Value Of Contrast-enhanced Ultrasound In Evaluating The Efficacy Of Early Neoadjuvant Chemotherapy For Breast Cancer

Objective:To explore the value of contrast-enhanced ultrasound in evaluating the efficacy of early neoadjuvant chemotherapy for breast cancerMaterials and methods:We collected breast cancer patients who underwent NAC at Peking University Shenzhen Hospital from February 2020 to January 2021.US and CEUS examinations were performed before,after 1 cycle,and after 2 cycle of chemotherapy.MRI examinations was performed before and after 2 cycle of chemotherapy.The change of lesion size was recorded.Replayed the CEUS video to obtain the CEUS qualitative parameters,and select 3 regions of interest(ROI)from them.Three regions of interest(ROI)were delineated:ROI 1,the region with the most obvious local enhancement was selected,ROI 2 was selected as the maximum enhancement area of the lesion,and ROI 3 was the normal tissue area around the lesion which was roughly equal to the area of ROI 1.The corresponding TIC was generated by fitting.The changes of CEUS qualitative and quantitative parameters of ROI 1 and ROI 2 after different cycles were analyzed.ROI 3 was used as control,and some quantitative data in ROI 1 were converted.The differences of the above parameters between the effective group and the ineffective group were analyzed.In addition,the positive indicators were further compared with the clinical indicators before NAC and after operation.Results:A total of 29 patients were collected in this study,15 were pathologically effective,and 14 were pathologically ineffective.The MD values of the three examinations after 1 cycle and 2 cycles of NAC were significantly reduced,and there was a difference between before NAC(p<0.05).Paired comparison found that the MD values of CEUS and MRI lesions after 2 cycles were greater than US(p<0.05),but there was no significant difference between CEUS and MRI(p>0.05).The consistency of the three inspection results and the pathological results after 2 cycles was checked.The Kappa values calculated by CEUS and MRI were 0.445 and 0.442 respectively greater than 0.4,while the Kappa values calculated by US were 0.239<0.4.Indicated that MRI and CEUS are better than US in measuring changes before and after chemotherapy.MRI and CEUS have good consistency with the pathological results.After 2 cycles,MD in the effective group was less than that in the ineffective group(P<0.05).The RPI value of the ineffective group in ROI 1 was higher than that of the effective group(p<0.05).After 2 cycles of chemotherapy,PI and AUC of ROI 1 in the effective group were lower than those in the ineffective group,and PI value of effective group in ROI 2 was lower than that of ineffective group(p<0.05).After 2 cycles,the difference of △AUC%between the effective group and the ineffective group was statistically significant(P<0.05).The sensitivity,specificity and accuracy of RPI were 64.3%,86.7%and 70.7%respectively.After 2 cycles,the sensitivity,specificity and accuracy of PI and AUC were 50%,86.7%and 57.6%.After 2 cycles,the sensitivity,specificity and accuracy of PI in ROI 1 were 92.9%,53.3%and 74.8%,respectively,The sensitivity of the PI value after 2 cycles in ROI 2 is 50%,the specificity is 80%,and the accuracy is 70.7%.The combined evaluation sensitivity is 86.7%,the specificity is 71.4%,and the accuracy is 80.5%.The differences between the clinical and pathological index groups of ROI 1 after the second cycle before NAC and after the operation were compared in ROI 1.There were no significant differences(p>0.05).After NAC,9 cases achieved PCR and 20 cases did not.After PCR,there was no difference in PI value between the two groups after 2 cycles.Conclusion:CEUS and MRI are better than US in the assessment of lesion size and changes,and CEUS and MRI are in good agreement.The value of CEUS qualitative parameters in early prediction is low.The PI value and AUC value of quantitative parameters can be used to evaluate the early efficacy of NAC.The prediction and evaluation efficiency of quantitative parameters after two cycles is better than that after one cycle.The evaluation performance of ROI 1 is better than ROI 2,and the combination of ROI 1 and ROI 2 can improve the evaluation performance.In general,CEUS has considerable value in the evaluation of NAC efficacy in early breast cancer,and can be one of the important supplementary methods for NAC efficacy in early breast cancer.In summary,CEUS has considerable value in early evaluation of NAC efficacy of breast cancer,and can be one of the important supplementary methods for early NAC efficacy of it.