剪切波弹性成像预测乳腺癌新辅助化疗病理反应性的效能分析

Effect of shear wave elastography in predicting pathological responses to neoadjuvant chemotherapy in patients with breast cancer

目的探讨Q-box手动描绘模式超声剪切波弹性成像(shear wave elastography,SWE)预测乳腺癌新辅助化疗病理反应性的临床价值。方法收集福建省肿瘤医院2019年8月至2020年9月接受新辅助化疗的患者56例,根据术后病理Miller&Payne分级(G1-G5)分为反应组(G4-G5)和非反应组(G1-G3)。在化疗前及化疗2、4周期末行常规超声和SWE检查,获得肿瘤最大径的变化率(ΔD2、ΔD4),弹性最大值和弹性平均值的变化率(ΔEmax2、ΔEmax4、ΔEmean2、ΔEmean4),并纳入年龄、肿瘤最大径、T分期、N分期及ER、PR、HER2、Ki67、分子分型等,采用Logistic回归分析得出病理反应的独立影响因素并进行诊断试验。结果反应组23例(41.1%),非反应组33例(58.9%)。ΔEmax4和HER2是病理反应的独立影响因素(OR=1.11,P<0.001;OR=31.81,P=0.002)。ΔEmax4以49.3%为截断值预测病理反应的ROC曲线下面积(area under curve,AUC)为0.869(95%CI=0.746-0.941),效能优于HER2(AUC=0.690)。二者联合可提升诊断效能,其AUC为0.930(95%CI=0.829-0.981),敏感性78.26%,特异性96.97%,准确性75.23%,阳性预测值94.73%,阴性预测值86.49%。结论ΔEmax4和HER2是乳腺癌新辅助化疗后病理反应的独立预测因子,联合ΔEmax4和HER2可提高预测乳腺癌新辅助化疗后病理反应性的诊断效能。

Objective To investigate the clinical value of shear wave elastography(SWE)in predicting pathological responses to neoadjuvant chemotherapy in breast cancer.Methods According to the postoperative pathological responses,56 patients who received neoadjuvant chemotherapy followed by surgical excision in the Fujian Cancer Hospital from August 2019 to September 2020 were divided into responders and non-responders.The relative change rates of tumor maximum diameter(ΔD2,ΔD4)and SWE stiffness(ΔEmax2,ΔEmax4,ΔEmean2,ΔEmean4)were assessed before NAC and after different NAC cycles(t2,t4).Clinical information,including age,T,N stages,ER,PR,HER2,Ki67,and molecular subtype were also considered as the variables.The independent influencing factors of pathological responses after neoadjuvant chemotherapy were obtained by logistic regression analysis and diagnostic test was carried out.Results There were 23 cases as responders(41.0%,23/56),and 33 cases as non-responders(58.9%,33/56).Results of multivariate analysis showedΔEmax4 and HER2 index were independent influencing factors of pathological responses(OR=1.11,P<0.001;OR=31.81,P=0.002).Area under curve of theΔEmax4(AUC:0.869,95%CI:0.746-0.941)was higher than that of HER2(AUC:0.690,95%CI:0.545-0.834).The combination ofΔEmax4 and HER2 gave the best prediction of pathological responses(AUC 0.930,95%CI:0.829-0.981).the sensitivity,specificity,diagnostic accuracy,postive predictive value,and negative predictive value were 78.26%,96.97%,75.23%,94.73%,and 86.49%,respectively.ConclusionsΔEmax4 and HER2 are independent predictors of pathological responses after neoadjuvant chemotherapy for breast cancer.CombinedΔEmax4 and HER2 can improve the predictive diagnostic efficacy of pathological responses to chemotherapy for breast cancer.