剪切波弹性成像评价乳腺癌新辅助化疗疗效的价值

Prediction of clinical efficacy of breast cancer neoadjuvant chemotherapy using shear wave elastography

目的探讨剪切波弹性成像（SWE）技术早期预测乳腺癌新辅助化疗（NAC）疗效的价值。方法选取接受NAC的患者53例，共55个病灶，于NAC前及NAC后2、4、6周期均行SWE检查。以术后病理为标准，分为病理反应显著组和反应非显著组。测量两组病灶化疗前后病灶最大径，并比较两组的最大径变化率。测量并比较两组化疗前和化疗后各周期病灶最大弹性值（Emax）及弹性值变化率（△Emax）。应用ROC曲线评价NAC后2周期末、4周期末△Emax对NAC疗效的预测价值。结果病理反应显著组病灶大小变化率高于非显著组[（64．82±21．06）％对（26．49±26．11）％]（P〈0．001）。随着化疗时间的延长，病理反应显著组和非显著组病灶Emax值均逐渐降低，但下降程度不同。反应显著组Emax值2周期末明显降低（P〈0．05），非显著组Emax值4周期末开始明显降低（P〈0．05）。反应显著组△Emax各周期末均大于非显著组（均P〈0．05）。ROC曲线显示，NAC后2周期末AEmax以26．1％为诊断截点值，预测NAC反应显著的敏感性为81．8％，特异性为75％；4周期末△Emax以35．5％为诊断截点值，敏感性为87．9％，特异性为83．3％，两者曲线下面积比较差异无统计学意义（P=0．264）。结论△Emax可早期预测乳腺癌患者NAC疗效，SWE能为二维超声评价乳腺癌NAC疗效提供有价值的补充。

Objective To investigate the value of shear wave elastography （SWE） to early predict clinical efficacy of breast cancer neoad3uvant chemotherapy （NAC）. Methods Fifty three patients （55 lesions） with breast cancer who underwent NAC were enrolled in this study. SWE was performed at baseline and after the end of 2,4,6 cycles of NAC. According to the postoperative pathological results, the lesions were divided into major pathologic response group and minor pathologic response group. The maximum diameter of the lesions between the baseline and the end of the last cycle of the two groups were measured and the maximum diameter changes （△Dmax） of the two groups were compared. The maximum elastic modulus （Emax） and the maximum elastic modulus changes （△Emax） of the two groups were measured and compared at baseline and after the end of 2,4,6 cycles of NAC. The ROC curves of AEmax at the end of 2 and 4 cycles were used to evaluate the predictive value of NAC response. Results The ADmax of the major pathologic response group [（64.82 ± 21.06）%] was higher than that of the minor pathologic response group [（26.49±26.11）%, P〈0.001]. With the prolongation of NAC, the values of Emax were significantly decreased in the two groups, but the decreasing degrees were different. The Emax was significantly decreased at the end of 2 cycles in the major pathologic response group （ P〈0.05）, however, at the end of 4 cycles in minor pathologic response group （ P （0.05）. The value of AEmax in the major pathologic response group was higher than that in the minor pathologic response group in every cycle significantly （all P〈0.05）. The AEmax threshold of the 2 cycles for predicting the NAC response was 26.1% （81.8% of sensitivity, 75% of specificity）, while the threshold of the 4 cycles was 35.5% （87.9% of sensitivity, 83.3% of specificity）, there was no significant difference between the areas under the two curves （ P = 0. 264）. Conclusions The value of AEmax in breast cancer lesions can predict the efficacy of NAC early. SWE can provide a valuable eomplement for two-dimensional ultrasound in the evaluation of NAC efficacy in breast cancer.