The Curative Efficacy Evaluation Of Neoadjvant Chemotherapy For Breast Cancer By Contrast-enhanced Ulrasonography(CEUS)and Acoustic Radiation Force Impulse(ARFI) Imaging

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The curative efficacy evaluation of neoadjuvant chemotherapy for breast cancer by contrast-enhanced ultrasonography(CEUS)and acoustic radiation force impulse(ARFI)imagingOBJECTIVE: To investigate the value of conventional ultrasound,contrast-enhanced ultrasound(CEUS)and radiation force impulse(ARFI)imaging in assessing the efficacy of neoadjuvant chemotherapy in breast cancer.METHOD: 67 patients of breast cancer with pathologically diagnosis underwent four to eight cycles of neoadjuvant chemotherapy.Conventional ultrasound and contrast-enhanced ultrasonography(CEUS)were used tomeasure the size of the lesion before and after neoadjuvant chemotherapy.Color doppler flow imaging and CEUS were used to evaluate the blood supply of the tumors before and after neoadjuvant chemotherapy.Acoustic radiation force impulse imaging was used to measure shear wave velocity inside and around the tumor.Tumor perfusion parameters were measured with contrast-enhanced ultrasound.Pathological evaluation of neoadjuvant chemotherapy efficacy based on Miller-Payne system.Imaging assessment of neoadjuvant chemotherapy efficacy based on RECIST system.To investigate the value of CEUS and ARFI in assessing the efficacy of neoadjuvant chemotherapy in breast cancer.RESULT: Among the 67 patients,with pathological MP system,21(31.34%)cases were effective and 46(68.66%)cases were ineffective.CEUS is more accurate than conventional ultrasound in measuring the maximum diameter of residual lesions.According to the RECIST criteria and M-P system,the sensitivity of conventional ultrasound in assessing the efficacy of NAC was 81.0%,specificity was 65.2%,and pathological correlation coefficient was 0.400.The sensitivity of CEUS was81.0%,the sp ecificity was 78.3%,and the correlation coefficient was 0.549.The sensitivi ty of tumor internal SWV was 90.5%,specificity was 84.8%,and patholog ical correlation coefficient 0.707.The sensitivity of tumor edge SWV was85.7%,specificity was 80.4%,and the pathological correlation coefficient of 0.614.The parameters of perfusion imaging,PI and AUC had statistical significance before and after NAC(P<0.05).CONCLUSION: CEUS and ARFI are effective methods to evaluate the efficacy of neoadjuvant chemotherapy in breast cancer.CEUS is more accurate than conventional ultrasound in measuring the maximumdiameters of the residual lesions and ARFI can accurately reflect the changes of the breast tumor tissue elasticity before and after neoadjuvant chemotherapy.Therefore,CEUS and ARFI are of useful clinical value in evaluating the efficacy of neoadjuvant chemotherapy.CHAPTER ? Assessing MVD changes after NAC of implanted breast tumor in mice by contrast-enhanced ultrasound OBJECTIVE:The contrast-enhanced ultrasound was used to compare the perfusion changes of implanted breast tumor in mice after neoadjuvant chemotherapy to evaluate the changes of implanted breast tumor's microvascular density(MVD).To study the value of CEUS in evaluating the efficacy of neoadjuvant chemotherapy in breast cancer.METHOD: MDA-MB-231 breast cancer cells were cultured.Twenty nude mice models of breast cancer xenografts were established.Nude mice wear randoml divided into the control group and treatment group.The treatment group received docetaxel,and the control group received norm al saline.After chemotherapy,nude mice underwent routine ultrasonograph y and contrast-enhanced ultrasound.The maximum diameter of transplante dtumor and perfusion parameters were measured.After that,the nude mice were dissected and the size of the transplanted tumor was measured.The effect of neoadjuvant chemotherapy was observed by HE staining and the MVD was detected by immunohistochemistry.The correlation between the quantitative parameters of CEUS and MVD were analyzed respectively.RESULT : Twenty nude mice models of breast cancer xenografts were successfully established,with a tumorigenic rate of 100%.The volume of the treatment group was 1023 ± 294 mm3,the volume of the control group was 1747± 349 mm3,and the tumor inhibition rate was(30.74 ± 11.7)%.Pathological measurement of the treatment group long axis diameter was 10.9 ± 2.2mm,conventional ultrasound measurement of the treatment group long axis diameter9.2 ± 1.2mm,CEUS examination measurement of the treatment group long axis diameter was 10.1 ± 1.7mm,there was no statistical difference between two methods(P > 0.05).Quantitative analysis software was used to compare the CEUS quantitative parameters RT(reaching time),PI(peak intensity),TTP(time to peak)and AUC(area under curve)of NAC group and control group.There was no statistical difference in RT between treatment group and control group(P>0.05)while PI,TTP and AUC had statistical difference between in treatment group and control group(P<0.05).Spearman rank correlation was used to calculate the correlation coefficient between perfusion parameters and MVD.The correlation coefficient between PI and MVD was 0.712,and the correlation coefficient between TTP and MVD was 0.311.The correlation coefficient between AUC and MVD was 0.556.CONCLUSION: CEUS is of clinical application value in assessing MVD changes after neoadjuvant chemotherapy of implanted breast tumors in mice.In addition,CEUS can accurately show the distribution of bloodf low within the breast cancer xenografts and has high consistency with pathological evaluation.Therefore,it can provide valuable and reliable bases for predicting the efficacy of neoadjuvant chemotherapy.