The Value Of Ultrasonography Applied In Therapeutic Effect Assessment Of Neoadjuvant Chemotherapy For Breast Cancer

Background:Breast cancer is the most common malignant tumor of women.In recent years, its incidence has been increasing and the age of patients has been decreasing year by year. In China,it has been located in the first place in female malignant tumor of city, and threatened females'health of mind and body seriously.Neoadjuvant chemotherapy (NAC) has been widely accepted in the treatment of breast cancer in recent years. It can not only improve the surgery resection rate, but also increase the opportunity of breast-conserving srugery.And neoadjuvant chemotherapy can guide the postoperative drugs of choice as it offers the rare drug sensitive test in vivo. Therefore,it is the key of research to improve the curative effect of neoadjuvant chemotherapy and identify the reliable predictive markers for the response of it. It will certainly help to make treatment scheme in the management of breast cancer.Objective To compare the features changes of primary lesion and axillary lymph node by analyzing the ultrasonograms before and after neoadjuvant chemotherapy in the patients with breast cancer who finally do the surgical treatment,including size, gray-scale ultrasound imaging characteristics, color flow of primary lesion and axillary lymph node, hemodynamic parameters and elastic score of ultrasound of the primary lesion.To analyze the correlation between the change of each index of ultrasonograms and pathological curative effect, regarding pathological curative effect as the gold standard. And judge the contribution magnitude of each index of ultrasound in the curative effect, aim to sum up and form some of the sensitive ultrasound judged index to be beneficial to the analysis and judgment of neoadjuvant chemotherapy curative effect, and provide more valuable information for further clinical diagnosis and treatment options.Methods Using color Doppler ultrasound,59patients with breast cancer were contrasted the features changes in primary lesion and axillary lymph node by analyzing the ultrasonograms before and after neoadjuvant chemotherapy,including size, two-dimensional ultrasound imaging characteristics, color flow in primary lesion and axillary lymph node, hemodynamic parameters and elastic score of ultrasound in the primary lesion.And we give the statistical assignment to the changes of primary focal ultrasonographic feature. Binary classification Logistic regression was performed,a Logistic model for predicting therapeutic effect on the basis of ultrasonographic feature changes was obtained and the contribution degrees were ranked through OR values.Results Compared with neoadjuvant chemotherapy than before, the largest length of original tumor decreased obviously (P<0.001). With standard of RECIST, color Doppler ultrasound evaluate primary cancer complete remission in2cases, partial remission in41patients, stablized in16, ultrasonic response rate was72.88%, and pathology testing results in (79.66%), and residual carcinoma measurements beween Ultrasound and postoperative pathology are moderate related (r=0.675, P<0.001); Before chemotherapy the color flow within the original tumors are more common with Ⅱ or Ⅲ grade (83.05%), after chemotherapy they are0-1(86.44%),which has reduced.The difference was statistically significant (P<0.001); Vmax and RI were measured before and after chemotherapy, the difference in Vmax before and after chemotherapy is (7.90±3.64) and (0.14±0.07) in RI.Both differences are significant in the paired t test (t=16.66, P<0.001; t=14.13,P<0.001); After chemotherapy,53patients whose original tumor in elastic score is4-5grade reduced to13cases, the difference was statistically significant (P<0.001).59cases of breast cancer original tumor mass except2cases disappeared, in the rest of57patients,16cases of the irregular shape increased to38cases,23cases with strong echo halo around fell to8cases after neoadjuvant chemotherapy,the clear boundary from18cases to47cases, the more mass echoes from10to38cases,2cases occur cystic-changes, calcification increased in8cases, no change in the posterior echo from9 cases to43cases. The gray-scale sonographic features changes after treatment above which were analysis with statistics, are statistically significant (P<0.01).36patients with positive lymph node is disappeared in7cases,29cases reduce in different levels, in32cases which can be examined color flow,25cases reduced the rich blood flow,7cases disappear. Above changes before and after treatment in lymph nodes showed a statistically significant difference (P<0.05).Through the binary classification Logistic regression analysis screening the independent variable, nine characteristics have statistical significance, among them7independent variable were elected to the model, get Logistic regression equation. The variable regression coefficients and OR values were ranked as follows:X7>X8>X1>X9>X10>X4>X3.That is the contribution of each sonographic features changes in effect assessment arrange order for: color Doppler flow>peak systolic velocity (PSV)>the tumor size>resistance index (RI)>elastic score>strong echo halo around>the mass boundary.Conclusion (1).The correlation between Ultrasound for the evaluation of treatment response and pathological evaluation in neoadjuvant chemotherapy is better.(2). Residual carcinoma measurements beween Ultrasound and postoperative pathology are significant correlative after neoadjuvant chemotherapy.(3). The Logistic model of sonographic features changes such as color Doppler flow, peak systolic velocity (PSV), the tumor size, resistance index (RI), elastic score, strong echo halo around and boundary are helpful to judge the curative effect of the breast cancer neoadjuvant chemotherapy.