Multivariate Analysis Of Ultrasound Evaluation Early Response Of Breast Cnacer To Neoadjuvant Chemotherapy

Neoadjuvant chemotherapy for breast cancer is the first step in the treatment of breast cancer. It is a general and systemic cytotoxic drug therapy before surgery or surgery plus radiotherapy. The significance lies in reducing the stage of tumor, increasing the probability of breast conserving surgery and improving the long-term prognosis of breast cancer. In recent years, with the clinical application of more and more widely, the evaluation of its efficacy has become a hot research topic. A large number of studies have shown that ultrasound has a certain advantage in the evaluation of NAC in breast cancer. But most of the studies focused on the evaluation of the efficacy of various indexes after the end of chemotherapy. China Cancer Society guidelines says that after 2 courses of chemotherapy, the tumor without change or instead, should be based on the actual situation to consider whether the need to replace the chemotherapy regimen or other therapies. Therefore, it has become the focus to find a reliable method or index to evaluate the efficacy of NAC in the early stage of breast cancer.79 patients with primary breast carcinoma received US examination before NAC and after 2 cycles. We monitor the two-dimensional ultrasound index: the maximum diameter of the lesions, shape, boundary, internal echo, rear echo; color Doppler ultrasound index: grade of blood flow, resistance index(RI), peak systolic velocity(PSV); ultrasound elastography indexes: elasticity scores, elastic strain rate(SR). According to the postoperative pathology, the response of chemotherapy were divided into effective group(MHR) and ineffective group(NMHR). Comparing the change of parameters in MHR and NMHR the before and after2 course of NAC. Univariate and multivariate Logistic regression analysis were used to analyze the factors that can be used to early evaluate the efficacy of NAC in breast cancer. The mathematical model is established, and ROC analysis test method regression model of diagnostic efficiency. Establish mathematical model, and use ROC analysis method to test the diagnostic efficiency of regression model.Single factor analysis showed that the internal echo, blood flow classification, elasticity score, maximum diameter changes, RI, PSV, SR can be used as an assessment of breast cancer NAC early efficacy of the relevant factors. Logistic regression analysis of the 7 indicators, the results show that RI, PSV, SR, the maximum diameter of the changes in the model can be set into the group. Ratio Odds were 6.936, 7.228, 9.717, 6.312, sorting for SR>PSV>RI> maximum diameter variation. The Logistic regression model was obtained: Logist(P)=-15.970+1.937X4+1.978X5+ 2.274X6+1.843X7. The ROC curve of multi parameter regression model was drawed, and its AUC is 0.954(S.E.= 0.025, P < 0.001, 95%CI =0.900-1.000). The area under the curve was significantly larger than that of the single index to assess the efficacy of the area under the curve.This study suggests that the effect of ultrasonic parameters on the early stage of breast cancer NAC is better correlated with pathologic correlation. It can be used as a reliable examination method for early evaluation of NAC in breast cancer. But the parameters before chemotherapy can not evaluate the final efficacy. The changes of RI, PSV, SR and maximum diameter can make the reliability assessment of the early effect of NAC. Multivariate regression model has higher diagnostic accuracy than single factor index in predicting early breast cancer NAC. Multi factor combined diagnosis can greatly enhance the ability of single factor diagnosis, and it has a certain clinical significance for early treatment of breast cancer NAC.