多模态超声动态评估乳腺癌新辅助化疗疗效

目的 观察多模态超声动态评估新辅助化疗(NACT)用于乳腺癌效果的价值。方法 回顾性分析50例接受术前NACT的单发乳腺癌患者,根据术后病理将其分为组织学显著反应(MHR)组(n=26)及组织学非显著反应(NMHR)组(n=24);对比观察组间NACT前,以及NACT前、中、后期超声指标变化,以及组间、组内定量指标在接受NACT过程中的缩小率。结果 完成 NACT后,组间病灶最大径、最大杨氏模量值(E_max)变化及平均杨氏模量值(E_mean)变化差异均有统计学意义(P均＜0.05),病灶缩小方式及血流分级差异均无统计学意义(P均＞0.05)。NACT前、中、后期,MHR组病灶最大径渐进缩小率(PRR)逐渐降低,而NMHR组呈“中期缩小-后期增大”趋势;2组组内最大径≥2 cm病灶(n=3、9)总缩小率(TRR)及各期PRR均高于最大径＜2 cm病灶(n=23、15,P均＜0.05)。NACT前、中、后期,2组E_max及E_mean的PRR均呈逐渐增高趋势,组内E_max降低≥30%病灶(n=14、5)TRR及各期PRR均高于E_max降低＜30%病灶(n=12、19),E_mean降低≥30%病灶(n=18、7)TRR及各期PRR均高于E_mean降低＜30%病灶(n=8、17,P均＜0.05)。结论 多模态超声可用于动态评估NACT用于乳腺癌效果,进而指导制定个体化治疗方案。

Multimodal ultrasound for dynamic evaluating therapeutic effect of neoadjuvant chemotherapy for breast cancer

Objective To observe the value of multimodal ultrasound for dynamic evaluating the therapeutic effect of neoadjuvant chemotherapy (NACT) for breast cancer. Methods Data of 50 patients with single breast cancer who underwent complete NACT were retrospectively analyzed. The patients were divided into major histological response (MHR) group (n=26) and non-major histological response (NMHR) group (n=24) according to postoperative pathology. The changes of ultrasonic indicators of lesions before NACT and during the early, middle and late periods of NACT were comparatively observed between groups, so as the reduction rates of quantitative indicators during NACT between groups and within groups. Results After NACT, the maximum diameter of lesions, as well as the changes of lesions'' maximum (E_max) and the mean (E_mean) value of Young''s modulus were significant different (all P＜0.05), while no significant difference of lesions'' reduction modes nor blood flow classifications was found between groups (both P＞0.05). At early, middle and late periods of NACT, progressive reduction rate (PRR) of the maximum diameter of lesions in MHR group showed a decreasing trend, while showed decreasing trend at the middle but increasing trend at the later period of NACT in NMHR group. The total reduction rate (TRR) and PRR of lesions with the maximum diameter ≥2 cm (n=3, 9) at all period of NACT were higher than those with the maximum diameter ＜2 cm in both groups (n=23, 15, all P＜0.05). At early, middle and late periods of NACT, PRR of E_max and E_mean within both groups showed gradually increasing trends, while TRR and PRR at all periods of NACT with E_max decreased ≥30% lesions (n=14, 5) were all higher than those with E_max decreased ＜30% lesions(n=12, 19), TRR and PRR at all periods of NACT of E_mean decreased ≥30% lesions (n=18, 7) were all higher than those with E_mean decreased ＜30% lesions within both groups (n=8, 17, all P＜0.05). Conclusion Multimodal ultrasound could be used to dynamically evaluate the efficacy of NACT for breast cancer, hence guiding the formulation of individualized treatment planning.