常规超声及超声光散射技术评估乳腺癌新辅助疗效的价值比较

Comparison of ultrasonography and ultrasound-guided response of breast cancer to neoadjuvant chemotherapy diffuse optical tomograpby in assessing treatment

目的探讨常规超声、超声光散射技术及二者联合评估乳腺癌新辅助化疗疗效的价值。方法选取88例乳腺癌患者共93个病灶，于化疗前及末次化疗结束后术前分别行超声及超声光散射检查获得病灶超声大小和总血红蛋白浓度（THC），计算病灶大小的变化（△Size）和THC的变化率（△THC）。根据影像学实体瘤评估标准将病灶分为完全缓解组、部分缓解组、稳定组、进展组。根据Miller—Payne系统分为病理完全缓解和病理部分缓解组。结果93个乳腺癌新辅助化疗临床有效率81．7％，完全缓解率24．7％，ROC曲线分析超声和超声光散射评估乳腺癌新辅助化疗有效和无效的△Size和△THC阈值分别为42．6％和23．9％，曲线下面积（AUC）分别为0．666和0．751，二者并联及串联后AUC分别为0．680和0．737；ROC分析超声和超声光散射评估乳腺癌新辅助化疗完全缓解和部分缓解的△Size和△THC阈值分别为64．5％和27．2％，AUC分别为0．690和0．728，二者并联及串联后AUC分别为0．693和0．726。结论超声光散射成像与常规超声可术前评估乳腺癌新辅助化疗疗效，二者联合后并未改善各自评估乳腺癌新辅助化疗疗效的价值。

Objective To investigate the clinical value of conventional ultrasonographic （US）, US- guided diffuse optical tomography （US-guided DOT） and both combined to assess treatment response of breast cancer to neoadjuvant chemotherapy（NAC）. Methods Eighty eight breast cancer patients, totally 93 lesions were included in the study. Pre- and post-last chemotherapy, size, and total hemoglobin concentration （THC） of each lesion were measured by conventional US and US-guided DOT before biopsy, the change of lesion Size（ASize） and the change of THC（ATHC） were calculated respectively. Based on the guidelines to evaluate the response to treatment in solid tumors, the responses to NAC were classified into complete response, partial response, static disease, progressive disease groups. The histological response to chemotherapy were categorised as partial pathological response and complete pathological response using Miller and Payne system. Results Of 93 breast cancers, the overall response rate was 81.7%, the cPR rate was 24.7 %. According to ROC curve analysis, when △Size 42.6 % and △THC 23.9 % as cutoff values to evaluate the complete response and partial response, the area under the curve （AUC） were 0.666 and 0. 751, respectively, the AUC of US and US-guided DOT combined in parallel and in series were 0. 680 and 0. 737 respectively. When △Size 64.5 % and △THC 27.2 % as cutoff values to evaluate complete pathologial response, the AUC were 0. 690 and 0. 728 respectively, the AUC of US and US-guided DOT combined in parallel and in series were 0. 693 and 0. 726 respectively. Conclusions US-guided DOT and US can be used to predict breast cancers response to NAC, US and US-guided DOT combined in parallel and in series can not improve response prediction comparing with US or US-guided DOT alone.