The Value Of Color Doppler Ultrasound And Contrast-enhanced Ultrasound In The Assessment Of Response To Neoadjuvant Chemotherapy In Breast Cancer

Objective:The value of color doppler ultrasound and contrast-enhanced ultrasound in the evaluation of neoadjuvant chemotherapy in breast cancer.Methods:The first part:A retrospective analysis of 108 cases of female breast cancer patients(109 lesions)information, including neoadjuvant chemotherapy before the ultrasound examination, the results of ultrasound-guided biopsy and preoperative ultrasound and pathologic data.Summary analysis of breast lesions simultaneously with the pathology of neoadjuvant postoperative sonographic characteristics(size, shape, border, internal echo, blood flow grade) changes before and after chemotherapyThe second part:Collected in the Tumor Hospital of Shanxi Medical University, hospitalized from October 2014 to December 2015 period 21 cases of female breast cancer cases, all cases were neoadjuvant chemotherapy.After neoadjuvant chemotherapy patients underwent modified radical mastectomy. Before and after neoadjuvant chemotherapy twice a color Doppler ultrasound and ultrasound imaging. First, the record size of the lesion and color Doppler ultrasound CEUS size, after neoadjuvant chemotherapy residual tumor size measured by ultrasound and pathologic correlation test size. Again, the lesions observed before and after neoadjuvant chemotherapy contrast-enhanced ultrasound features:ultrasound contrast agent distribution(uniform, non-uniform), the degree of enhancement(0-3). Finally, QLAB software to establish the state of the lesion contrast time- intensity curve, before and after neoadjuvant chemotherapy lesions start by time, beginning enhanced degree of peak time, peak intensity, the slope of the curve rise, enhanced time(peak time- the beginning of growth time), enhancing the strength(peak intensity- the beginning enhanced degree) parameter.Results:The first part:108 patients in 102 neoadjuvant lesion size and level of blood flow before and after chemotherapy can comparative analysis sonographic features of 93 lesions before and after neoadjuvant chemotherapy(shape, boundary, echo) can be compared.(1)Changes in lesion size: 102 lesions neoadjuvant two largest section diameters difference was statistically significant(P<0.05) before and after chemotherapy. 79.4% of lesions shrink the lesions increased 11.8%, 8.8% lesions disappeared.(2)Neoadjuvant chemotherapy lesions: according to lesion biggest slice large diameter line divided into four groups(d≤2cm group, 2cm<d≤3cm group, 3cm <d≤4cm group,d>4cm group), there were 57.1% efficiency, 50%, 55.6%, 57.71%, 4 lesions efficiency was no significant difference(P>0.05).(3)Lesions characteristic sonographic changes: neoadjuvant chemotherapy before and after the lesion shape, border, internal echo, no significant change.(4)Changes in blood flow in the lesion level: according to Response Evaluation Criteria in Solid Tumors, the lesion is divided into effective group(complete response+partial response)and inactive group(stable+progress). Effective blood level changes focus group difference was statistically significant(P<0.05), decreased blood flow level than before chemotherapy, the lesions after neoadjuvant chemotherapy, neoadjuvant chemotherapy before to Class II, III mainly after neoadjuvant chemotherapy to 0, level I based. Invalid focus group difference was not statistically significant change in the level of blood flow(P>0.05), before and after neoadjuvant chemotherapy are Class II, III based.(5)Ultrasound lesions after neoadjuvant chemotherapy and postoperative pathologic comparison(lesions whether specific, measurable): After neoadjuvant chemotherapy andpostoperative ultrasound consistent gross pathological lesions in 73.4%,26.6% of lesions after neoadjuvant chemotherapy and postoperative pathologic ultrasound inconsistent.The second part:(1)The pathological lesion size and the size of the ultrasound correlation: the lesion size neoadjuvant color Doppler ultrasound and ultrasound contrast changes in the size difference was statistically significant before and after chemotherapy(P<0.05). After neoadjuvant chemotherapy lesions color Doppler ultrasound measured the size of the size and the pathological correlation test, transverse diameter(r=0.61 P<0.05), anteroposterior diameter(r= 0.55 P<0.05). Lesions after neoadjuvant chemotherapy CEUS size and the pathological size correlation test, about(r=0.91 P<0.05), anteroposterior diameter(r=0.85 P<0.05). Tumor size and pathologic correlates better CEUS size measured.(1)Ultrasound contrast-enhanced lesions characteristic of change: focus neoadjuvant chemotherapy prior to contrast agent evenly distributed unevenly distributed after chemotherapy.Enhance the degree of difference before and after neoadjuvant chemotherapy lesions was statistically significant(P<0.05).90.5% of lesions after neoadjuvant chemotherapy to reduce the degree of enhancement.(3)Lesions after neoadjuvant chemotherapy time- intensity curve parameters: peak lesions after prolonged neoadjuvant chemotherapy, the peak intensity decreases, enhanced strength decreases, the slope of the curve rise reduced(P<0.05), and the start time increase, beginning enhanced degree, enhanced time before and after neoadjuvant chemotherapy was no significant difference(P>0.05).Conclusion:(1)Color doppler ultrasound can help the majority of neoadjuvant chemotherapy were evaluated.(2)CEUS from the size of the lesion, the blood supply to nourish a better assessment of response to neoadjuvant chemotherapy in breast cancer.