Quantitative Ultrasound Texture Analysis of Breast Tumor Responses to Chemotherapy: Comparison of a Cart-Based and a Wireless Ultrasound Scanner

This study assessed the level of agreement between quantitative ultrasound (QUS) feature estimates derived from ultrasound images of breast tumors in women with locally advanced breast cancer (LABC) produced using a cart-based and a handheld ultrasound system. Thirty LABC patients receiving neoadjuvant chemotherapy were imaged at two separate times: a pre-treatment ‘baseline’ time point, and four weeks after the start of chemotherapy. Three sets of QUS features were produced using the reference phantom technique, one for each imaging time and a third set calculated by taking the differences in feature estimates between times. Cross-system statistical testing using the Wilcoxon signed-rank test was performed for each feature set to assess the level of feature estimate agreement between ultrasound systems. The Bland–Altman method was employed to graphically assess feature sets for systematic skew. The range of p-values was 4.50 × 10−11 to 0.277 for the baseline features, 2.77 × 10−5 to 0.865 for the week 4 features, and 2.03 × 10−9 to 1 for the feature differences. For the feature differences, all five of the primary QUS features (MBF, SS, SI, ASD, AAC) were found to be in agreement between the two scanner types at the 5% confidence level. For the baseline feature set and week 4 feature set, 0 out of 5 and 3 out of 5 of the primary features were found to be in agreement, respectively. Of the 20 QUS texture features examined, the number and proportion of the total for each feature set which were found to have statistically significant similarity in their sample medians at the 5% confidence level were as follows: 2 out of 20 (10%) for the baseline features; 17 out of 20 (85%) for the week 4 features; and 12 out of 20 (60%) for the feature differences. The specific texture features found to be in agreement varied between QUS-specific feature sets. Overall, a moderate level of agreement between sets of feature differences produced using the two systems was demonstrated.