^99mTc-MIBI显像联合超声对乳腺癌新辅助化疗疗效的评估

Evaluation of the Efficacy of Neoadjuvant Chemotherapy for Breast Cancer Using ^99mTc-MIBI Imaging Combined with Ultrasound

摘要: 本文探讨^99mTc-MIBI显像联合彩色多普勒超声诊断与临床触诊法在乳腺癌新辅助化疗(neoadjuvant chemotherapy, NAC)疗效评估的应用价值。研究对象为70例未接受手术的乳腺癌患者(76个病灶)，分别在NAC化疗前和进行2~3疗程化疗后进行临床触诊、彩色多普勒超声以及^99mTc-MIBI显像检查。以^99mTc-MIBI显像的核素肿瘤反应(STR) > 30%为有效标准，临床疗效参照WHO标准评价。以NAC后手术切除病理反应为标准，以I级定为无效，II、III级定为有效。^99mTc-MIBI显像法检查NAC化疗前后乳腺癌患者的放射性计数比值(T/N)，NAC化疗有效者45例，其T/N值前后分别为3.326 ± 1.119和1.996 ± 0.792，差异有统计学意义(t = 19.986, p < 0.001)；NAC化疗无效者31例，其T/N值前后分别为3.001 ± 1.153和2.434 ± 1.104，差异有统计学意义(t = 8.181, p < 0.001)。病理评价II级~III级的60例乳腺癌患者，T/N值经过NAC化疗前后存在显著性差异，具有统计学意义(p < 0.001)，而病理评价I级的16例乳腺癌患者经NAC化疗前后T/N值无显著性变化，无统计学意义(p = 0.342 > 0.05)。^99mTc-MIBI显像法、彩色多普勒超声诊断法和临床触诊法评价NAC疗效的敏感度、特异度和准确度分别为87.500%、89.286%、88.158%，80.851%、82.759%、81.579%，72.727%、75.001%、73.750%。以病理检查为标准，^99mTc-MIBI显像评价NAC疗效的灵敏度、特异性和准确性高于彩色多普勒超声诊断法和临床触诊法，后续对乳腺癌患者可进行^99mTc-MIBI显像与彩色多普勒超声共同检查，提高NAC疗效评估的准确性。

Abstract: This study aims to explore the effectiveness of combining ^99mTc-MIBI scintigraphy with color Doppler ultrasound diagnosis and clinical palpation for evaluating the efficacy of neoadjuvant chemotherapy (NAC) in treating breast cancer. The study included 70 cases of non-operated breast cancer patients with a total of 76 lesions. Clinical palpation, color Doppler ultrasound, and ^99mTc-MIBI scintigraphy were conducted before NAC chemotherapy and after 2~3 courses of chemotherapy. In the assessment, a tumor response (STR) of >30% based on ^99mTc-MIBI imaging was considered effective, and the clinical efficacy was evaluated according to the WHO criteria. The post-NAC surgical pathological response was used as the standard, with Grade I defined as ineffective and Grades II and III as effective. The study assessed the radiotracer uptake ratio (T/N) in breast cancer patients before and after neoadjuvant chemotherapy (NAC) using ^99mTc-MIBI scintigraphy. The result indicated that the effective cases of NAC chemotherapy were 45 (n = 45), and the T/N values before and after treatment were 3.326 ± 1.119 and 1.996 ± 0.792, respectively, with a statistically significant difference observed (t = 19.986, p < 0.001). The result demonstrated that NAC chemotherapy was ineffective (n = 31), the T/N values before and after treatment were 3.001 ± 1.153 and 2.434 ± 1.104, respectively, showing a statistically significant difference (t = 8.181, p < 0.001). Among the 60 patients with pathological grade II~III breast cancer, there was a significant difference in T/N values before and after NAC chemotherapy, which was statistically significant (p < 0.001). However, among the 16 patients with pathological grade I breast cancer, there was no significant change in T/N values before and after NAC chemotherapy, with no statistical significance observed (p = 0.342 > 0.05). The sensitivity, specificity, and accuracy for evaluating the effectiveness of NAC using the ^99mTc-MIBI imaging method, color Doppler ultrasound diagnostic method, and clinical palpation method were: ^99mTc-MIBI imaging: sensitivity 87.500%, specificity 89.286%, accuracy 88.158%; color Doppler ultrasound: sensitivity 80.851%, specificity 82.759%, accuracy 81.579%; clinical palpation: sensitivity 72.727%, specificity 75.001%, accuracy 73.750%. Based on pathological examination as the gold standard, the sensitivity, specificity, and accuracy of evaluating NAC effectiveness using ^99mTc-MIBI imaging are higher than those of color Doppler ultrasound diagnostic method and clinical palpation. Subsequent examinations of breast cancer patients with both ^99mTc-MIBI imaging and color Doppler ultrasound can enhance the accuracy of NAC effectiveness assessment.