Roubidoux Marilyn A, LeCarpentier Gerald L, Fowlkes J Brian, Bartz Brett, Pai Deepa, Gordon Sasha P, Schott Anne F, Johnson Timothy D, Carson Paul L
Department of Radiology, University of Michigan Health Systems, Ann Arbor, MI 48109-0326, USA.
J Ultrasound Med. 2005 Jul;24(7):885-95. doi: 10.7863/jum.2005.24.7.885.
We prospectively evaluated low-stage breast cancers treated with neoadjuvant chemotherapy using whole-volume sonography and color Doppler imaging.
Thirty-four women with breast cancer (mean maximum size, 2.4 cm) received neoadjuvant chemotherapy with doxorubicin and docetaxel. Targeted whole-volume sonography of tumor sites was performed before and after chemotherapy to assess mass size, color pixel speed-weighted density, and American College of Radiology Breast Imaging Reporting and Data System sonographic characteristics. After chemotherapy, tumor sites were excised by lumpectomy or mastectomy.
Three (11.3%) of 34 patients had a complete histologic response. After chemotherapy, correlation was r = 0.716 between final histologic and sonographic sizes. Compared with histologic residual tumors, sonography had 4 false-negative results, 3 false-positive results, and 27 true-positive results (sensitivity, 87%), with no false-negative results among a subgroup of tumors of 7 mm and larger (sensitivity, 100%). The 3 cases with false-positive results were histologic fibrosis or biopsy changes. Mean speed-weighted density was 0.015 before and 0.0082 after chemotherapy (P = .03). After chemotherapy, vascularity was less common within (P = .06) or adjacent to (P = .009) masses or in tumor sites (P = .05). Prechemotherapy variables of gray scale characteristics and vascularity were compared with final histologic size, and all had P > .20.
Postchemotherapy sensitivity of sonography was high for residual tumors of 7 mm or larger. Correlation was moderate between histologic and sonographic final tumor sizes. False-positive results were caused by fibrosis or biopsy-related changes. False-negative results occurred with residual tumor size of 6 mm or smaller. After chemotherapy, vascularity usually decreased, and this was not specific for complete response. Before chemotherapy, no vascular or gray scale feature at initial imaging predicted complete responders.
我们采用全容积超声和彩色多普勒成像对接受新辅助化疗的低分期乳腺癌进行前瞻性评估。
34例乳腺癌女性患者（平均最大尺寸为2.4厘米）接受了阿霉素和多西他赛新辅助化疗。化疗前后对肿瘤部位进行靶向全容积超声检查，以评估肿块大小、彩色像素速度加权密度以及美国放射学会乳腺影像报告和数据系统超声特征。化疗后，通过肿块切除术或乳房切除术切除肿瘤部位。
34例患者中有3例（11.3%）达到完全组织学缓解。化疗后，最终组织学大小与超声大小之间的相关性为r = 0.716。与组织学残留肿瘤相比，超声检查有4例假阴性结果、3例假阳性结果和27例真阳性结果（敏感性为87%），在7毫米及以上的肿瘤亚组中无假阴性结果（敏感性为100%）。3例假阳性结果的病例为组织学纤维化或活检改变。化疗前平均速度加权密度为0.015，化疗后为0.0082（P = 0.03）。化疗后，肿块内部（P = 0.06）或附近（P = 0.009）或肿瘤部位（P = 0.05）的血管分布较少见。将化疗前灰度特征和血管分布的变量与最终组织学大小进行比较，所有P值均大于0.20。
超声检查对化疗后7毫米及以上的残留肿瘤敏感性较高。组织学和超声最终肿瘤大小之间的相关性为中等。假阳性结果由纤维化或活检相关改变引起。假阴性结果出现在残留肿瘤大小为6毫米或更小的情况下。化疗后，血管分布通常减少，这并非完全缓解的特异性表现。化疗前，初始成像时的血管或灰度特征无法预测完全缓解者。
