ABVS对乳腺癌新辅助化疗疗效评价的应用价值

发布时间：2018-04-21 09:59

本文选题：乳腺肿瘤 + 超声检查　；参考：《中国临床医学影像杂志》2017年11期

【摘要】：目的 :评估局部进展期乳腺癌患者在新辅助化疗(Neoadjuvant chemotherapy,NACT)前后癌灶最大径、面积、体积及其缩小率与NACT病理反应性分级的关系,进而探讨自动乳腺全容积扫描(Automated breast volume scanner,ABVS)在NACT疗效评价中的应用价值。方法 :本研究为前瞻性研究。81例病例均根据术后病理反应性结果 (MillerPayne分级)分为组织学显著反应(MHR)与组织学非显著反应(NMHR)2组,所有病例术前对2组NACT前、NACT第2周期后、NACT第4周期后均做ABVS测量癌灶最大径、面积、体积及其缩小率分别进行两独立样本t检验比较(非正态分布的数据进行Mann-Whitney U检验);采用CCC分析3次ABVS测量的癌灶最大径与面积、体积之间的一致性。利用受试者工作特征曲线(ROC)分析判断ABVS测量的癌灶大小对NACT病理反应性的评估价值。结果 :NACT前后,MHR组和NMHR组肿物最大径、面积及体积分别组内比较,差异均有统计学意义(P0.05)。MHR组和NMHR组最大径、面积及体积组间比较,最大径差异有统计学意义(P0.05),面积及体积差异无统计学意义(P0.05)。MHR组与NMHR组最大径、面积及体积的第一次及第二次缩小率比较,差异均有统计学意义(P0.05),MHR组的缩小率高于NMHR组,而且MHR组中的第二次缩小率均明显高于NMHR组。两组组内第一次与第二次缩小率比较,差异均有统计学意义(P0.05),各组第二次缩小率高于第一次缩小率,而且在MHR组中较NMHR组更明显。以NACT后癌灶最大径、面积和体积第一次和第二次缩小率为评估参数、术后病理反应性为金标准,第一次缩小率R0C曲线的曲线下面积(AUC)分别为0.696、0.693、0.723,第二次缩小率R0C曲线AUC分别为0.807、0.824、0.858,有一定诊断价值,三者评估效能无显著性差异。结论:ABVS测量乳腺癌灶最大径与面积、体积的一致性较好,对评估NACT疗效有一定的应用价值。NACT后,癌灶最大径、面积与体积的缩小率可预测评估癌灶对NACT的病理反应性。
[Abstract]:Objective: to evaluate the relationship between the maximum diameter, area, volume and size of neoadjuvant chemotherapy before and after neoadjuvant chemotherapy in patients with locally advanced breast cancer. To evaluate the value of automated breast volume scannerus (ABVS) in evaluating the curative effect of NACT. Methods: one hundred and eighty-one cases of prospective study were divided into two groups according to the results of pathological reactivity: histologic significant response (MHRs) and histologic nonsignificant response (NMHR2). All the patients were performed ABVS before and after the second cycle of NACT before and after the second cycle of NACT, and the maximum diameter and area of the lesion were measured by ABVS before and after the second cycle of NACT. The volume and the reduction rate were compared with two independent samples by t test (Mann-Whitney U test for non-normal distribution data, and CCC analysis for the consistency between the maximum diameter, area and volume of cancer focus measured by ABVS three times). The evaluation value of tumor focus size measured by ABVS on pathological reactivity of NACT was evaluated by ROC-based operating characteristic curve. Results the maximum diameter, area and volume of tumor in MHR group and NMHR group were significantly different before and after 1% NACT. There were significant differences between MHR group and NMHR group in maximum diameter, area and volume. There was no significant difference in area and volume between MHR group and NMHR group. The first and second reduction rates of maximum diameter, area and volume in MHR group were significantly higher than those in NMHR group. The second reduction rate in MHR group was significantly higher than that in NMHR group. There were significant differences in the first and second reduction rates between the two groups. The second reduction rate in each group was higher than that in the first reduction rate, and it was more obvious in the MHR group than in the NMHR group. The maximum diameter, area and volume of the tumor after NACT were used as the evaluation parameters, and the postoperative pathological reactivity was the gold standard. The area under the curve of the first reduction rate R0C curve was 0.696 and the AUC of the second R0C curve was 0.807 / 0.824 / 0.858, respectively. There was no significant difference in the evaluation efficacy among the three curves. Conclusion the measurement of the maximum diameter and area, volume and volume of breast cancer focus by NACT is of great value. After NACT, the maximum diameter, area and volume of breast cancer focus can be predicted to evaluate the pathological reactivity of tumor focus to NACT. [WT5HZ] [WT5 "HZ] [WT5" HZ] [WT5 "BZ] [WT5" BZ]
【作者单位】：河北省沧州中西医结合医院;
【分类号】：R730.44;R737.9

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