Value Of Quantitative Analysis By Ultrasonic Elastography To Assess Liver Damage Caused By TAC Combination Chemotherapy In Breast Cancer Patients

Objective: To investigate the liver tissue elasticity in breast cancer patients with TAC combined with chemotherapy by ultrasonic elastic tissue diffusion and quantitative analysis,for providing an effective ultrasound method on quantitative detection to early liver injury induced by chemotherapy.Methods: 38 healthy people from health examination and 35 inpatients with breast cancer to be treated with 6 cycles TAC conbination chemotherapy were collected in Zhongshan Hospital affiliated to Dalian University from September 2015 to December 2016,and allocated into the control group with 38 cases and the chemotherapy group with 35 cases.Chemotherapy group,including 24 cases in neoadjuvant chemotherapy and 11 cases in adjuvant chemotherapy,was given 6 consecutive cycles of chemotherapy,21 days for a cycle.The chemotherapy group's data were collected before chemotherapy and 1 to 2 days after the 2nd,4th,and 6th cycle of chemotherapy.The major inspection items included traditional ultrasound examination;liver fibrosis index(LFI),blue area percentage(%AREA),average strain(MEAN),standard deviation(SD),complexity(COMP),contrast(CONT),kurtosis(KURT),skewness(SKEW),entropy(ENT),inverse difference moment(IDM),angular second moment(ASM)and correlation(CORR)of tissue dispersion quantitative analysis;alanine aminotransferase(ALT),aspertate aminotransferase(AST),glutamine transferase(GGT),alkaline phosphatase(ALP)and total bilirubin(TB)of liver function test.All items were compared between pre-chemotherapy and the control group,as well as during various stages of chemotherapy treatment.The correlation of elastic parameters with liver function indexes were analyzed by correlation test.At the same time,the ROC curves of LFI,%AREA and MEAN during the 2nd and 4th cycle of chemotherapy were plotted,while areas under the curve,critical values,sensitivity values,and specificity values were also calculated.Results: 1.Traditional ultrasound examination: All subjects within chemotherapy group had normal liver images before chemotherapy.Compared with pre-chemotherapy,3 cases(8.57%)displayed abnormal images(P<0.05)after 2 cycles of chemotherapy and 18 cases(51.43%)displayed abnormal images(P<0.05)after 4 cycles of chemotherapy.29 subjects(82.86%)displayed abnormal images(P<0.05)after 6 cycles of chemotherapy.2.Tissue dispersion quantitative analysis: Compared with the control group,12 elastic parameters didn't show significant change(P>0.05)during the pre-chemotherapy stage.Compared with pre-chemotherapy,%AREA,SD and LFI increased(P<0.05)after 2 cycles of chemotherapy.%AREA,SD,CONT and LFI increased(P<0.05)after 4 cycles of chemotherapy,while MEAN decreased(P<0.05).The %AREA,SD,CONT,COMP and LFI increased(P<0.05)after 6 cycles of chemotherapy,while MEAN decreased(P<0.05).Compared with the 2nd cycle of chemotherapy,after the 4th cycle,MEAN decreased,while %AREA,CONT,COMP and LFI increased(P<0.05).After the 6th cycle,MEAN decreased,while SD,%AREA,COMP,CONT and LFI increased(P<0.05).Compared with the 4th cycle of chemotherapy,MEAN decreased,while %AREA,SD and LFI increased(P<0.05)after 6 cycles of chemotherapy.3.Liver function test: Comparing each indicator between pre-chemotherapy and control group,related indexes didn't show any statistical difference(P>0.05).Comparing data from the 2nd cycle of chemotherapy with pre-chemotherapy data,both ALT and AST showed an increase(P<0.05),but AST was still in the normal range and ALT was in the normal upper limit.ALT,AST and ALP increased(P<0.05)after 4 cycles of chemotherapy,and ALT,AST,ALP,TB and CB increased after 6 cycles of chemotherapy(P<0.05).ALT,AST,ALP and CB increased in 4th cycle of chemotherapy than in 2nd one(P<0.05).ALT,AST,ALP,TB and CB increased in 6th cycle of chemotherapy than in 2nd and 4th one(P<0.05).4.Correlation test: Excluding the influence of chemotherapy cycles,LFI and %AREA were positively correlated with ALT(r=0.341,P=0.000;r=0.261,P=0.002),but MEAN was negatively correlated with ALT(r=-0.215,P=0.011).5.The ROC curve showed that the area under the LFI,%AREA and MEAN curves were 0.752,0.655 and 0.623 after 2 cycles of chemotherapy,meanwhile the values increased to 0.921,0.795,and 0.804 after 4 cycles.When maximizing the sum of sensitivity and specificity,the critical values of LFI,%AREA and MEAN were 1.94(sensitivity:77.1%,specificity:63.2%),17.33(Se:85.7%,Sp:42.1%)and 112.81(Se:88.6%,Sp:36.8%)after 2 cycles of chemotherapy.The values increased to 1.99(Se:97.1%,Sp:73.7%),21.36(Se:71.4%,Sp:73.7%)and 109.75(Se:82.9%,Sp:78.9%)after 4 cycles.Conclusion: The technology of ultrasonic elastography tissue dispersion quantitative analysis can be used to quantitatively detect the elastic characteristics of liver tissue in breast cancer patients undergoing chemotherapy.Elastic parameters LFI,%AREA and MEAN are more sensitive,especially the sensitivity and specificity of LFI are better,which is expected to be an effective index for quantitative assessment of early liver injury in patients with TAC combined with chemotherapy.