乳腺癌新辅助化疗疗效评价方法的比较

目的 比较查体、超声和钼靶在乳腺癌新辅助化疗(NAC)疗效评价中的差异.方法 通过查体、超声和钼靶分别测量、记录141例NAC患者肿瘤状况,分析治疗前后原发灶、淋巴结的变化.结果 全组中晚期患者居多,Ⅰ期仅占8.5%.化疗前查体的乳腺肿块较超声检查明显偏大(P＜0.01).评价疗效时,原发灶查体误判完全缓解(CR)率高达46.8%(22/47),而超声误判残留率为84.0%(21/25).43例行钼靶检查患者中,有23例(53.5%)患者困难以测量肿块大小而无法评价疗效;5例有钙化的患者,虽化疗后肿块缩小,但钙化范围无变化.在治疗中,25例有效患者行原发灶空芯针穿刺,在9例穿刺病理阴性者中,仅有3例达pCR;16例穿刺阳性者均未达pCR.超声检查怀疑腋窝淋巴结转移的患者,通过空芯针穿刺的病理阳性率为88.3%(53/60),超声检查不怀疑者仍有20.0%(1/5)为阳性.24例超声未探及腋窝肿大淋巴结患者中,有9例(37.5%)前哨淋巴结活检阳性.化疗前淋巴结病理阳性患者64例,化疗后转阴36例(56.3%).全组原发灶及淋巴结均达病理完全缓解(pCR)者21例,占14.9%(21/141).结论 乳腺癌患者化疗前对腋窝淋巴结进行空芯针穿刺或前哨淋巴结活检明确病理状态非常重要,查体、超声及铜靶检查对原发灶肿瘤大小的判断都有相当的误差,可采用病灶穿刺来评价NAC的疗效,但对结果 的判断还需综合分析.

Comparison of response evaluation methods of neoadjuvant chemotherapy in breast cancer patients

Objective To compare the efficiency of response evaluation by clinical examination,ultrasonograghy and mammography in neoadjuvant chemotherapy (NAC) for breast cancer.Methods A retrospective cohort study was conducted to analyze the data of 141 patients treated with neoadjuvant chemotherapy.Response evaluation was performed by clinical palpation,ultrasound and mammography.Results Only 12 (8.5%) among the 141 patients presented with a stage I tumor.The tumor size determined by palpation was often larger than that by ultrasound before therapy (P＜0.01).Among patients with suspicions axillary nodes checked by ultrasound,88.3% (53/60) of them had positive nodes by pathology before NAC,and 34.5% (10/29) of patients with negative nodes determined by ultrasound had positive nodes by pathology.In all the 141 patients,21 (14.9%) showed pathological complete remission in both the primary tumor and lymph node.For response evaluation,the false complete remission rate judged by clinical examination was 46.8% (22/47),and the false tumor residual rate by ultrasound was 84.0%(21/25).In 53.5% (23/43) of patients the response could not be assessed by mammography due to that the tuners were undistinguishable in size.The range of microcalcification was not reduced in 5 patients with a partial response of the tumor.25 patients experienced needle puncture during therapy.Among them,in the 9 pathologically negative patients,only 3 achieved pCR,and the other 16 positive patients didn't achieve pCR.Conclusion Using the puncture or sentinel lymph node biopsy,clinicians should pay enough emphasis on the pathological determination of the node status before chemotherapy.Clinicians will make a quite of false judgment of the tumor by clinical examination,ultrasound or mammography.They may use needle puncture during therapy to evaluate the response of neoadjuvant chemotherapy,and the result should be analyzed synthetically.