数字乳腺断层摄影评价乳腺癌新辅助化疗疗效的临床价值

Evaluation of the efficacy of neoadjuvant chemotherapy in breast cancer by digital breast tomosynthesis

目的探讨数字乳腺断层摄影(DBT)对肿块并钙化乳腺癌新辅助化疗疗效评估的可行性。方法分析100例肿块伴钙化乳腺癌新辅助化疗(Neoadjuvant chemotherapy,NAC)前后最长径线、钙化数目的变化,每次检查均行DBT及全数字化乳腺X线摄影(Full-field digital mammography,FFDM)检查(一次拍摄,同时获得两种图像)。以术后病理MP(Miller&Payen分级)分级为金标准,分析肿块最长径线与钙化数目变化对NAC疗效的影响价值及两种检查方法的诊断效能。结果根据实体瘤疗效评价标准(RECIST1.1)NAC后,FFDM评价完全缓解(CR)40例、部分缓解(PR)38例、疾病稳定(SD)22例,DBT评价CR40例、PR38例、SD22例,钙化数目减少40例,不变54例,增加6例。MP分级1、2、3、4、5级:10、18、28、11、33例。NAC后RECIST分类、钙化数目变化与MP分级经卡方检验,P值均小于0.05。以MP分级为金标准,NAC后FFDM及DBT测量的最长径线变化率ROC曲线下面积比较,P<0.05;第二、六疗程前后DBT上肿块最长径线变化率ROC曲线下面积比较,P>0.05,差异无统计学意义。结论DBT在评估新辅助化疗疗效方面较FFDM诊断效能更高且影像手段可早期预测新辅助化疗疗效,钙化数目减少者易获得肿瘤病理完全反应(Pathological complete response,pCR)。

Objective To explore the feasibility of digital breast tomosynthesis(DBT)in eva-luating neoadjuvant chemotherapy for breast cancer with mass and calcification.Methods A retrospective analysis was made on the changes of the longest di-ameter and calcification before and after neoadjuvant chemotherapy(NAC,Neoadjuvant Chemotherapy)in 100 cases of mass and calcified breast cancer.DBT and full-field digital mammography(FFDM)were performed in each examination(one shot and two images at the same time).Taking the postoperative pathological MP(Miller&Payen grade)as the gold standard,the influence value of the changes of the longest diameter line of the mass and the number of calcifications on the curative effect of NAC and the diagnostic efficacy of the two examination methods were analyzed.Results According to the evaluation standard of response evalution criteria in solid tumors(RECIST1.1),after NAC,FFDM evaluated that there were 40 cases of complete response(CR),38 cases of partial response(PR),22 cases of stable disease(SD).DBT evaluated that there were 40 cases of CR,38 cases of PR and 22 cases of SD,and the number of calcification decreased in 40 cases,unchanged in 54 cases and increased in 6 cases.By the MP grades 1,2,3,4,there were 5,10,18,28,11 and 33 cases.After NAC,the RECIST classification,the change of calcification number and MP classification were all less,than 0.05 by chi square test.Taking MP classification as the gold standard,the area under ROC curve of the change rate of the longest diameter measured by FFDM and DBT after NAC was compared(P<0.05);Before and after the second and sixth courses of treatment,there was no significant difference in the change rate of the longest diameter line of the mass on DBT and the area under the ROC curve(P>0.05).Conclusion DBT has higher diagnostic efficiency than FFDM in evaluating the efficacy of neoadjuvant chemotherapy,and imaging methods can early predict the efficacy of neoadjuvant chemotherapy.Those with less calcification are easy to obtain PCR.