| Objective: In recent years,the incidence of breast cancer has continued to rise,in most areas of our country,the incidence of breast cancer in female malignant tumor has leapt to the top,is one of the common malignant tumors at this stage by the majority of women,a serious impact on women's physical and mental health of the patients.With the development of basic and clinical trials,it is now recognized that breast cancer is a systemic disease,the focus of treatment from local treatment to systemic therapy.Therefore,neoadjuvant chemotherapy(NCT)has become a widely accepted method for the treatment of patients with breast cancer.Although the NCT for breast cancer patients has good curative effect,but due to individual differences,NCT also delayed the chemotherapy tolerance on the part of the real effective treatment.This makes we need to explore methods for assessing the efficacy of neoadjuvant chemotherapy.The prediction model of the NCT after the pathological response effectively predicted,so as to achieve the purpose of individualized treatment.At present,there are many methods for evaluating the curative effect of neoadjuvant chemotherapy for breast cancer,but each method to evaluate the sensitivity and accuracy of the NCT effect is not the same.There have been many studies on mammography,CT,MRI,ultrasound and breast cancer histopathology,molecular typing and other aspects of the evaluation on the efficacy of neoadjuvant chemotherapy for the value of the reports,but the current study by imaging of breast cancer and biological changes in the way of the combination of the evaluation of the efficacy of NCT less.US-diffuse optical tomography(US-DOT)is a biological imaging and optical imaging ultrasound combined with the new,can detect breast cancer in vivo total hemoglobin concentration(THb)content.While the change of THb can reflectthe growth status of tumor,represents the change of tumor biology.Therefore,the study on January 2016 to October 2016 in Hebei Province Center for diagnosis and treatment of breast disease diagnosed with primary breast cancer patients undergoing neoadjuvant chemotherapy,ultrasonic light scattering imaging technique examination,compared with the traditional CT,color Doppler ultrasound,change data at the same time will exceed the acousto optic scattering imaging,pathology and surgery comparative analysis,molecular typing and microvessel density,hoping to find an optimal method for the evaluation of the efficacy of neoadjuvant chemotherapy for breast cancer.Methods: The total number of cases in January 2016 to October 2016 in Hebei Province,diagnosis and treatment center of breast disease diagnosed with primary breast cancer and received neoadjuvant chemotherapy and US-DOT examination of a total of 60 cases.The 60 cases were divided into groups,according to the RECIST1.1 standard,divided into 4 groups,PR(partial response),CR(complete response),PD(progressive disease)and SD(stable disease).According to Miller and Payne(MP)grading system,divided into 2 groups,MP 1-3 grade for the poor efficacy group,MP4-5 grade for excellent group.According to the expression of hormone receptor and HER2 expression,it was divided into 3 groups: hormone receptor positive group,HER2 positive group and the triple negative group.The 62 cases were examined the microvessel density(MVD)of preoperative core needle biopsy and postoperative specimens.Accurate data input SPSS19.0 statistical software to collect good statistics.Results:1 Of the 62 patients after NCT,CR group has 9 cases(14.6%),PR group has 27 cases(43.5%),SD group has 26 cases(41.9%)and PD group has none.The THb value before chemotherapy was 278.222±43.150,270.148±34.674,263.731 ± 36.275.THb value after chemotherapy was 78.444 ± 55.184,120.741 ± 45.597,140.231±44.846.After NCT,the average value of THb decreased was 25.453±5.700,18.489±7.182,13.562±8.027,the difference inTHb value was statistically significant(P < 0.001).After first cycles of chemotherapy,the THb value began to decline,the value of THb decreased was 96.111±12.888,69.852±8.950,40.923±5.470,the difference in THb value was statistically significant(P<0.001).If the THb value is greater than63,tumor size is likely to reach CR or PR status after chemotherapy.2 Postoperative pathology was pCR in 13 cases.The THb values of pCR group and non pCR group before chemotherapy were 259.462 ± 36.085,267.408±37.508.Compared with the non pCR group,no matter after NCT or after 1 cycles of chemotherapy,the THb value of decline was higher in the pCR group than in the non pCR group,and the difference of THb value was statistically significant(P<0.001).3 According to the histopathological grading of MP,62 cases were pathologically diagnosed as grade MP1-3 with a total of 36 cases,THb value before chemotherapy was 262.806±36.718.There were 26 cases of MP4-5after operation,and the THb value before chemotherapy was 269.808±37.881.The value of THb after NCT was 135.246±44.317 in MP1-3gruop,in MP4-5group was 21.843±6.202,the value of THb of decline was 127.863±57.973 in MP1-3gruop,in MP4-5 group was 162.848 ± 61.349,the difference between groups was statistically significant(P=0.007).After 1 cycles of chemotherapy,THb decreased in MP1-3 group was 46.833±5.833,in MP4-5group was104.361±40.160,the difference between groups was statistically significant(P=0.011).4 There was no significant difference about the THb value of decline between the 3 groups,hormone receptor positive group,HER2 positive group and the triple negative group(P>0.05).There was no significant difference between HER2 positive group and HER2 negative group in the decrease of THb value(P>0.05).6 The decline of MVD value before and after chemotherapy was correlated with the decline of THb value(P=0.037).In pCR group and non pCR group,the difference of MVD value was statistically significant(P <0.001),the change of THb value is great value in predicting and evaluating theefficacy of neoadjuvant chemotherapy.Conclusion:1 In the neoadjuvant chemotherapy of breast cancer,the decrease of THb is directly proportional to the curative effect of chemotherapy.2 The change of THb value was consistent with the change of MVD value,which indicated that THb could be used as a functional index of breast cancer detection.3 In the process of neoadjuvant chemotherapy for breast cancer,the change of THb value will be in the early to make the assessment and prediction of chemotherapy efficacy of neoadjuvant chemotherapy,the future can be used as an effective index to neoadjuvant chemotherapy in breast cancer early clinical efficacy evaluation and prediction. |
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