应变力与剪切波弹性成像对乳腺癌新辅助化疗后病理反应预测效能的比较

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摘要目的：评估并比较应变力（Strain elastography，SE）与剪切波（Shear-wave elastography，SWE）弹性成像技术预测乳腺癌新辅助化疗（Neoadjuvant chemotherapy，NACT）的病理反应性的能力。方法：纳入符合条件的乳腺癌患者56例，分别使用SE、SWE评估穿刺活检前乳腺肿物的硬度，记录穿刺活检的免疫组化结果及NACT后肿物切除的病理反应性，进一步采用Logistic回归分析得出影响NACT病理完全缓解（Pathological complete response，pCR）的独立影响因素。绘制不同指标预测pCR结局受试者工作特征（Receiver operation characteristic，ROC）曲线，并评估其总体诊断效能，Z检验比较不同指标的曲线下面积（AUC）差异。结果：参照Miller-Panye分级，术后证实pCR组14例。SE高弹性评分、SWE平均硬度分级是pCR的独立影响因素。诊断试验证实SE应变率比值的预测效能最佳，AUC为0.92±0.04（SE）， SWE平均硬度的AUC为0.81±0.06 （SE），两种弹性成像技术的总体诊断效能差异无统计学意义（P=0.12）。结论：弹性成像可较好地预测pCR结局，有助于提高NACT的临床应用价值。

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	马燕
	臧丽
	李晶
	任卫东
	邓力军

关键词 ：乳腺肿瘤；超声检查, 乳房

Abstract：Objective: To evaluate and compare the diagnostic performances of strain elastography(SE) and shear-wave elastography(SWE) for predicting the pathological response to breast cancer neoadjuvant chemotherapy(NACT). Methods: The study included 56 eligible cases with breast cancer. The stiffness of breast tumor was assessed by SWE and SE respectively before biopsy. Immunohistochemical analysis of biopsy and pathologic response after NACT were recorded. Logistic regression analysis was performed to explicit the independent factors of pathological complete response(pCR) of NACT. The receiver operating characteristics(ROC) curve, the area under the ROC curve(AUC) and the overall diagnostic efficacy were calculated. Z test was used to compare the differences among AUCs. Results: Postoperative findings confirmed 14 patients with pCR according to the Miller and Payne classification. The high elasticity score in SE and SWE mean stiffness were independent factors. Diagnostic test suggested SE strain ratio had the best overall predictive performance, with the AUC of 0.92±0.04(SE). And the AUC of SWE mean stiffness was 0.81±0.06(SE). However, the difference of AUC between SE strain ratio and SWE mean stiffness was not statistical(P=0.12). Conclusion: Ultrasonic elastography can predict pCR with good performance, which may improve the clinical value of NACT.

Key words： Breast neoplasms Ultrasonography, mammary

收稿日期: 2016-04-19

PACS:	Ｒ737.9
	Ｒ445.1

基金资助:中国医科大学附属盛京医院院内课题资助项目（MD63）。

通讯作者: 任卫东，中国医科大学附属盛京医院超声科，110004。E-mail：renwd01@163.com

作者简介: 马燕（1983-），女，辽宁沈阳人，主治医师。E-mail：horsebird@163.com

引用本文:

马燕，臧丽，李晶，任卫东，邓力军. 应变力与剪切波弹性成像对乳腺癌新辅助化疗后病理反应预测效能的比较[J]. 中国临床医学影像杂志, 2016, 27(12): 859-863.
MA Yan, ZANG Li, LI Jing, REN Wei-dong, DENG Li-jun. Comparison of strain and shear-wave elastography for predicting the pathological response after breast cancer neoadjuvant chemotherapy. JOURNAL OF CHINA MEDICAL IMAGING, 2016, 27(12): 859-863.

链接本文:

http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2016/V27/I12/859

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