超声光散射成像技术对乳腺癌新辅助化疗疗效早期评价的研究

Evaluation of ultrasound-diffuse optical tomography on the early efficacy of neoadjuvant chemotherapy for breast cancer

目的探讨超声光散射成像技术早期预测及评估乳腺癌新辅助化疗疗效的价值。方法选择62例原发性乳腺癌患者，于每周期化疗前及术前进行超声光散射成像检查，测定血红蛋白浓度（total hemoglobin concentration，Hb），根据RECIST1．1标准进行临床评价分组，分为部分缓解（partialresponse，PR）组、完全缓解（completeresponse，CR）组、疾病进展（progressive disease，PD）组及疾病稳定（stabledisease，SD）组；术后根据Millerand Payne（MP）病理分级系统，分为疗效不佳组（MP分级1～3级）及疗效优良组（MP分级4～5级）；根据术后病理结果分为病理完全缓解（pathologic complete response，pCR）组及非pCR组。将Hb与影像学及术后病理疗效评估进行统计学分析。结果62例患者均完成新辅助化疗全部周期，化疗1周期后及全部化疗结束后，Hb值在上述分组中均有不同程度的下降，且下降值的差异具有统计学意义（P〈0．001）。Hb早期预测新辅助化疗疗效下降值44．5，曲线下面积0．745，此阈值的诊断敏感性75．0％，特异性为73．1％，阳性预测值79．4％，阴性预测值67．9％，准确性74．2％。结论在乳腺癌新辅助化疗过程中，Hb值的下降与化疗疗效呈正相关，Hb值的变化在化疗早期便可对新辅助化疗疗效做出评估及预测。

Objective To discuss the value of early prediction and evaluation using ultrasound-guided diffuse optical tomography （US-guided DOT） of neoadjuvant chemotherapy （NCT） for breast cancer. Methods Sixty-two primary breast cancer patients were included. Before every neoadjuvant chemotherapy and surgery, the total hemoglobin concentration（Hb） was measured by US guided DOT. According to the RECIST 1.1 standard, 62 patients were divided into partial response （PR） group, complete response（CR） group,progressive disease（PD） group and stable disease（SD） group. According to the Miller and Payne （MP） grading system, the patients were divided into poor efficacy group（MP grade 1 -3） and the effect of excellent group （MP grade 4 - 5）. According to the postoperative pathological results, patients were divided into pathologic complete response（pCR） group and non pCR group. Hb with imaging and postoperative pathological results were analyzed. Results All of the 62 patients finished the NCT. After first cycle of chemotherapy and all chemotherapy, the value of Hb in the above groups had different degrees of decline, and the difference among the groups was statistically significant（ P 〈0. 001）. When the descending value of Hb was 44.5 as the threshold for early prediction of NCT efficiency, the area under the curve of ROC （Az） was 0.745, and the sensitivity was 75.0%, specificity was 73.1%, positive predictive value was 79.4%, negative predictive value was 67.9%, and accuracy was 74.2%, respectively. Conclusions In the process of neoadjuvant chemotherapy of breast cancer, the decrease of Hh value is positively related to the therapeutic effect of chemotherapy. The change of Hb value can predict and evaluate the efficacy of neoadjuvant chemotherapy in the early time.