Contrast-enhanced Ultrasound Combined With MRI-ADC Value To Evaluate The Efficacy Of Neoadjuvant Chemotherapy For Breast Cancer

Objective: To investigate the value of contrast-enhanced ultrasound and magnetic resonance imaging(MRI)in the evaluation of neoadjuvant chemotherapy(NAC)for breast cancer.Methods: From July 2017 to February 2020,45 cases of breast cancer confirmed by pathological mechanism were analyzed retrospectively.And the age of the patients was from 26 to 67 years old,with an average age of 44.0±9.7years.Before NAC and after the fourth cycle chemotherapy,the contrastenhanced ultrasound of tumor and breast MRI were used to evaluate the curative effect;the operation was performed at least after the fourth cycle of chemotherapy or after NAC.According to the gold standard taken by the pathological evaluation of Miller Payne method and the differences between the indexes such as the MRI-ADC value before and after treatment through paired t test,nonparametric Mann Whitney test and chi-square test,the peak intensity(PI)of perfusion parameters in contrast-enhanced ultrasound,the time to peak(TTP)and the area under curve,the receiver operating characteristic(ROC)curve was made to compare the sensitivity,specificity,area under curve,Youden index,positive predictive value and negative predictive value,so as to analyze the evaluation efficiency.Results :(1)Compared with NMHR group,the proportion of the patients with HER-2 positive in MHR group was higher than that in NMHR group(P=0.04).There was no difference in other indexes such as age,T stage,ER,PR,Ki-67 and molecular typing(P>0.05).(2)45 cases of breast cancer were evaluated by MRI after NAC for at least four cycles.The average apparent diffusion coefficient(ADC)value before operation was higher than that before chemotherapy(1.193±0.229 vs 0.896±0.210)×10-3mm2/s,(P<0.01);there was no difference in ADC value between MHP group and NMHP group before NAC(P > 0.05).After NAC,the average ADC value of MHP group was higher than that of NMHP group.(3)The differences of PI and the area under curve(area)of the timeintensity curve parameters before and after chemotherapy are statistically significant(P<0.05).There was no difference in TTP before and after NAC.There was statistical significance in the differences between the NMHP group and MHP group in ΔPI and Δarea(P<0.05).(4)There were statistical differences in the area under the ROC curve of joint index of ΔADC+Δarea and ΔPI+ΔADC+Δarea(P<0.05).The combined index of ΔPI+ΔADC+Δarea had the highest predictive value(AUC=0.845)and Youden index(0.613).The specificity(87.50%),the negative predictive value(87.50%)and the negative likelihood ratio(0.316)of ΔPI were the highest,ΔADC + Δ area of sensitivity(90.48%).Δ PI + Δ ADC + Δ area three joint index positive predictive value(76.19%)and positive likelihood ratio(3.061)is highest,the negative predictive value of Δ PI(87.50%)and negative likelihood ratio(0.316)is highest,assess the efficiency of chemotherapy is invalid.Conclusions :(1)The peak intensity(PI),the area under the curve(area)and the apparent diffusion coefficient(ADC)value of magnetic resonance imaging(MRI)are helpful for the evaluation of neoadjuvant chemotherapy(NAC)in breast cancer patients.(2)The efficacy evaluation of breast cancer NAC by-adc combined with ceus is higher than that by CEUS alone and MRI alone(sensitivity: 90.48%),and the authenticity of early efficacy evaluation is higher,which is worthy of clinical application.(3)Contrast-enhanced ultrasound evaluation of NAC poor effects of breast cancer patients with a specific degree is high(87.5%).