超声定量参数早期评估乳腺癌新辅助化疗效果的价值研究

Study on the value of ultrasound quantitative parameters in early evaluation of the effect of neoadjuvant chemotherapy for breast cancer

目的评估剪切波弹性成像(shear wave elastography,SWE)联合动态血流定量分析技术(quantitative flow analysis,QFA)对乳腺癌新辅助化疗(neoadjuvant chemotherapy,NAC)效果的早期预测价值。方法选取于北部战区总医院行NAC后手术切除的乳腺癌患者41例,在首次NAC之前、化疗两个周期后行超声检查。测量参数包括肿块最大直径(diameter,D)、剪切波杨氏模量最大值(Emax)、彩色血流面积比值(Ratio),并计算其相应参数变化率(△D、△Emax、△Ratio)。术后,根据Miller-Payne(MP)评分将患者分为有效组(16例)和无效组(25例),比较化疗前、2周期后两组SWE定量参数及彩色血流定量参数变化,绘制ROC曲线,分析定量参数对NAC疗效的预测效能。结果41例患者化疗前,两组间肿块大小、T分期差异有统计学意义(P<0.05),其他临床及病理特征比较差异无统计学意义(P>0.05)。NAC两周期后两组之间病灶最大径变化率(△D)无明显差异(17.21±2.43)vs(16.33±3.34)(P>0.05)。NAC两周期后两组之间硬度变化率(△Emax)、血流面积变化率(△Ratio)差异有统计学意义(29.45±5.31 vs 17.72±4.42,28.03±4.67 vs 18.70±4.88,P<0.05)。△Emax和△Ratio预测NAC疗效的最佳截断值分别为25.1%和24.4%,△Emax、△Ratio和△Emax+△Ratio预测NAC疗效的敏感性和特异性分别为79.3%、81.5%、76.6%、80.4%和77.4%、87.3%。结论剪切波弹性成像和动态血流的定量参数可以早期评估乳腺癌NAC的疗效。

Objective To evaluate the early predictive value of shear wave elastography(SWE)combined with Quantitative flow analysis(QFA)on the effect of neoadjuvant chemotherapy(NAC)for breast cancer.Methods 45 breast cancer patients who underwent surgical resection after NAC in the northern theater general hospital were collected.Ultrasonography was performed before the first NAC and after two cycles of chemotherapy.We measured Quantitative measwrement parameters including the maximum diameter of the mass(diameter,D),shear wave Young's modulus(Emax),color blood flow area ratio(Ratio,Ra),and the corresponding parameter change rate(△D,△Emax),△Ratio)was calculated.After the operation,the patients were divided into effective group(16 cases)and ineffective group(25 cases)according to Miller-Payne(MP)score,and the changes in SWE quantitative parameters and color blood flow quantitative parameters of the two groups before and after 2 cycles of chemotherapy were compared,and plotted ROC curve was used to analyzes the predictive power of quantitative parameters for NAC curative effect.Results Before chemotherapy in 41 patients,there were statistically significant differences in tumor size and T stage between the two groups(P<0.05),but there was no significant difference in other clinical and pathological characteristics(P>0.05).There was no significant difference in the maximum diameter change rate(△D)of the lesions between the two groups after two cycles of NAC(17.21±2.43)vs(16.33±3.34)(P>0.05).The difference in hardness change rate(△Emax)and blood flow area change rate(△Ratio)between the two NAC cycles was statistically significant(29.45±5.31 vs 17.72±4.42,28.03±4.67 vs 18.70±4.88,P<0.05).The best cut-off values of△Emax and△Ratio for predicting the efficacy of NAC were 25.1%and 24.4%,respectively.The sensitivity and specificity of△Emax and△Ratio and△Emax+△Ratio in predicting the efficacy of NAC were 79.3%,81.5%,and 76.6%,respectively,80.4%,77.4%and 87.3%.Conclusion Shear wave elastography and quantitative parameters of dynamic blood flow can early evaluate the efficacy of breast cancer NAC.