Procjena učinka neoadjuvantne terapije kontrastnim ultrazvukom u pacijenata s dijagnosticiranim karcinomom dojke

doctoral thesis

• Title (english): Neoadjuvant therapy impact assessment with contrast enhanced ultrasound in patients diagnosed with breast cancer
• Author: Iva Biondić Špoljar
• Mentor: Gordana Ivanac (mentor)
• Committee member: Zoran Brnić (predsjednik povjerenstva)
• Committee member: Rado Žic (član povjerenstva)
• Committee member: Lidija Beketić-Orešković (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Radiology); Zagreb
• Defense date and country: 2025-03-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Radiology
• Universal decimal classification (UDC): 616 - Pathology. Clinical medicine

Abstract

Uvod: CEUS je novija slikovna dijagnostička metoda u radiologiji dojke. Metoda izbora za praćenje učinka neoadjuvantne terapije je MR, kojom je moguće osim morfološke analize procijeniti i imbibiciju te mikrostrukturu lezije. Primjenom ultrazvučnog kontrastnog sredstva također je moguće analizirati prokrvljenost lezije. Neoangiogeneza je odlika malignih lezija, a poznato je da neoadjuvantna terapija primarno djeluje na stanice krvnih žila. Učinci terapije već u ranim fazama liječenja mogu se primijetiti upravo u promjeni imbibicije lezije, dok morfološke promjene slijede naknadno.
Cilj: Utvrditi dijagnostičku točnost CEUS-a kod praćenja djelovanja neoadjuvantne terapije te usporedba s rezultatima MR-a.
Ispitanici i metode: Uključeno je 40 pacijentica te su učinjena 106 pregleda svakom dijagnostičkom metodom, prije početka primjene terapije u sklopu dijagnostičkog protokola te tijekom i/ili po završetku liječenja. Prikupljeni su i analizirani podatci obje metode, a dijagnostička točnost računata je na temelju patohistološkog nalaza i RCB klasifikacije.
Rezultati: Usporedba odgovora na terapiju tijekom i po završetku terapije pokazuje značajnu podudarnost radioloških metoda. CEUS pokazuje veći broj slučajeva podudaranja s patohistološkim nalazom, te nižu osjetljivost uz veću specifičnost i ukupnu dijagnostičku točnost u odnosu na MR. CEUS jednako dobro utvrđuje stupanj bolesti neovisno o podtipu karcinoma dojke.
Zaključak: CEUS dijagnostičkim performansama može parirati MR-u kod praćenja djelovanja neoadjuvantne terapije. Zbog jednostavnosti primjene i izvedbe omogućuje brzi uvid u dinamiku perfuzije karcinoma u stvarnom vremenu.

Abstract (english)

Introduction: Contrast enhanced ultrasound (CEUS) is a relatively new diagnostic method in the breast imaging field. The golden standard for monitoring the effects of the neoadjuvant therapy (NACT) in patients diagnosed with breast cancer is magnetic resonance imaging (MRI), which can be used to assess not only morphological analysis but also imbibition and the microstructure of the lesion. By applying an ultrasound contrast agent it is possible to analyze the blood supply of the lesion. Neoangiogenesis is a feature of malignant lesions and it is well established that neoadjuvant therapy primarily affects the blood vessels that supply it. The effects of and response to the therapy in the early phase of treatment can be noticed precisely in the change in the lesion's imbibition, while morphologic changes usually follow later.
Objective: To determine the diagnostic accuracy of CEUS in monitoring the effect of neoadjuvant therapy and to compare it with MRI results.
Subjects and methods: 40 patients were included and 106 examinations were performed by each diagnostic method before the start of therapy as part of the diagnostic protocol and during and/or after the end of the treatment. The data of both methods was collected and analyzed, and the diagnostic accuracy was calculated based on the pathohistological findings and the RCB classification.
Results: The comparison of the therapy response during and after the completion of the therapy shows a significant congruence of radiological methods. CEUS shows a higher number of cases matching the pathohistological finding, and a lower sensitivity with higher specificity and overall diagnostic accuracy compared to MRI. CEUS determines the stage of the disease equally well regardless of the subtype of breast cancer.
Conclusion: CEUS’s diagnostic performance can match MRI when monitoring the effect of neoadjuvant therapy. Due to the simplicity of the application and performance, it allows a quick insight into the dynamics of cancer perfusions in real time.

• Keywords: karcinom dojke; kontrastni ultrazvuk; magnetska rezonancija; neoadjuvantna terapija
• Keywords (english): breast cancer; contrast enhanced ultrasound; magnetic resonance imaging; neoadjuvant therapy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:879632
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo (doktor/doktorica znanosti, područje biomedicine i zdravstvo)
• Type of resource: Text
• Extent: 101 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2025-03-27 08:19:07