超声和钼靶对乳腺癌新辅助化疗后残瘤评估的精准性分析

Accuracy of ultrasonography and mammography in evaluating the residual tumor after neoadjuvant chemotherapy for breast cancer

目的通过超声和钼靶x线的影像学方法评估乳腺癌新辅助治疗后的病理应答情况，从而为新辅助治疗的疗效评价及用药方案提供重要的检测依据。方法纳入136例初诊为乳腺癌的女性患者，病理诊断明确，并采用新辅助化疗进行术前治疗。收集患者临床信息，包括年龄等基本信息、肿瘤大小、临床分期等信息，手术前分别接受4到6个周期化疗，方案不限。术前采用乳腺钼靶和／或超声检测化疗后残瘤大小，比较影像学测定的肿瘤大小与病理测量肿瘤大小的误差，及影像学检测对乳腺肿瘤病理应答率的评估。结果116例钼靶影像记录中41（35．34％）例影像未检测到残瘤，106例超声影像记录中19例（17．92％）未检测到残瘤，影像学预测为完全缓解。98例同时进行钼靶和超声评估的病例中，有61（62．24％）例钼靶影像可评估肿瘤大小，有83（84．69％）例超声影像可评估肿瘤大小。钼靶准确评估了31例，超声准确评估了59例，精准率高于钼靶，两科，影像学方法对新辅助化疗后的残瘤评估差异显著（60．20％孤31．63％，X2=16．11，P〈0．001）。超声的正确检查率为92．85％（91／98），钼靶的正确检出率为68．37％（67／98），超声诊断效力略高于铝靶，但差异无统计学意义（X2=2．028，P=0．164）。结论乳腺超声在测量新辅助化疗后残余肿瘤的大小的准确率方面比乳腺钼靶结果更可靠。

Objective Uhrasonongraphy and mammography were employed to estimate the pathological response of patients with breast cancer,who had been accepted neoadjuvant chemotherapy. According to the pres- ent study, we can provide additional evidence on therapeutic effect on evaluation of neoadjuvant chemotherapy and better selection of regime for breast cancer. Methods One hundred Thirty - six patients who were previously dia- gosed diagnosed with primary breast cancer were included in this study. All subjects were female with clearly pathological detection and accepted neoadjuvant chemotherapy about 4 to 6 cycles regardless of regime. The resid- ual tumor size was evaluated by mammography and/or ultrasonography before operation. Tumor size measured by image were compared with pathological size to predicting the accuracy of two types of imaging. Results Forty one of 116 records were undeteetable imaging by mammogram and 19 of 106 records were undetectable by ultrasound which were considered a pathologic complete response. Sixty one （62.24%）of 98 patients who were accepted de- tection of mammogram and ultrasound would be predicted the tumor size by mammogram. Eighty three（ 84.69% ） of 98 patients would be predicted the residual tumor by ultrasound. 31 and 59 were accurately evaluated by mam- mogram and ultrasound, respectively. The result indicated that ultrasound was more accurate than mammogram （60.20% vs. 31.63% , ~2 = 16.11 ,P 〈 0. 001 ）. The correctly rate was 92.85% （91/98）for ultrasound and 68. 37% （67/98）for mammogram. The diagnosis efficiency of ultrasound was more higher than mammogram, even though there was no different significance between the two methods （ X2 = 2. 028, P = 0.164 ）. Conclusion Ultra- sonongraphy in estimating the residual tumor size after neoadjuvant chemotherapy of patients with breast cancer displays more accurately than mammography.