超声检查早期评价乳腺癌新辅助化疗疗效的临床研究  

Clinical study of ultrasound evaluation of early response to neoadjuvant chemotherapy in breast cancer

作　　者：张彦[1] 陈翠京[1] 史秀云[1] 张紫杰 范雪[1] 白玲[1] 毛京宁[1] 

机构地区：[1]解放军307医院超声科,北京100071

出　　处：《临床肿瘤学杂志》2015年第10期926-929,共4页Chinese Clinical Oncology

摘　　要：目的探讨超声检查定量指标在早期评价乳腺癌新辅助化疗疗效中的价值。方法收集在我院经超声引导下穿刺活检病理确诊的乳腺癌患者60例,共64个病灶。所有患者均行4~8个周期新辅助化疗后手术治疗。根据手术后病理组织检查结果,将患者分为化疗有效组和无效组。分别在化疗前和化疗第1周期结束后3周（第2个周期开始前）进行超声检查。共观察4项定量指标：二维超声测量病灶最大径（D）、彩色多普勒测量最高血流速度（PSV）、阻力指数（RI）、弹性应变率比值（ESR）。采用配对样本t检验比较化疗前、后病灶4项指标的变化,绘制受试者工作特征（ROC）曲线并分析4项指标的灵敏度、特异度。结果 64个病灶中化疗有效组53例,化疗无效组11例。新辅助化疗后与化疗前相比,化疗有效组中D、PSV、RI、ESR的变化均有统计学意义（P〈0.001）,化疗无效组4项指标均无显著变化（P〉0.05）。根据ROC曲线分析拟合的数据,分别应用D缩小8.0%、PSV降低15.0%、RI下降3.6%及ESR下降15.7%为阈值,预测化疗有效的灵敏度为64.2%、63.4%、83.2%、88.7%,特异度为91.1%、100%、100%、100%。结论通过超声监测D、PSV、RI和ESR的变化,可作为评价乳腺癌新辅助化疗早期疗效的可靠指标。Objective To investigate the value of early evaluation of neoadjuvant chemotherapy（ NAC） response in breast cancer by using ultrasound quantitative indicators. Methods Sixty cases of breast cancer patients（ 64 lesions） in our hospital diagnosed by ultrasound guided biopsy were collected. All patients received 4-8 cycles of NAC and then treated with operation. According to the results of histopathology after surgery,the patients were divided into a significant response group（ R group） and a nonsignificant response group（ NR group）. All the patients underwent ultrasound twice,within one week before and three weeks after the first cycle of NAC,respectively. Four quantitative indexes were observed,including maximum diameter of lesions（ D）,peak systole velocity（ PSV）,resistance index（ RI） and elastography strain ratio（ ESR） by ultrasonic measurement. Four quantitative indexes before and after the first cycle of NAC were compared using paired sample t test. The receiver operating characteristic（ ROC） curves were drawn and their sensitivity and specificity were analyzed. Results Among the 64 lesions,53 were in the R group and 11 in the NR group. In the R group,D,PSV,RI and ESR after the first cycle of NAC changed significantly compared with those before NAC（ P〈0. 001）. In the NR group,the four parameters had no significant change（ P〉0. 05）. According to the ROC curve fitting data,the values of lesion D decreased by 8. 0%,PSV by 15. 0%,RI by 3. 6% and ESR by 15. 7% in predicting the sensitivity and specificity for the early response of breast cancer to NAC were 64. 2%,63. 4%,83. 2%,88. 7% and 91. 1%,100%,100%,100%,respectively. Conclusion By monitoring the changes of D,PSV,RI and ESR,they may serve as reliable indicators for early evaluation of NAC on breast cancer.

关 键 词：超声 乳腺肿瘤 化学治疗 

分 类 号：R737.9[医药卫生—肿瘤]