The Value Of Panoramic Ultrasound Combined With Conventional Ultrasound In The Evaluation Of Neoadjuvant Chemotherapy For Breast Cancer

Objective:To explore the application of conventional ultrasound combined with panoramic technique in the observation of neoadjuvant chemotherapy(NAC)in breast cancer.Methods:136 patients with pathologically confirmed with invasive breast cancer,examined by ultrasound combined with panoramic technique for breast examination before NAC and after the end of all the treatment,observe ultrasonic signs,record number and the maximum diameter of lesions and repeat in the obtained specimens after operation.The gold standard was obtained specimens observation and pathological evaluation.Pathological evaluation was performed by Miller Payne(MP)grade.MP was divided into major histological response(MHR)including MP4~5 and non-major histological response(NMHR)including MP1~3.Using SPSS 22.0 statistical software,the residual lesion's diameter measured by ultrasound combined with panoramic technique and pathology are compared with Pearson correlation analysis.Whether the lesion is single or multiple measured by ultrasound and pathology compared with chi square test.The correlation between the change rate of maximal diameter in NAC early and after the end of whole cycle in MHR and NMHR was analyzed by t-test.Plot receiver operating characteristic curve(ROC)to find the optimize value of lesion predicting the MHR.P <0.01 considered the difference was statistically significant.Results:All of the 136 cases of breast cancer lesions before NAC ? 2 for 19 cases,accounting for 13.97%;the lesion is ? 4cm for 78 cases,accounting for 57.35%,the average size of 4.93cm;irregular or small leaf for 124 cases,accounting for 91.18%;the edge burr was 38 cases,accounting for 27.94%;with microcalcification in 69 cases,accounting for 50.74%;peripheral hyperechoic halo was 78 cases,accounting for 57.35%;Alder flow grade II-III grade 96 cases,accounting for 70.59%;axillary lymph node metastasis were 104 cases,accounting for 76.47%.NAC after the end of the treatment,104 cases of lesions compared to NAC before appeared different degrees of reduction,malignant signs weakened or disappeared,accounting for 94.55%,.The maximum diameter of the residual lesion was 3.05 + 1.65 cm by ultrasound combined with panoramic technique and 3.25 + 1.56 cm in obtained specimens.The Pearson correlation coefficient was 0.759(P <0.001).11 cases were no residuals and 125 cases exist in ultrasound combined with panoramic technique,19 cases were no residuals and 117 cases exist in obtained specimens(P<0.001 and Kappa =0.730).111 cases of breast cancer residuals with 95 cases of single lesion and 16 cases of multiple lesions with ultrasound combined with panoramic technique.102 cases were single lesion and 9 cases were multiple lesions with obtained specimens(P <0.001 and Kappa=0.688).Ultrasonography to determine the residual lesions for the multiple lesions of the sensitivity of 100%,for the single lesion specificity of 100%.The maximal reduction ratio of MHR and NMHR in the two groups was significantly different after the end of NAC.The area under the ROC curve was 0.708,and the maximum diameter reduction rate was 45.86%,the sensitivity was 78.6%,specificity was 60.0%.Conclusion:Ultrasound combined with panoramic technique can accurately measure the number of breast lesions and the maximum diameter of NAC after all treatment,and can be expected to be one of the ways to determine the efficacy of NAC;and through the end of the course of breast cancer NAC,the maximum diameter reduction rate of the lesion was predicted and the pathologic response was predicted.