Ma B X, Fan Z N, Wu G
Department of Ultrasound, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China.
Zhonghua Zhong Liu Za Zhi. 2020 Dec 23;42(12):1049-1054. doi: 10.3760/cma.j.cn112152-20190828-00552.
To investigate the clinic value of ultrasound 3-dimensional shear wave elastography (3D-SWE) in therapeutic effect evaluation of neoadjuvant chemotherapy (NAC) for HER-2 positive breast cancer patients. A total of 43 lesions from 43 HER-2 positive breast cancer patients were selected and all of the lesions were confirmed by biopsy. Ultrasound examination was performed routinely before each chemotherapy cycle. The interested regions were selected under the 3-dimensional (3D) elasticity and gray-scale mode, the relevant data such as shear waves in the transverse, longitudinal and coronal sections of the mass were generated automatically. According to the histopathological results, the patients were divided into the pathological complete remission (pCR) group and the incomplete remission (non-pCR) group. The maximum elastic hardness value (Emax) and the reduction degree (ΔEmax) of the lesions in the two groups were measured and compared in each cycle of NAC. The accuracy of 3D-SWE technique for predicting the efficacy of NAC was evaluated using indicators such as sensitivity, specificity and area under the receiver operating characteristic (ROC) curve. The clinicopathologic features between pCR group (18 cases) and non-pCR Group (25 cases) were not significantly different (>0.05). Compared with pre-chemotherapy, the Emax values of pCR group and non-pCR Group during chemotherapy were declined (<0.05). Moreover, the Emax values of pCR group before and after chemotherapy were lower than those of non-pCR group (<0.05). At the end of the first cycle of chemotherapy, the predictive specificity, sensitivity and area under the curve (AUC) of pCR group were 72.0%, 83.3% and 0.838 (95%=0.6800.930) respectively when the cutoff value of Emax was 118 kPa. At the end of the second cycle, the predictive specificity, sensitivity and AUC of pCR group were 76.0%, 83.3% and 0.863 (95%=0.7200.940) respectively when the cutoff value of Emax was 87 kPa. At the end of the third cycle, the predictive specificity and sensitivity and the AUC of the pCR group were 88.0%, 77.8% and 0.893 (95%=0.7600.970) when the cutoff value of Emax was 57 kPa. At the end of the fourth cycle of chemotherapy, the predictive specificity, sensitivity and AUC of pCR group were 92.5%, 88.9% and 0.960 (95%=0.8500.990) respectively when the cutoff value of Emax was 30 kPa. After one cycle of NAC, the predictive sensitivity and specificity and AUC of pCR group were 88.0%, 60.0%, and 0.719 (95%=0.6200.890) when the cutoff value of ΔEmax was 16.8%. After two cycles, the predictive sensitivity, specificity and AUC of pCR group were 55.5%, 80.0% and 0.712 (95%=0.5500.840) when the cutoff value of ΔEmax was 34.9%. After three cycles, the predictive sensitivity, specificity and AUC of pCR group were 67.4%, 81.2% and 0.779 (95%=0.6800.930) when the cutoff value of ΔEmax was 55.2%. After four cycles, the predictive sensitivity, specificity and AUC of pCR group was 72.3%, 92.0% and 0.831 (95%=0.6900.930) when the cutoff value of ΔEmax was 75.1%. The Emax and ΔEmax values measured by 3D-SWE technology can predict the curative effect of NAC for breast cancer.
探讨超声三维剪切波弹性成像（3D-SWE）在HER-2阳性乳腺癌患者新辅助化疗（NAC）疗效评估中的临床价值。选取43例HER-2阳性乳腺癌患者的43个病灶，所有病灶均经活检确诊。在每个化疗周期前常规进行超声检查。在三维（3D）弹性和灰阶模式下选取感兴趣区域，自动生成肿块横切面、纵切面和冠状切面的剪切波等相关数据。根据组织病理学结果，将患者分为病理完全缓解（pCR）组和未完全缓解（非pCR）组。在NAC的每个周期中，测量并比较两组病灶的最大弹性硬度值（Emax）和降低程度（ΔEmax）。采用灵敏度、特异度和受试者操作特征（ROC）曲线下面积等指标评估3D-SWE技术预测NAC疗效的准确性。pCR组（18例）和非pCR组（25例）的临床病理特征差异无统计学意义（>0.05）。与化疗前相比，pCR组和非pCR组化疗期间的Emax值均下降（<0.05）。此外，pCR组化疗前后的Emax值均低于非pCR组（<0.05）。化疗第一周期结束时，当Emax的截断值为118 kPa时，pCR组的预测特异度、灵敏度和曲线下面积（AUC）分别为72.0%、83.3%和0.838（95%=0.6800.930）。化疗第二周期结束时，当Emax的截断值为87 kPa时，pCR组的预测特异度、灵敏度和AUC分别为76.0%、83.3%和0.863（95%=0.7200.940）。化疗第三周期结束时，当Emax的截断值为57 kPa时，pCR组的预测特异度、灵敏度和AUC分别为88.0%、77.8%和0.893（95%=0.7600.970）。化疗第四周期结束时，当Emax的截断值为30 kPa时，pCR组的预测特异度、灵敏度和AUC分别为92.5%、88.9%和0.960（95%=0.8500.990）。NAC一个周期后，当ΔEmax的截断值为16.8%时，pCR组的预测灵敏度、特异度和AUC分别为88.0%、60.0%和0.719（95%=0.6200.890）。两个周期后，当ΔEmax的截断值为34.9%时，pCR组的预测灵敏度、特异度和AUC分别为55.5%、80.0%和0.712（95%=0.5500.840）。三个周期后，当ΔEmax的截断值为55.2%时，pCR组的预测灵敏度、特异度和AUC分别为67.4%、81.2%和0.779（95%=0.6800.930）。四个周期后，当ΔEmax的截断值为75.1%时，pCR组的预测灵敏度、特异度和AUC分别为72.3%、92.0%和0.831（95%=0.6900.930）。3D-SWE技术测量的Emax和ΔEmax值可预测NAC对乳腺癌的疗效。
