双模态超声在评估乳腺癌新辅助化疗疗效中的应用价值  

Application value of dual modality ultrasound in evaluating the efficacy of neoadjuvant chemotherapy for breast cancer

作　　者：耿怡[1] 马富成[1] 热西达.加帕尔 冷晓玲[1] 

机构地区：[1]新疆医科大学附属肿瘤医院超声诊断科,乌鲁木齐830011

出　　处：《新疆医科大学学报》2017年第3期275-278,共4页Journal of Xinjiang Medical University

基　　金：国家自然科学基金(81260332)

摘　　要：目的分析双模态超声在评估乳腺癌新辅助化疗疗效中的应用价值。方法选取2014年11月-2016年1月就诊于新疆医科大学附属肿瘤医院的单发乳腺癌女性患者42例,在新辅助化疗前、后行常规超声、常规超声联合超声造影检查(即双模态超声),全部化疗周期结束后行手术取得病理结果,采用Miller and Payne病理反应分级标准评估新辅助化疗疗效,将术后病理切片与治疗前活检病理切片相对比,癌细胞减少≤30%定义为无效,癌细胞减少>30%或者无浸润性癌成分定义为有效。结果有效组24例,无效组18例,以病理学评估结果为金标准做一致性检验,得到常规超声的Kappa值为0.507,双模态超声的Kappa值为0.667,差异有统计学意义(P<0.05);新辅助化疗前、后病灶的达峰时间(TTP)、平均增强时间(MTT)差异均无统计学意义(P>0.05),化疗后病灶的峰值强度(PI)和曲线下面积(AUC)均低于化疗前,且差异有统计学意义(P<0.05);有效组与无效组间病灶的峰值强度变化率、曲线下面积变化率差异有统计学意义(P<0.05)。构建ROC曲线,得到最佳诊断界值为0.379,可在最大程度上区分化疗的有效和无效。结论双模态超声可较准确地评估乳腺癌新辅助化疗疗效,同时超声造影参数具有一定的评估疗效的价值。Objective To evaluate the value of dual modality ultrasound in evaluating the curative effect of neoadjuvant chemotherapy for breast cancer. Methods Choosing 42 cases of women with solitary breast cancer who admitted to the Affiliated Tumor Hospital of Xinjiang Medical University from November 2014 to January 2016,before and after neoadjuvant chemotherapy, all cases underwent routine ultrasound and conventional ultrasound combined contrast-enhanced ultrasound （dual modality ultrasound）. After all cycles of chemotherapy, the patients accepted operations and pathological results were obtained, using Miller and Payne classification criteria was used to the evaluate the effect of neoadjuvant chemotherapy and the pathologic biopsy was compared with the pathologic biopsy before treatment.The cancer cells were re- duced by less than thirty percent was defined as ineffective. The cancer cells were reduced by more than thirty percent or no invasive cancer was defined as effective. Results 24 cases was effective and 18 cases was ineffectiven.The consistency test was done with the results of pathology evaluation.The Kappa value of conventional ultrasound was 0.507, and the Kappa value of dual modality ultrasound was 0.667, and the difference was statistically significant （P〈0.05）. The peak time （TTP） of lesions before and after Neoad-juvant chemotherapy and average time enhancement （MTT） showed no significant difference （P 〉0.05）, while the peak intensity of the lesions after chemotherapy （PI） and the area under the curve （AUC） was lower than that before chemotherapy, and the difference was statistically significant （P 〈0.05）. There was significant difference in the rate of change of peak intensity and area under curve between effective group and ineffective group （P〈0.05）. To construct the ROC curve, the optimal diagnostic boundary value was 0.379, which is the value to discriminate between effective and ineffective chemotherapy. Conclusion Dual modality ultrasound can accurately

关 键 词：双模态超声 常规超声 超声造影 乳腺癌 新辅助化疗 

分 类 号：R445.1[医药卫生—影像医学与核医学]