超声与磁共振成像对乳腺癌新辅助化疗疗效评价的比较分析  

Comparative analysis between ultrasound and magnetic resonance imagining on assessment of neoadjuvant chemotherapy for breast cancer

作　　者：戴萦企 杨奔[2] 左文述[2] 刘岩松[2] 郑刚[2] 郑美珠[2] 杨莉[2] 

机构地区：[1]济南大学·山东省医学科学院·医学与生命科学学院,山东济南250022 [2]山东省肿瘤医院乳腺外科二病区,山东省乳腺病防治中心,山东济南250117

出　　处：《中华肿瘤防治杂志》2015年第12期958-963,共6页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的探讨超声（ultrasound,US）和磁共振成像（magnetic resonance imaging,MRI）在评价新辅助化疗（neoadjuvant chemotherapy,NAC）治疗浸润性乳腺癌方面的应用价值。方法 2012-03-01-2013-01-31山东省肿瘤医院乳腺外科接受NAC的乳腺癌患者98例,行4个周期NAC后分别用临床触诊、US及MRI方法检测NAC前后肿瘤最大径,并记录US图像病灶形态、边界、回声和彩色多普勒血流显像（color Doppler flow imaging,CDFI）下血流信号等级,以及MRI病灶血流时间-信号强度曲线（time intensity curve,TIC）在NAC前后的变化。以病理学Miller-Payne（M-P）分级为评价金标准,用诊断试验的方法分别检验US和MRI与病理学评价NAC疗效的一致性,并比较化疗前后US和MRI各参数的变化。按M-P分级分为组织学显著反应（major histological response,MHR）组（n=42）和组织学非显著反应（non-major histological response,NMHR）组（n=56）。结果在检测残留病灶的最大径与病理最大径之间的相关性上,MRI（r=0.852,P=0.005）优于US（r=0.636,P=0.005）和触诊（r=0.374,P=0.049）。临床触诊评价NAC疗效的准确性达57.1%（56/98）,与病理学评价的一致性（Kappa）为0.171,P=0.036;US评价疗效的准确性达87.8%（86/98）,一致性为0.679,P〈0.001;单纯应用MRI测量原发灶长径评价疗效的准确性为90.8%（89/98）,一致性为0.748,P〈0.001;合并TIC分析结果后MRI的准确性为83.7%（82/98）,一致性为0.618,P〈0.001。MHR组患者NAC前后US病灶形态不规则由13例升至22例,边界清晰由3例升至15例,后方回声无异常由9例升至21例,血流信号0-Ⅰ级由2例升至14例,差异均有统计学意义,P〈0.05;而肿瘤周围有强回声带由5例降至2例,内部回声偏多由6例升至8例,差异均无统计学意义,P〉0.05。NMHR组患者US表现,NAC前后原发灶形态不规则由26例升至41例,肿瘤周围有强回声带由21例降至6例,肿瘤内部回声偏多由12例升至23例,血流信号0-�OBJECTIVE To investigate the clinical value of doppler ultrasound and magnetic resonance imaging（MRI）in evaluation of the effect of neoadjuvant chemotherapy（NAC）for breast cancer.METHODS Our study selected98 patients with breast cancer treated by NAC from March 2012 to January 2013.The longest diameter of tumors were measured by physical examination,ultrasound and MRI before and after 4cycles of NAC respectively.Tumor shapes,echoes and blood flow degree measured by ultrasound,together with time-signal intensity curves（TIC）measured by MRI were documented.Miller-Payne degree system（M-P）was employed as gold standard.The changes in ultrasound and MRI after NAC and their Kappa coefficient with histological measurement were recorded.RESULTS After 4cycles of NAC,42 of 98patients were included in MHR group under M-P degree system,56 patients were included in NMHR group.MRI（r=0.852,P=0.005）was better than ultrasound（r=0.636,P=0.005）and physical examination（r=0.374,P=0.049）in correlation between measured longest diameters and histological longest diameters of tumors.The veracity of physical examination was 57.1%（56/98）,Kappa coefficient with histological measurement was 0.171（P=0.036）;ultrasound showed 87.8%（86/98）in veracity and 0.679 in Kappa coefficient（P〈0.001）;MRI showed 90.9%（89/98）in veracity and 0.748 in Kappa coefficient（P〈0.001）;the outcome of MRI became 83.7%（82/98）and 0.618 plus TIC analysis（P〈0.001）.In MHR group,Ultrasound changed significantly in terms of shape（irrgeluar 13 up to 22,P〈0.05）,boundary（clear 3up to 15,P〈0.05）,rear echoes（normal 9up to 21,P〈0.05）,blood flow（0-Ⅰ 2up to 14,P〈0.05）after NAC,the change in enhanced circle（with circle 5down to 2,P=0.218）,inner echos（echos increased 6up to 8,P=0.522）was non-significant.In NMHR group,the change of shape（irrgeluar 26 up to 41,P〈0.05）,enhanced circle（with circle 21 down to 6,P〈0.05）,inner echos（echos increased 12 up to 23,P〈0.05）and blood f

关 键 词：乳腺肿瘤 新辅助化疗 疗效评价 超声 磁共振成像 临床触诊 

分 类 号：R737.9[医药卫生—肿瘤]