高强度聚焦超声治疗乳腺癌

Extracorporeal High Intensity Focused Ultrasound in the Treatment of Human Breast Cancer

目的:观察高强度聚焦超声(HIFU)体外治疗乳腺癌的临床安全性和有效性,并初步筛选判断治疗效果的检查手段。方法:24例乳腺癌患者在行乳腺癌改良根治术前1～2周行HIFU治疗,HIFU治疗中和治疗后,监测患者血压、呼吸、脉搏和外周血氧饱和度的变化。同时,观察HIFU对靶区处组织和皮肤的损伤作用。手术切除标本送病理检查,观察HIFU对靶区组织的破坏效应。其中3例患者在HIFU治疗前后行99mTc-MIBIECT检查,1例患者在HIFU治疗前后行MRI检查。结果:HIFU治疗对靶区外邻近组织和患者生命体征无明显影响,HIFU靶区内组织呈完全凝固性坏死。99mTc-MIBIECT和MRI显示靶区内组织坏死。结论:在实时超声引导下,HIFU治疗安全、有效,99mTc-MIBIECT和MRI可作为判断疗效的检查方法,HIFU技术可望成为乳腺癌保乳治疗方法之一。

Objective:To observ e the efficacy and safety of high intensity focused ultra-sound(HIFU)in the tre atment of patients with breast cancer and select evaluating modalities.Methods :Twenty-four patients with breast cancer underwent extracorporeal HIFU ablat ion for pri-mary focus1-2weeks before modified radical mastectomy.During an d after HIFU procedure,blood pressure,pulse,respiratory rate,temperature,an d peripheral oxygenation of treated patient were monitored to assess the safety of the treatment.Also,adverse effects on surrounding breast tissue and skin w ere carefully examined after HIFU ablation.Pathological examination of removal specimen was performed to observe the gross and microscopic changes within the t argeted-tumor.3patients underwent 99m Tc-MIBI ECT and1patient underwent MRI pre-and after HIFU treat-ment .Results:during and after HIFU procedure,no significant change in treated-p atient 's blood pressure,pulse,respi ra tory rate,temperature,and peripheral oxygenation was observed.There was not any evidence of skin burn and adjacent tissue damage outside targeted tissue in the treated breast.Pathological exami nation showed that HIFU induced a complete ablation of targeted tissue.The exte nt of coag ulation necrosis included breast cancer focus and its adjacent brea st tissue about 1.5-2.0cm around the visible tumor.The image of 99m Tc-MIBI ECT and MRI showed tar-geted tis sue ablated by HIFU treatment. Conclusion:With real-time ultrasound image guided,extracorporeal HIFU can co mpletely ablate breast cancer. 99m Tc-MIBI ECT and MRI may be become effective evaluating modalities.This extraocorporeal HIFU could provide a novel modality for non invasive treatment of human breast cancer.