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（Miller&Payne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（P<0．05）。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（P<0．05），面积及体积差异无统计学意义（P>0．05）。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（P<0．05），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（P<0．05），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 estimate the relations between tumor’s longest diameter, area, volume and their reduction rate after neoadjuvant chemotherapy(NACT) and pathological response classification in patients of locally advanced breast cancer, and then investigate the application value of automated breast volume scanner(ABVS) in evaluating the curative effect of NACT. Methods: A prospective study was undertaken in patients undergoing NACT for locally advanced breast cancer in order to determine the ability of quantitative ABVS to assess the final pathologic response. Eighty-one patients were divided into two groups based on pathological response. Pathological response was assessed according to Miller & Payne grading system, of which grade 4 and 5 defined as major histological response(MHR), and grade 1 to 3 as non-major histological response(NMHR). Eighty-one cases with pathologically confirmed locally advanced breast cancer who had been performed four courses of NACT underwent preoperative breast ABVS three times during the NACT. The results are analyzed with T test(or Mann-Whitney U test). Concordance correlation coefficient(CCC) was used to evaluate the agreement among above methods． Receiver operating characteristic curve(R0C) analysis was applied to assess the predictive value of tumor size and the reduction rate． Results: Before, after the second and the fourth cycle of NACT, there were statistical differences in tumor’s longest diameters, areas and volumes among three measurements in MHR group(P<0．05), so does NMHR group(P<0．05)． There were also statistical difference in tumor’s longest diameters between MHR and NMHR(P<0．05), while no difference in tumor’s areas and volumes(P>0．05). The differences between first and second measurements after NACT showed significantly statistical difference(P<0．05)． The reduction rate in MHR group was higher. The same results of reduction rate were found in inter-group between first and second measurements(P<0．05). And the value of second measurement was higher, while the tendency was more obvious in MHR group. Base on reduction rate of their longest diameters, areas and volumes of two times, we take postoperative pathological response as golden standard to get the ROC curve and area under curve(AUC), the above indicators results of first measurement were as follows: 0.696, 0.693, 0.723, the second measurements results were 0.807, 0.824, 0.858. But there were no statistical significance between them. Conclusion: To measure the lesion’s longest diameters, areas and volumes of breast cancer patients with ABVS before and after NACT, we found their agreement are well. ABVS is valuable in evaluating the curative effect of neoadjuvant chemotherapy in patients with breast cancer. After NACT the assessment efficacy of the reduction rate of tumor’s longest diameter, area and volume had significantly predicted effect on estimating pathological reaction
关键词
乳腺肿瘤；超声检查 /
乳房
Key words
Breast neoplasms /
Ultrasonography, mammary
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