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(Department of Ultrasound, Shengjing Hospital ofChina Medical University, Shenyang 110004, China)



Strain ultrasound elastography predicting pathological complete response to neoadjuvant chemotherapy in breast cancer patients

MAYan,LIJing,RENWeidong*,DENGLijun

(DepartmentofUltrasound,ShengjingHospitalofChinaMedicalUniversity,Shenyang110004,China)

ObjectiveTo evaluate the predictive diagnostic performance of strain ultrasound elastography (SUE) in pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) in breast cancer patients. MethodsSixty breast cancer patients were consecutively included. The strain ratio and strain score was assessed by SUE before biopsy. Pathologic response was evaluated according to Miller-Panye grading system, and immunohistochemical analysis was recorded.Logisticregression analysis was performed to explicit the independent risk factors of pCR. The ROC curve and the area under the ROC (AUC) were calculated,Ztest was used to compare the differences between AUCs. ResultsHigh strain score was the independent risk factor for pCR. The predictive value of the strain ratio was the best among all variables, the AUC was 0.92±0.03. The difference of AUC between Ki-67 (0.60±0.08) and strain ratio was significant (P<0.01); but the difference between strain ratio and strain score (0.89±0.05) had no significant (P=0.36). ConclusionThe stiffness evaluated by SUE is variable for predicting the pCR to NAC, SUE plays an important role in individualized treatment of breast cancer.

Breast neoplasms; Elasticity imaging techniques; Neoadjuvant chemotherapy; Ultrasonography

乳腺癌是威胁女性身体健康的恶性疾病之一。新辅助治疗是乳腺癌整体治疗的重要组成部分，目的在于对一些局部晚期乳腺癌患者采用全身治疗，使肿瘤体积缩小、分期降低，从而使不可手术的乳腺癌患者重新获得手术治疗的机会，使不适合保乳手术的患者获得可以保乳治疗的机会。乳腺癌新辅助治疗包括新辅助化疗(neoadjuvant chemotherapy, NAC)、新辅助内分泌治疗和靶向治疗，以NAC应用最为广泛[1]。

近年来，应变力超声弹性成像 (strain ultrasound elastography, SUE)技术通过评估组织的变形能力反映组织的硬度，从而判断病灶的良恶性，与传统的B型超声相比显示出其独特的优越性。在NAC治疗前，利用SUE预测乳腺癌NAC的病理反应性，有利于尽早发现对化疗抵抗的肿瘤，并及时调整更换治疗方案，合理安排手术时机，以减少不必要的治疗及化疗药物的毒副反应[1-3]。本研究旨在探讨SUE在早期预测乳腺癌NAC疗效中的价值。

1　资料与方法

1.1一般资料选取2014年1月—2015年12月于我院乳腺外科接受NAC并最终手术的女性乳腺癌患者60例，年龄27～66岁，平均(46.9±10.2)岁，肿瘤最大径1.0～10.0 cm，平均(4.17±1.82)cm。患者均为临床分期Ⅱ～Ⅲ期高级别乳腺癌，其中42例肿瘤较大或有淋巴结转移，18例拟行保乳手术治疗，均无远处转移。所有患者NAC治疗前均经超声引导下粗针穿刺活检证实为乳腺癌，且未接受其他治疗。

所有患者均行6个周期NAC后进行手术治疗。采用TEC化疗方案，为多西他赛(75 mg/m2)、表柔比星(75 mg/m2)、环磷酰胺(500 mg/m2)；荧光原位杂交(fluorescence in situ hybridization, FISH)检测示人表皮生长因子受体2(human epidermal growth factor receptor 2, HER2)阳性的患者中6例同时给予靶向药物赫赛汀治疗，首次8 mg/kg体质量，之后6 mg/kg体质量。……