超声回声强度预测乳腺癌化疗敏感性的研究  

Ultrasound echo intensity predicts chemotherapy sensitivity in breast cancer

作　　者：袁权 陈楠 韩丕华 宋灿许 李逢生 YUAN Quan;CHEN Nan;HAN Pihua;SONG Canxu;LI Fengsheng(Ultrasound Department,Shaanxi Provincial Cancer Hospital,Shaanxi Xi'an 710061,China;Breast Surgery Department,Shaanxi Provincial Cancer Hospital,Shaanxi Xi'an 710061,China)

机构地区：[1]陕西省肿瘤医院超声科,陕西西安710061 [2]陕西省肿瘤医院乳腺外科,陕西西安710061

出　　处：《现代肿瘤医学》2020年第22期3951-3955,共5页Journal of Modern Oncology

基　　金：陕西省自然科学基础研究计划项目(编号:S2020-JC-YB-0903)。

摘　　要：目的:探讨乳腺癌患者新辅助化疗(neoadjuvant chemotherapy,NAC)期间通过超声评估化疗反应性的价值。方法:对60例原发性乳腺癌患者在4轮NAC前后进行超声检查,包括回声强度、肿瘤体积和超声弹性成像,并与穿刺活检病理评估的恶性耐药细胞(resistant malignant cell,RMC)百分比和组织学反应性进行比较。结果:60例患者的肿瘤病灶在NAC前均为低回声团块,在4轮NAC结束后,仅有11例为持续性低回声,有29例转为等回声,20例转为混合回声,等回声强度患者的RMC低于混合回声强度,混合回声强度患者的RMC低于低回声强度,差异均存在统计学意义(P <0.05)。在第3轮NAC后,超声回声强度变化与RMC百分比降低具有明显的统计学相关性(P <0.05),回声强度变化对预测组织学显著反应(major histological response,MHR)的优势比达12.42 (95%CI:4.07~21.22,P <0.001)。同时,达到MHR患者(27例)在4轮NAC期间的肿瘤体积减少程度和肿瘤弹性应变减少程度均优于N-MNR患者(33例)(P <0.05)。结论:乳腺癌在超声检查中呈现的回声强度、肿瘤体积、弹性应变与NAC反应性存在统计学相关性,肿瘤回声强度改变可以准确预测病理性反应,具有较高的预测价值。Objective:To evaluate the value of ultrasound-based assessment of chemotherapy response during neoadjuvant chemotherapy(NAC)in breast cancer patients.Methods:Ultrasound of 60 patients with primary breast cancer before and after 4 rounds of NAC,including echo intensity,tumor volume and ultrasound elastography were examed,and the percentage of resistant malignant cell(RMC)via pathological biopsy was assessed and histological reactivity was compared.Results:The tumor lesions of 60 patients were all hypoechoic mass before NAC.After 4 rounds of NAC,only 11 patients were persistent hypoechoic,29 patients converted to iso-echo,and 20 patients converted to mixed echo.The RMC in patients with equal echo intensity was lower than that of mixed echo,The RMC in patients with mixed echo intensity was lower than that of hypoechoic intensity,and both the difference was statistically significant(P<0.05).After the third round of NAC,there was a statistically significant correlation between the change in ultrasound echo intensity and major histological response(MHR)(P<0.05),and the odds ratio of echo intensity change to chemotherapy response was 12.42(95%CI:4.07~21.22,P<0.001).At the same time,27 cases with MHR had better reductions in tumor volume and in tumor stiffness during 4 rounds of NAC than 33 cases with N-MNR(P<0.05).Conclusion:There is a statistical correlation between echogenicity,tumor volume,stiffness and NAC response in breast cancer.The change of tumor echo intensity can accurately predict pathological response and has high predictive value.

关 键 词：乳腺癌 超声 回声强度 

分 类 号：R737.9[医药卫生—肿瘤]