CAJ | 학술논문

目的：通过超声和钼靶X线的影像学方法评估乳腺癌新辅助治疗后的病理应答情况，从而为新辅助治疗的疗效评价及用药方案提供重要的检测依据。方法纳入136例初诊为乳腺癌的女性患者，病理诊断明确，并采用新辅助化疗进行术前治疗。收集患者临床信息，包括年龄等基本信息、肿瘤大小、临床分期等信息，手术前分别接受4到6个周期化疗，方案不限。术前采用乳腺钼靶和/或超声检测化疗后残瘤大小，比较影像学测定的肿瘤大小与病理测量肿瘤大小的误差，及影像学检测对乳腺肿瘤病理应答率的评估。结果116例钼靶影像记录中41（35．34％）例影像未检测到残瘤，106例超声影像记录中19例（17．92％）未检测到残瘤，影像学预测为完全缓解。98例同时进行钼靶和超声评估的病例中，有61（62．24％）例钼靶影像可评估肿瘤大小，有83（84．69％）例超声影像可评估肿瘤大小。钼靶准确评估了31例，超声准确评估了59例，精准率高于钼靶，两种影像学方法对新辅助化疗后的残瘤评估差异显著（60．20％vs．31．63％，χ2＝16．11，P＜0．001）。超声的正确检查率为92．85％（91/98），钼靶的正确检出率为68．37％（67/98），超声诊断效力略高于钼靶，但差异无统计学意义（χ2＝2．028，P＝0．164）。结论乳腺超声在测量新辅助化疗后残余肿瘤的大小的准确率方面比乳腺钼靶结果更可靠。
목적：통과초성화목파X선적영상학방법평고유선암신보조치료후적병리응답정황，종이위신보조치료적료효평개급용약방안제공중요적검측의거。방법납입136례초진위유선암적녀성환자，병리진단명학，병채용신보조화료진행술전치료。수집환자림상신식，포괄년령등기본신식、종류대소、림상분기등신식，수술전분별접수4도6개주기화료，방안불한。술전채용유선목파화/혹초성검측화료후잔류대소，비교영상학측정적종류대소여병리측량종류대소적오차，급영상학검측대유선종류병리응답솔적평고。결과116례목파영상기록중41（35．34％）례영상미검측도잔류，106례초성영상기록중19례（17．92％）미검측도잔류，영상학예측위완전완해。98례동시진행목파화초성평고적병례중，유61（62．24％）례목파영상가평고종류대소，유83（84．69％）례초성영상가평고종류대소。목파준학평고료31례，초성준학평고료59례，정준솔고우목파，량충영상학방법대신보조화료후적잔류평고차이현저（60．20％vs．31．63％，χ2＝16．11，P＜0．001）。초성적정학검사솔위92．85％（91/98），목파적정학검출솔위68．37％（67/98），초성진단효력략고우목파，단차이무통계학의의（χ2＝2．028，P＝0．164）。결론유선초성재측량신보조화료후잔여종류적대소적준학솔방면비유선목파결과경가고。
Objective Ultrasonongraphy and mammography were employed to estimate the pathological response of patients with breast cancer ,who had been accepted neoadjuvant chemotherapy .According to the pres-ent study ,we can provide additional evidence on therapeutic effect on evaluation of neoadjuvant chemotherapy and better selection of regime for breast cancer .Methods One hundred Thirty-six patients who were previously dia-gosed diagnosed with primary breast cancer were included in this study .All subjects were female with clearly pathological detection and accepted neoadjuvant chemotherapy about 4 to 6 cycles regardless of regime .The resid-ual tumor size was evaluated by mammography and /or ultrasonography before operation .Tumor size measured by image were compared with pathological size to predicting the accuracy of two types of imaging .Results Forty one of 116 records were undetectable imaging by mammogram and 19 of 106 records were undetectable by ultrasound which were considered a pathologic complete response .Sixty one(62.24%)of 98 patients who were accepted de-tection of mammogram and ultrasound would be predicted the tumor size by mammogram .Eighty three(84.69%) of 98 patients would be predicted the residual tumor by ultrasound .31 and 59 were accurately evaluated by mam-mogram and ultrasound , respectively .The result indicated that ultrasound was more accurate than mammogram (60.20%vs.31.63%,χ2 =16.11,P<0.001).The correctly rate was 92.85%(91/98)for ultrasound and 68. 37%(67/98) for mammogram.The diagnosis efficiency of ultrasound was more higher than mammogram ,even though there was no different significance between the two methods (χ2 =2.028,P=0.164).Conclusion Ultra-sonongraphy in estimating the residual tumor size after neoadjuvant chemotherapy of patients with breast cancer displays more accurately than mammography .