Sun Bing, Song San-tai, Wu Shi-kai, Jiang Ze-fei, Wang Tao, Zhang Shao-hua, Zhao Yi-bing, Yu Cheng-ze, Li Xiao-bing, Yang Tao, Li Gong-jie
Department of Breast Cancer, Affiliated Hospital of the Academy of Military Medical Sciences, Beijing 100071, China.
Zhonghua Zhong Liu Za Zhi. 2009 Oct;31(10):783-5.
To compare the efficiency of response evaluation by clinical examination, ultrasonograghy and mammography in neoadjuvant chemotherapy (NAC) for breast cancer.
A retrospective cohort study was conducted to analyze the data of 141 patients treated with neoadjuvant chemotherapy. Response evaluation was performed by clinical palpation, ultrasound and mammography.
Only 12 (8.5%) among the 141 patients presented with a stage I tumor. The tumor size determined by palpation was often larger than that by ultrasound before therapy (P < 0.01). Among patients with suspicions axillary nodes checked by ultrasound, 88.3% (53/60) of them had positive nodes by pathology before NAC, and 34.5% (10/29) of patients with negative nodes determined by ultrasound had positive nodes by pathology. In all the 141 patients, 21(14.9%) showed pathological complete remission in both the primary tumor and lymph node. For response evaluation, the false complete remission rate judged by clinical examination was 46.8% (22/47), and the false tumor residual rate by ultrasound was 84.0% (21/25). In 53.5% (23/43) of patients the response could not be assessed by mammography due to that the tumors were undistinguishable in size. The range of microcalcification was not reduced in 5 patients with a partial response of the tumor. 25 patients experienced needle puncture during therapy. Among them, in the 9 pathologically negative patients, only 3 achieved pCR, and the other 16 positive patients didn't achieve pCR.
Using the puncture or sentinel lymph node biopsy, clinicians should pay enough emphasis on the pathological determination of the node status before chemotherapy. Clinicians will make a quite of false judgment of the tumor by clinical examination, ultrasound or mammography. They may use needle puncture during therapy to evaluate the response of neoadjuvant chemotherapy, and the result should be analyzed synthetically.
比较临床检查、超声检查和乳腺钼靶检查在乳腺癌新辅助化疗（NAC）中进行疗效评估的效率。
进行一项回顾性队列研究，分析141例接受新辅助化疗患者的数据。通过临床触诊、超声和乳腺钼靶检查进行疗效评估。
141例患者中仅12例（8.5%）为Ⅰ期肿瘤。治疗前触诊确定的肿瘤大小通常大于超声检查确定的肿瘤大小（P<0.01）。在超声检查怀疑有腋窝淋巴结的患者中，88.3%（53/60）在新辅助化疗前病理检查显示淋巴结阳性，超声检查确定为淋巴结阴性的患者中34.5%（10/29）病理检查显示淋巴结阳性。在全部141例患者中，21例（14.9%）原发肿瘤和淋巴结均显示病理完全缓解。对于疗效评估，临床检查判断的假完全缓解率为46.8%（22/47），超声检查的假肿瘤残留率为84.0%（21/25）。53.5%（23/43）的患者因肿瘤大小难以区分而无法通过乳腺钼靶检查评估疗效。5例肿瘤部分缓解的患者微钙化范围未缩小。25例患者在治疗期间接受了穿刺活检。其中，9例病理检查为阴性的患者中仅3例达到病理完全缓解，其他16例阳性患者未达到病理完全缓解。
使用穿刺活检或前哨淋巴结活检时，临床医生应充分重视化疗前淋巴结状态的病理判定。临床医生通过临床检查、超声或乳腺钼靶检查对肿瘤会做出相当多的错误判断。他们可以在治疗期间使用穿刺活检来评估新辅助化疗的疗效，且结果应综合分析。
