ULTRASOUND ASSESSMENT OF RESIDUAL ABNORMALITIES FOLLOWING PRIMARY CHEMOTHERAPY FOR BREAST-CANCER

The purpose of this study was to assess the usefulness of ultrasonogra phy (US) in the assessment of the breast following primary medical the rapy (PMT) of large operable breast cancer. A total of 52 patients wer e studied; all had invasive breast cancer, confirmed by core biopsy, w ith initial size > 4 cm by palpation, T2-3, N0-1, M0. PMT was with epi rubicin, cisplatin and continuous infusional 5-fluorouracil, as previo usly described (Jones et al, 1994, J Clin Oncol 12: 1259-1265). Indepe ndent clinical and US assessments were made during PMT before surgery or biopsy. A total of 31 (60%) patients achieved complete clinical res ponse (cCR), but in only five of these was the post-treatment ultrasou nd normal. Post-treatment sonographic findings of diffuse parenchymal distortion or a mass lesion without Doppler signal were associated wit h more favourable histology (pathological CR, non-invasive or microinv asive carcinoma), whereas a mass with Doppler positivity was more ofte n associated with residual macroscopic invasive carcinoma. Patients wh o did not achieve cCR had a high incidence of residual macroscopic car cinoma (71%) regardless of the sonographic characteristics. With media n follow-up of 27 months (range 12-43), ten (19%) patients have relaps ed and six (12%) have died, but only one relapse has occurred within t reated breast. Ultrasonography is a sensitive technique for assessing the response to PMT, particularly in patients who achieve cCR. It may be helpful in selecting those patients who do not require post-PMT sur gery and in localizing abnormalities in those who do, particularly in those with cCR. However, clinicians should be aware that a residual US abnormality is by no means pathognomonic of residual cancer.