常规超声联合声脉冲辐射力成像预测新辅助化疗对乳腺癌的效果  

Conventional ultrasound combined with acoustic radiation force impulse imaging for predicting efficacy of neoadjuvant chemotherapy of breast cancer

作　　者：彭娟[1] 刘娜[1] 蒲欢 贾妍[1] PENG Juan;LIU Na;PU Huan;JIA Yan(Department of Ultrasound Imaging,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院超声影像科,湖北武汉430060

出　　处：《中国介入影像与治疗学》2021年第7期416-420,共5页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的观察常规超声(US)联合声脉冲辐射力成像(ARFI)技术预测新辅助化疗(NAC)对乳腺癌效果的价值。方法对52例接受NAC的女性乳腺癌患者分别于化疗前1周内(T0)及4个周期化疗结束时(T4)行US及ARFI检查。疗程结束后手术切除肿瘤,获取病理学结果,以Miller-Payne(MP)病理反应分级为金标准,将MP3~5级患者归入组织学显著反应组(MHR组)、MP1~2级归入组织学非显著反应组(NMHR组);对比组间T0及T4时病灶最大径(D)、血流分级、弹性评分及平均剪切波速度(V mean),计算最大径缩小率(ΔD)及V mean缩小率(ΔV mean)。采用受试者工作特征(ROC)曲线分析US、ARFI参数评估NAC疗效的效能。结果30例MP3~5级(MHR组),22例MP1~2级(NMHR组)。T0时组间D、血流分级、弹性评分及SWV差异均无统计学意义(P均>0.05)。T4时与MHR组相比,NMHR组残余病灶ΔD增加,血流分级0~1级比率增加、2~3级比率减少;弹性评分4~6分比率减少、1~3分比率增加,ΔV mean增加(P均<0.01)。US联合ARFI评估NAC疗效的曲线下面积(AUC)为0.95。结论US、ARFI定量和定性参数均可预测NAC对于乳腺癌的疗效,二者联合预测效能较高。Objective To explore the value of conventional ultrasound(US)combined with acoustic radiation force impulse imaging(ARFI)in predicting the efficacy of neoadjuvant chemotherapy(NAC)for breast cancer.Methods US and ARFI examinations were performed in 52 women with breast cancer 1 week before chemotherapy(T0)and at the end of 4 cycles of NAC(T4).Then the tumors were surgically resected,and the pathological results were obtained.Taken Miller-Payne(MP)pathological reaction classification as the gold standard,the patients with MP3-5 grade were divided into the major histological response group(MHR group),while those with MP1-2 were divided into non-major histological response group(NMHR group).The maximum diameter(D),the grade of blood flow,elasticity score and the mean shear wave velocity(V mean)of the lesions at T0 and T4 were compared between groups,and the reduction rate of the maximum diameter(ΔD)and V mean(ΔV mean)were calculated.The efficacy of US and ARFI parameters for evaluating NAC efficacy were analyzed with receiver operating characteristic(ROC)curve.Results MP3-5 grade were found in 30 patients(MHR group),and MP1-2 in 22 patients(NMHR group).No significant difference of D,blood flow grade,elasticity score nor V mean was detected between groups at T0(all P>0.05).At T4,compared those in NMHR group,theΔD of lesions increased,the proportion of blood flow grade 0-1 increased and of 2-3 decreased,the ratio of elastic 4-6 scores decreases but 1-3 scores increased,whileΔV mean increased in MHR group(all P<0.01).The ROC curve showed that the area under curve(AUC)of US combined with ARFI for evaluating the efficacy of NAC was 0.95.Conclusion Both quantitative and qualitative parameters of US and ARFI could predict the efficacy of NAC for breast cancer,and the combination of them brought higher predictive efficiency.

关 键 词：乳腺肿瘤 超声检查 声脉冲辐射力成像 新辅助治疗 

分 类 号：R737.9[医药卫生—肿瘤] R445.1[医药卫生—临床医学]