Ultrasound strain elastography combined with radiomics methods can improve diagnostic efficacy of predicting pathological response after neoadjuvant chemotherapy in breast cancer

HUANG Xiaowen; HUANG Qingxiu; SUN Jimei; LUO Weiquan; ZENG Fuqiang

doi:10.12122/j.issn.1674-4500.2025.10.14

Abstract：Objective To compare the diagnostic efficacy of ultrasound strain elastography and radiomics in predicting pathological response after neoadjuvant chemotherapy for breast cancer,and to explore the feasibility of their combined application.Methods A retrospective analysis was conducted on 100 breast cancer patients who received neoadjuvant chemotherapy at Zhongshan Hospital of Traditional Chinese Medicine from January 2021 to June 2024.Ultrasound images of breast cancer were collected before neoadjuvant chemotherapy,and the stiffness parameters and radiomics scores of the lesions were obtained using strain elastography and radiomics methods.After neoadjuvant chemotherapy,surgical resection was performed,and the patients were confirmed as pathological complete response(pCR)or non-pathological complete response(npCR).The diagnostic efficacy of individual and combined parameters was evaluated by plotting ROC curves,including the area under the curve(AUC),sensitivity,and specificity.Results Postoperative pathology was divided into pCR(n=41)and npCR(n=59).The lesion size,proportion of hard lesions,and strain rate FLR(fat/lesion ratio)in the pCR group were all lower than those in the npCR group(P<0.05).The AUC of FLR for predicting pCR was 0.833(optimal cut-off value 14.3,sensitivity 78.05%,specificity 77.97%);the AUC of radiomics score was 0.825(optimal cut-off value 1.92,sensitivity 82.93%,specificity 71.19%),and there was no difference in efficacy between the two(P=0.88).The AUC of the combined model increased to 0.914,which was significantly better than that of individual indicators(all P<0.01).Conclusion Strain elastography and radiomics have comparable value in the assessment of pCR,and their combined application can significantly improve diagnostic efficacy,providing a new strategy for non-invasive assessment of the efficacy of neoadjuvant chemotherapy.