compared with magnetic resonance imaging (MRI) in predicting the response to NAC in patients with breast lesions. METHODS: This prospective, single-center observational study enrolled 110 patients diagnosed with BC who received NAC from January 2022 to May 2024. All patients underwent breast MRI, US, and SWE both at baseline and after treatment. The treatment response was evaluated using the Miller-Payne (MP) classification, which assigns a score from G1 (no response) to G5 (complete response, absence of malignant cells). RESULTS: The results showed that 43.64% (48/110) of patients achieved a pathological complete response (pCR), while 56.36% (62/110) had a partial response (NpCR). Tissue stiffness analysis using SWE revealed a significant reduction in stiffness, with an average decrease of 10 kPa in more than 50% of patients. Thresholds of 10, 20, 30, and 50 kPa were evaluated to assess their predictive value for pCR. All thresholds demonstrated statistically significant discriminative power (P < .0001), with AUCs of 0.675 (Se 51.6%, Sp 83.3%), 0.751 (Se 70.97%, Sp 79.17%), 0.749 (Se 79.03%, Sp 70.83%) and 0.677 (Se 85.5%, Sp 50.0%), respectively. CONCLUSIONS: The Shear Wave Elastography system, which measures tissue stiffness through the speed of shear wave propagation, has proven to be a promising method for monitoring the response to chemotherapy, providing quantitative information that can complement other diagnostic methods such as magnetic resonance.