摘要
目的对HER-2过表达型及基底样型雌激素受体(estrogen receptor,ER)阴性乳腺癌新辅助化疗(neoadjuvant chemotherapy,NAC)前后声像图进行回顾性分析,探讨超声对ER阴性乳腺癌NAC早、中、后期疗效评估的价值。方法对HER-2过表达型48例、基底样型41例,共89例ER阴性患者进行NAC前后超声动态监测,以术后病理结果分组织学显著反应组和组织学非显著反应组,回顾性分析NAC前及NAC早、中、后期声像图变化。结果HER-2过表达型与基底样型ER阴性乳腺癌NAC总有效率分别为75.0%、53.66%,差异有统计学意义(P<0.05)。在HER-2过表达型中病灶最大径缩小率、病灶内部血流变化等参数可用于NAC早、中、后期疗效评估(均P<0.05),病灶二维图像特征变化可用于NAC早期疗效评估(P<0.05)。在基底样型中病灶最大径缩小率可用于NAC早、中期疗效评估(均P<0.05),病灶内部血流变化可用于NAC中、后期疗效评估(均P<0.05),病灶二维图像特征变化可用于NAC早期疗效评估(P<0.05)。实时组织超声弹性评分变化对ER阴性乳腺癌在NAC前后无统计学差异(均P>0.05)。结论超声能通过动态观察NAC前后病灶最大径、内部血流、二维图像特征等参数的变化对HER-2过表达型及基底样型ER阴性乳腺癌在NAC早、中、后期作出较为准确的疗效评估;NAC早、中、后期HER-2过表达型与基底样型评估疗效的参数存在差异,因此对ER阴性乳腺癌NAC疗效评估需结合分子分型考虑,才能进一步提高NAC不同时期超声评估的准确性。
Objective To retrospectively analyze the changes of sonogram before and after neoadjuvant chemotherapy(NAC)for estrogen receptor(ER)negative breast cancer,and to explore the value of ultrasound in evaluating the efficacy of NAC in early,middle and late stages.Methods 89 patients with ER negative surface type(48 cases with HER-2 overexpression type and 41 cases with basal-like type)were subjected to dynamic ultrasonic monitoring before and after NAC,and were divided into major histological response group and non-major histological response group according to the postoperative pathological results,retrospectively analyzed the changes of sonogram before NAC and NAC in early,middle and late stages.Results The total NAC response rates of patients with HER-2 over expression type and basal-like type were 75.0%and 53.66%,respectively,with significant differences(P<0.05).In the HER-2 overexpression type,the reduction rate of maximum diameter,internal blood flow were statistically significant differences in the early,middle and late stages of NAC(all P<0.05)and two-dimensional image characteristics change in the early stage of NAC(P<0.05).In the basal-like type,the reduction rate of maximum diameter was statistically significant differences in the early and middle stages of NAC(all P<0.05),internal blood flow in the middle and late stages(all P<0.05)and two-dimensional image characteristics change in the early stage(P<0.05).Real-time tissue elastography score before and after the change in the NAC was not statistical difference(P>0.05).Conclusions Ultrasound can accurately evaluate the efficacy of ER negative breast cancer after NAC by dynamically observing the changes of the maximum diameter of the lesion,internal blood flow,two-dimensional image characteristics,before and after NAC.The changes of indicators of efficacy evaluation of HER-2 overexpression type and basal-like type were not consistent,so the accuracy of evaluation could be further improved by combining the consideration of molecular typing of breast cancer in ultrasonic evaluation.
作者
郭玉萍
裴书芳
丛淑珍
梁照秋
江小艳
GUO Yu-ping;PEI Shu-fang;CONG Shu-zhen;LIANG Zhao-qiu;JIANG Xiao-yan(Department of Ultrasound,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)
出处
《循证医学》
2020年第6期357-362,共6页
The Journal of Evidence-Based Medicine
基金
广东省医学科学技术研究基金资助项目(B2019120)。
关键词
超声
乳腺癌
新辅助化疗
评估
ultrasonography
breast cancer
neoadjuvant chemotherapy
evaluation
