Correlation of Clinical Examination, Mammography and Color Doppler Ultrasonography with Histopathological Findings in Patients of Carcinoma Breast Undergoing Neo-Adjuvant Chemotherapy

Background
Neoadjuvant chemotherapy has become an accepted component of the multidisciplinary treatment of clinical stage II and III breast
cancer. The response to the neoadjuvant chemotherapy is important indicators of survival. Patients who achieve pathologic complete
response (pCR) may not require surgery for optimum local control. However, at present, surgical excision and histological examination
of the resected specimen is the only way to reliably identify this small subgroup of patients. More effective imaging strategies that can
non-invasively identify complete pathological responders could potentially distinguish a subgroup of patients who need not undergo
surgery at all. Aim of the present study was (1) assess the chemotherapeutic response for neoadjuvant chemotherapy by clinical
examination, color doppler ultrasonography and mammographic examination. (2) To correlate clinical examination, color doppler
ultrasonography and mammographic measurements of breast tumor and regional lymph nodes with that of histopathological findings.
Material and methods
The present prospective clinical study conducted during December 2009 to May 2011 includes 30 patients of breast cancer. All patients
received 3-4 cycles of neoadjuvant chemotherapy CAF (Cyclophosphamide 500mg/m2, Doxorubicin 50mg/m2 and 5-FU 500mg/m2).
Above patients underwent modified radical mastectomy after 10-15 days from last cycle of chemotherapy. The assessment of the
chemotherapeutic response in the breast tumor was done by all three methods (Clinical examination, Color Doppler Sonography and
Mammography) with respect to the reduction in the calculated volume. Response of the lymph nodes to chemotherapy was determined
by Clinical examination and Color Doppler Sonography from the reduction in the largest dimension.
Results
The correlation between histopathological response with response of the tumor assessed by clinical examination, mammogram and
ultrasonography were k=0.219, p=0.017; r=0.570, p=0.009 Vs k=0.077, p=0.628; r=0.449; p=0.047 Vs k=0.538; p=0.000; r=0.714;
p=0.001 respectively. The correlation between the chemotherapeutic response assessed by Doppler parameters and histopathological
parameters were k=0.339; p=0.04; r=0.075; p=0.77 Vs k=0.440; p=0.765; r=0.297; p=0.207 Vs k=0.44; p=0.767; r=0.114, p=0.633 for
RI, PI and Vmax respectively. The percentages of overestimation and underestimation of the tumor in 20 patients compared with the
histopathological examination by clinical examination, sonography and mammogram were 75% and 25% Vs 25% and 75% Vs 50% and
50% respectively. The mean of overestimation and underestimation by three methods were 1.22±0.77; 0.75±0.288 Vs 0.957±1.59;
1.07±1.32 Vs 0.538±0.255; 0.943±0.609 respectively. The correlation between clinical examination, sonography and mammogram with
that of histopathologial examination as the gold standard on estimation of the tumor size were t=-0.257, p=0.801; r=0.797, p=0.00 Vs
t=2.87, p=0.009; r=0.693, p=0.00 Vs t=0.718, p=0.04; r=0.911; p=0.00 respectively
Conclusion
Mammogram is the best non invasive modality in both assessing the chemotherapeutic response and estimation of size of the residual
breast tumor than Clinical examination and Color Doppler Ultrasonography while considering histopathological examination as gold
standard. In assessing the chemotherapeutic response of axillary lymph nodes, Clinical examination is a better modality than Color
Doppler Ultrasonography.