超声造影在乳腺癌新辅助化疗疗效评估中的应用价值

Value of contrast-enhanced ultrasound in the evaluation of neoadjuvant chemotherapy for breast cancer

目的探讨超声造影评估乳腺癌新辅助化疗（neoadjuvant chemotherapy，NAC）疗效的应用价值。方法应用超声造影对80例乳癌患者NAC前后的病灶图像特征进行观察与分析，评价NAC前后病灶大小变化以及血流灌注定性指标和定量指标的变化，并观察定性指标变化与病理反应的关联。结果NAC前后，超声造影测量的病灶大小的变化大于常规超声（P〈0．05），但NAC之前两者测量的大小差异并无统计学意义（P〉0．05）。NAC后所有超声造影定性观察指标均有明显良性转化的特征（P〈0．05），其中与病理反应密切相关的是增强程度变化、造影剂分布变化、造影顺序变化及造影模式变化（P〈0．05）。NAC后，病灶的超声造影灌注参数表现为慢进慢退、低增强、微循环灌注总量减小。结论NAC前后，超声造影较常规超声测量的病灶大小变化更接近于病理评估，超声造影定性指标及定量指标的良性特征转归也较病灶大小的改变更为明显。超声造影定性指标的改变对指导乳腺癌NAC具有较大实用价值，尤其是与病理疗效评估相关的超声造影指标。

Objective To explore the application value of contrast-enhanced ultrasound（CEUS） in evaluating the effect of neoadjuvant chemotherapy（NAC） on breast cancer. Methods Image features of 80 breast cancer patients with neoadjuvant chemotherapy were observed and analyzed by CEUS. In the process, the changes of primary foci before and after neoadjuvant chemotherapy and the changes of qualitative and quantitative indexes of blood perfusion were evaluated. The correlation between qualitative change and pathological response was also studied. Results The change of focus size measured by CEUS was higher than that of conventional ultrasound before and after neoadjuvant chemotherapy（ P 〈0.05）. However,there was no significant difference between the two measurements before NAC （ P 〉 0.05）. All the qualitative observation indexes of the ultrasound contrast after NAC revealed obviously benign conversion（ P 〈0.05）. Among them,the pathological response was closely related to the changes of the enhancement degree, the distribution of the contrast agent,the order of the contrast and the contrast mode. After NAC,the perfusion parameters of the lesions showed slowly crawl and slowly retreat, low enhancement and the diminished total amount of microcirculation perfusion. Conclusions Before and after neoadjuvant chemotherapy,the changes of the lesion size deteted by CEUS were more close to the pathological evaluation than those detected by conventional ultrasound. The benign outcome of qualitative and quantitative indexes of the CEUS was more obvious than the changes of the lesion size, which had practical value for guiding the neoadjuvant chemotherapy for breast cancer,especially the CEUS indexes related to pathological assessment.