查体、超声及钼靶检查对乳腺癌新辅助化疗后病理缓解程度预测价值的比较

J4 ›› 2011, Vol. 37 ›› Issue (5): 943-947.

查体、超声及钼靶检查对乳腺癌新辅助化疗后病理缓解程度预测价值的比较

韩冰¹|付彤¹|吴迪¹|张海鹏²|宋东¹|毕丽荣³|郑超¹|范志民¹

1.吉林大学第一医院乳腺外科|吉林长春130021；2.吉林大学第一医院产科|吉林长春 130021；3.吉林大学第一医院病理科|吉林长春 130021

收稿日期:2011-07-01 出版日期:2011-09-28 发布日期:2011-09-28
通讯作者: 张海鹏（Tel:0431-88782284,E-mail:zhanghaipeng8063@126.com） E-mail:zhanghaipeng8063@126.com
作者简介:韩冰(1977-)|男|吉林省长春市人|主治医师|在站医学博士后|主要从事乳腺癌基础及临床研究。
基金资助:
吉林省科技厅科技发展计划项目资助课题(3D209K633428)

Comparisons of predictive values of breast cancer pathology respones after neoadjuvant chemotherapy between physical examination, ultrasound and mammography

HAN Bing¹,FU Tong¹,WU Di¹,ZHANG Hai-peng²,SONG Dong¹,BI Li-rong³,ZHENG Chao¹,FAN Zhi-min¹

1.Department of Breast Surgery|First Hospital|Jilin University|Changchun 130021|China；2.Department of Obstetrics Surgery|First Hospital|Jilin University|Changchun 130021|China； 3.Department of Pathology|First Hospital|Jilin University|Changchun 130021|China

Received:2011-07-01 Online:2011-09-28 Published:2011-09-28

摘要/Abstract

摘要：

目的：通过对查体、超声和钼靶片测量化疗前后乳腺肿物大小的变化与术后病理Miller and Payne (MP)分级的比较，探讨预测新辅助化疗（NAC）后病灶病理缓解程度的方法。方法：选择本科室乳腺癌NAC并手术的患者65例，采用麦默通（14G）行穿刺活检，病理诊断明确后行1～6个疗程TAC方案（多西他赛、多柔比星和环磷酰胺）或其他化疗方案,最后一次化疗后3周以内行手术治疗。所有患者在化疗前及手术前采用查体、超声和钼靶片测量肿物大小；病理缓解程度通过比较手术后与化疗前穿刺组织中癌组织变化，应用MP分级评价。应用ROC曲线和Spearman相关性分析方法计算查体、超声及乳腺钼靶检查测量肿物大小变化与病理MP分级的关系。结果：NAC后查体、超声及乳腺钼靶检查测量肿物大小变化与病理MP分级存在相关（r=0.487,P=0.000 ;r=0.251, P=0.044 ;r=0.351,P=0.004）。查体、超声和钼靶3种检查方法评价病理完全缓解（pCR）的ROC曲线下面积分别为0.703、0.531和0.712 ，三者结合为0.727 。结论：查体和钼靶在预测乳腺肿物病理缓解程度上优于超声检查；3种方法结合对乳腺癌NAC后病理缓解程度有预测价值。

关键词: 新辅助化疗；乳腺肿瘤；Miller and Payne分级

Abstract:

Objective To evaluate the method for predicting breast cancer pathology response through comparisons between application value of physical examination,ultrasound and mammography in measuring the size of tumor before and after chemotherapy and the results of pathological Miller and Payne(MP) grade.Methods 65 patients who received neoadjuvant chemotherapy(NAC) in our department were selected.All patients received one to six cycles of TAC (Docetaxel,Doxorubicin and Cyclophosphamide) regimen or other regimen after being diagnosed as breast cancer by mammotomy biopsy.The following operation was undergone within 3 weeks after the last chemotherapy.The tumor sizes of all patients were examined by physical examination,ultrasound and mammography before NAC and before the operation.The pathological responses were evaluated by MP
grading system criteria by comparing the changes of cancer tissues in biopsy tissues before NAC and after the operation.ROC curve and spearman correlation analysis were used for the analysis between the changes of tumor sizes examined by physical examination,ultrasound and mammography and the results of MP grade．Results There was a significant correlation between MP grade and the results of physicalexamination,ultrasound and mammography (r=0.487,P=0.000;r=0.251,P=0.044;r=0.351,P=0.004 ).The area of pathology complete response (pCR)of MP grade 5 under the ROC curve (Az value) was 0.703 for physical examination,0.531 for ultrasound,0.712 for mammography,and 0.727 for combining three techniques.Conclusion Physical examination and mammography are more useful than ultrasound in predicting the pathologic results of NAC.Combining three techniques has predictive value in pathology response of breast cancer after NAC.

Key words: neoadjuvant chemotherapy；breast neoplasms；Miller and Payne grade

中图分类号:

韩冰|付彤|吴迪|张海鹏|宋东|毕丽荣|郑超|范志民. 查体、超声及钼靶检查对乳腺癌新辅助化疗后病理缓解程度预测价值的比较[J]. J4, 2011, 37(5): 943-947.

HAN Bing,FU Tong,WU Di,ZHANG Hai-peng,SONG Dong,BI Li-rong,ZHENG Chao,FANZhi-min. Comparisons of predictive values of breast cancer pathology respones after neoadjuvant chemotherapy between physical examination, ultrasound and mammography[J]. J4, 2011, 37(5): 943-947.

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