腋窝淋巴结超声造影预测乳腺癌新辅助化疗的疗效

Contrast-enhanced ultrasound of axillary lymph node for prediction of breast cancer response to nneoadjuvant chemotherapy

目的探讨腋窝淋巴结超声造影对浸润型乳腺癌新辅助化疗（NAC）疗效的预测价值。方法对58例Ⅱ、Ⅲ期浸润型乳腺癌患者的腋窝转移性淋巴结于NAC前、后进行超声造影检查，观察造影增强方式并进行时间强度分析，然后与手术病理对照。结果临床评价35例有效，23例化疗无变化。NAC有效组和无变化组两组之间灌注模式差异无统计学意义。到达淋巴结皮质时间化疗前两组间比较差异无统计学意义，化疗后有效组大于化疗无变化组。化疗前的弥散时间两组间差异有统计学意义，化疗后有效组弥散时间降低。以化疗后弥散时间275秒为最佳临界点，预测的敏感性为77％，特异性为90％。达峰时间、峰值强度两组之间差异无统计学意义。结论淋巴结超声造影增强方式对预测新辅助化疗的疗效无明显特异性，但到达淋巴结皮质时间、弥散时间对预测新辅助化疗的有效性有临床价值。

Objective To explore the predictive value Of response to neoadjuvant chemotherapy（NAC） in local advanced breast cancer with contrast-enhanced ultrasound （CEUS）of axillary lymph node. Methods CEUS of metastatic axillary lymph nodes in 58 patients staging Ⅱ、Ⅲ breast cancer was performed before and after NAC treatment. The enhancement patterns and parameters of time-intensity curve were assessed and compared with the pathology. Results The clinic response evaluation were drug-effective in 35 cases and no change in 23 ones. There were no significant differences in enhancement patterns between no-change and drugeffective groups. Lymph node cortex arriving time was longer in drug-effective cases than that in no-change ones after NAC ,whereas it showed no significant differences before NAC. Statistical significant difference in enhancement duration（ ED） was found between the two groups before NAC, which decreased markedly in drug-effective cases after NAC. Histopathologic response could be predicted with a sensitivity of 77% and a specificity of 90% by standardized ED below 275 seconds after NAC. No significant difference was found in time to peak （TP）, peak intensity （PI） between the two groups. Conclusion The perfusion pattern of axillary lymph node CEUS after NAC was insufficient to predict curative effect. But the lymph node cortex arriving time and enhancement duration may be of value in the prediction of clinical response to chemotherapy.