SWE定量分析在乳腺癌辅助化疗疗效评估中的应用及其与肿瘤血红蛋白的相关性

摘要

Objective To explore the application of shear-wave elastography (SWE) quantitative analysis to evaluate the pathologic response in breast cancer after adjuvant chemotherapy and its correlation with tumor hemoglobin.Methods A total of 56 patients with breast cancer(56 lesions) were treated with neoadjuvant chemotherapy(NAC) and surgery after biopsy diagnosis.The maximal modulus of elasticity was measured by SWE before and after NAC chemotherapy,the total hemoglobin concentration(HbT) was measured by US-diffuse optical tomography(US-DOT).The pathological evaluation was chosen as gold standard.The efficacy of NAC evaluation by the RECIST1.1 and the maximum elastic modulus was compared,and the correlation between HbT and HbT was analyzed.Results The reduction rate of tumor diameter,HbT value and maximum elastic modulus in significant pathological response patients were significant different with non-significant pathological response patients (P＜ 0.05).The sensitivity,specificity,accuracy and Kappa values of NAC evaluation by RECIST1.1 were 86.4％,91.7％,87.5％ and 0.678,and the sensitivity,specificity,accuracy and Kappa values of NAC evaluation by maximal modulus of elasticity were 88.6％,75.0％,85.7％ and 0.600,there was no difference in two groups(P＞0.05).There was a significant positive correlation between the maximum elastic modulus reduction rate and the HbT reduction rate(r=0.785,P=0.000).Conclusion The maximal modulus of elasticity of breast lesions measured by SWE can reflect tumor hemoglobin level objectively,wihch can be convenient,effective and accurate to evaluate NAC effacy with reduction rate of maximum elastic modulus.%目的 探讨剪切波弹性成像(shear-wave elastography,SWE)定量分析在乳腺癌辅助化疗疗效评估中的应用及其与肿瘤血红蛋白的相关性.方法 选择56例乳腺癌患者(共56个病灶),经穿刺活检病理确诊后行新辅助化疗(neoadjuvant chemotherapy,NAC),并行手术切除.NAC化疗前后采用SWE测定最大弹性模量值,采用超声光散射成像技术(US-diffuse optical tomography,US-DOT)测定肿瘤总血红蛋白浓度(total hemoglobin concentration,HbT).以病理学疗效判为金标准,比较实体瘤疗效评价标准RECIST 1.1 (Response Evaluation Criteria in Solid Tumors 1.1,2009年修订)和最大弹性模量值评估NAC疗效的评估效能,并分析最大弹性模量值与HbT的相关性.结果 病理反应显著组肿瘤直径降低率、HbT值降低率和最大弹性模量值降低率与病理反应非显著组差异有统计学意义(P＜0.05);RECIST 1.1评估NAC疗效的敏感度、特异度、准确度和Kappa值分别为86.4％、91.7％、87.5％和0.678,最大弹性模量值评估NAC疗效敏感度、特异度、准确度和Kappa值分别为88.6％、75.0％、85.7％和0.600,其差异均无统计学意义(P＞0.05);最大弹性模量值降低率与HbT降低率呈显著正相关(r=0.785,P=0.000).结论 SWE测定乳腺癌病灶的最大弹性模量值能够客观反映肿瘤血红蛋白水平,且采用化疗前后最大弹性模量值降低率能够方便、有效、准确地评估NAC疗效,是NAC疗效评估的有效方法.