形变弹性成像预测乳腺癌新辅助化疗疗效的价值
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摘要
目的:探讨弹性成像早期准确预测乳腺癌新辅助化疗(NAC)疗效的可行性。方法:选取接受NAC的乳腺癌患者80例,根据治疗前后的病理结果分为反应显著组(63例)和反应非显著组(17例)。记录并比较两组患者NAC前、NAC周期1、2、3、4病灶最大径和弹性比值(B/A值)。采用受试者工作特征(ROC)曲线分析NAC每个周期下病灶最大径和B/A值预测NAC疗效的价值,利用logistic回归探讨病灶最大径联合B/A值早期准确预测NAC疗效的最佳时间。结果:病灶最大径和B/A值在NAC治疗期间内均呈下降趋势,差异有统计学意义(F组内=82.286,P组内<0.001;F组内=141.905,P组内<0.001)。B/A值在反应显著组与非显著组中的差异有统计学意义(F组间=11.990,P组间=0.001)。ROC曲线分析结果显示病灶最大径仅在NAC周期4的曲线下面积(AUC)>0.8;B/A值在周期3的AUC接近0.8,周期4的AUC>0.9,具有较高的预测价值。NAC周期3最大径联合B/A值的拟合方程为logit(P)=-33.307+4.805×B/A值+3.087×最大径,此时AUC=0.915(>0.9),截断值为0.746,敏感度为100%,特异度为74.60%。结论:形变弹性成像中病灶B/A值联合病灶最大径可以提前准确预测乳腺癌患者的NAC疗效。
Objective:The purpose of this study was to investigate the feasibility of early prediction of the efficacy of neoadjuvant chemotherapy(NAC)in breast cancer.Methods:Eighty patients with breast cancer who underwent NAC were enrolled in this study.All were divided into significant response group(n=63)and non-significant response group(n=17)according to the pathological results before and after treatment.The maximum diameter and B/A value of the lesions before NAC,NAC cycle 1,cycle 2,cycle 3,and cycle 4were recorded and compared between the two groups.The ROC curve was established to analyze the value of the maximum diameter and B/A value of each cycle in predicting the efficacy of NAC.Logistic regression was used to explore the optimal time for the accurate prediction of NAC in the early stage of combined maximum diameter and B/A value.Results:The maximum diameter and B/A values showed a downward trend during the course of NAC treatment.The differences were statistically significant(Fwithin group=82.286,Pwithin group<0.001;Fwithingroup=141.905,Pwithingroup<0.001).The B/A value was significantly different between the significant response group and the non-significant response group(Fbetween group=1.1990,Pbetween group=0.001).Through ROC curve analysis it was found that the maximum diameter of the lesion only had an AUC of cycle 4 exceeding 0.8.The AUC of the B/A value in cycle 3 was close to 0.8,and the AUC in cycle 4 was greater than 0.9,which meant a high predictive value.The fitting equation of maximum diameter combined B/A value in NAC cycle 3 was logit(P)=-33.307+4.085×cycle 3B/A value+3.087×cycle 3maximum diameter.The AUC first reached 0.9in four cycles(0.915).The cutoff value was0.746.The sensitivity was 100%,and the specificity was 74.60%.Conclusion:The B/A value combined with the maximum diameter of the lesions in deformation elastography can accurately predict the efficacy of NAC in patients with breast cancer.
Objective:The purpose of this study was to investigate the feasibility of early prediction of the efficacy of neoadjuvant chemotherapy(NAC)in breast cancer.Methods:Eighty patients with breast cancer who underwent NAC were enrolled in this study.All were divided into significant response group(n=63)and non-significant response group(n=17)according to the pathological results before and after treatment.The maximum diameter and B/A value of the lesions before NAC,NAC cycle 1,cycle 2,cycle 3,and cycle 4were recorded and compared between the two groups.The ROC curve was established to analyze the value of the maximum diameter and B/A value of each cycle in predicting the efficacy of NAC.Logistic regression was used to explore the optimal time for the accurate prediction of NAC in the early stage of combined maximum diameter and B/A value.Results:The maximum diameter and B/A values showed a downward trend during the course of NAC treatment.The differences were statistically significant(Fwithin group=82.286,Pwithin group<0.001;Fwithingroup=141.905,Pwithingroup<0.001).The B/A value was significantly different between the significant response group and the non-significant response group(Fbetween group=1.1990,Pbetween group=0.001).Through ROC curve analysis it was found that the maximum diameter of the lesion only had an AUC of cycle 4 exceeding 0.8.The AUC of the B/A value in cycle 3 was close to 0.8,and the AUC in cycle 4 was greater than 0.9,which meant a high predictive value.The fitting equation of maximum diameter combined B/A value in NAC cycle 3 was logit(P)=-33.307+4.085×cycle 3B/A value+3.087×cycle 3maximum diameter.The AUC first reached 0.9in four cycles(0.915).The cutoff value was0.746.The sensitivity was 100%,and the specificity was 74.60%.Conclusion:The B/A value combined with the maximum diameter of the lesions in deformation elastography can accurately predict the efficacy of NAC in patients with breast cancer.
引文
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[10]张继博,史业辉,贾勇圣,等.三阴性乳腺癌治疗进展[J].肿瘤,2017,37(7):788-794.
[11] Zeichner SB,Hiromi T,Keerthi G.A review of systemic treatment in metastatic triple-negative breast cancer[J].Breast Cancer(Auckl),2016,22(10):25-36.
[12]张斌.乳腺癌的新辅助化疗[J].中华肿瘤杂志,2003,25(3):209-211.
[13]袁沙沙,程莹莹,杨春雪,等.剪切波弹性成像评价乳腺癌新辅助化疗的疗效[J].中国医学影像技术,2016,32(1):71-74.
[14]刘洋,丁莹莹,李卓琳,等.基线ADC值对不同分子亚型乳腺癌新辅助化疗疗效的预测价值[J].放射学实践,2016,31(11):1057-1061.
[15]周如海,邬颖杰,吴猛,等.超声造影技术在乳腺癌新辅助化疗疗效评估中的应用价值[J].医学影像学杂志,2015,26(4):711-714.
[16]韩咏峰,施丽英,蔡少雨,等.超声弹性应变率在乳腺癌新辅助化疗疗效评价中的应用价值[J].中国超声医学杂志,2016,32(4):298-300.
[17]宗瑜,吴佳毅,沈坤炜.乳腺癌新辅助治疗的国际共识与解读[J].中华外科杂志,2013,51(1):10-13.
[2] Castaneda CA,Mittendorf E,Casavilca S,et al.Tumor infiltrating lymphocytes in triple negative breast cancer receiving neoadjuvant chemotherapy[J].World J Clin Oncol,2016,7(5):387-394.
[3]张平安,罗娅红.乳腺癌功能磁共振[J].放射学实践,2017,32(6):582-586.
[4]杨晓婧,王法,娜迪热·铁列吾汗.超声造影在乳腺癌新辅助化疗疗效评价中的价值[J].中华实用诊断与治疗杂志,2016,30(4):396-398.
[5] Bae JS,Chang JM,Lee SH,et al.Prediction of invasive breast cancer using shear-wave elastography in patients with biopsy-confirmed ductal carcinoma in situ[J].Eur Radiol,2017,27(1):7-15.
[6] Evans A,Sim YT,Thomson K,et al.Shear wave elastography of breast cancer:Sensitivity according to histological type in a large cohort[J].Breast,2016,26(3):115-118.
[7]黄伟强,董常峰.弹性成像及血生化指标对肝纤维化的评价及研究进展[J].新发传染病电子杂志,2017,2(2):117-121.
[8] Sahoo S,Lester SC.Pathology of breast carcinomas after neoadjuvant chemotherapy:an overview with recommendations on specimen processing and reporting[J].Arch Pathol Lab Med,2009,133(4):633-642.
[9]《乳腺癌新辅助化疗后的病理诊断专家共识》编写组.乳腺癌新辅助化疗后的病理诊断专家共识[J].中华病理学杂志,2015,44(4):232-236.
[10]张继博,史业辉,贾勇圣,等.三阴性乳腺癌治疗进展[J].肿瘤,2017,37(7):788-794.
[11] Zeichner SB,Hiromi T,Keerthi G.A review of systemic treatment in metastatic triple-negative breast cancer[J].Breast Cancer(Auckl),2016,22(10):25-36.
[12]张斌.乳腺癌的新辅助化疗[J].中华肿瘤杂志,2003,25(3):209-211.
[13]袁沙沙,程莹莹,杨春雪,等.剪切波弹性成像评价乳腺癌新辅助化疗的疗效[J].中国医学影像技术,2016,32(1):71-74.
[14]刘洋,丁莹莹,李卓琳,等.基线ADC值对不同分子亚型乳腺癌新辅助化疗疗效的预测价值[J].放射学实践,2016,31(11):1057-1061.
[15]周如海,邬颖杰,吴猛,等.超声造影技术在乳腺癌新辅助化疗疗效评估中的应用价值[J].医学影像学杂志,2015,26(4):711-714.
[16]韩咏峰,施丽英,蔡少雨,等.超声弹性应变率在乳腺癌新辅助化疗疗效评价中的应用价值[J].中国超声医学杂志,2016,32(4):298-300.
[17]宗瑜,吴佳毅,沈坤炜.乳腺癌新辅助治疗的国际共识与解读[J].中华外科杂志,2013,51(1):10-13.