超声微血管成像在引导儿童腹膜后神经母细胞瘤穿刺活检中的应用价值  

Value of superb microvascular imaging in the guidance of puncture biopsy of retroperitoneal neuroblastoma in children

作　　者：唐宽丽 沈志云[1] 钟芙蓉 管雯斌[2] 陈亚青[1] 朱云开[1] TANG Kuanli;SHEN Zhiyun;ZHONG Furong;GUAN Wenbin;CHEN Yaqing;ZHU Yunkai(Department of Ultrasound in Medicine,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Pathology,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092)

机构地区：[1]上海交通大学医学院附属新华医院超声科,上海200092 [2]上海交通大学医学院附属新华医院病理科,上海200092

出　　处：《肿瘤影像学》2024年第3期282-287,共6页Oncoradiology

摘　　要：目的:探讨超微血管成像(superb microvascular imaging,SMI)对提高儿童腹膜后神经母细胞瘤(neuroblastoma,NB)肿瘤微血管显示和超声引导下肿瘤穿刺活检准确度的价值。方法:回顾并分析2015年3月—2021年7月上海交通大学医学院附属新华医院收治的24例难以手术完全切除的腹膜后NB患儿的临床资料、肿瘤超声影像和超声引导穿刺活检的资料。采用Image J软件测得取样区肿瘤内血流面积占比(blood flow area ratio,BFAR),以评估肿瘤微血管的丰富程度;以穿刺病理学诊断为标准统计分析SMI引导穿刺活检的取样成功率;应用儿童神经母细胞瘤诊疗专家共识2015版中的肿瘤疗效评估标准、肿瘤标志物测定以及化疗后肿瘤根治术后病理学检查评价穿刺活检病理学诊断的准确度。结果:SMI模式的肿瘤微血管BFAR显著高于彩色多普勒血流成像和彩色多普勒能量图模式(分别为14.74%、3.17%及5.88%,P<0.001);SMI引导24例肿瘤穿刺活检均获得NB病理学诊断,83.3%的肿瘤获得NB亚型分类,MYCN基因扩增分析成功率100%。20例获得明确肿瘤亚型分型的患者中18例患儿的化疗效果为部分缓解,2例为疾病稳定;而未获得明确病理学分型的4例中2例化疗评估结果为疾病稳定,2例为部分缓解。结论:SMI可明显提高肿瘤微血管的检出率,SMI引导穿刺活检对提高肿瘤病理学诊断尤其是肿瘤病理学亚型分型和分子分型准确度具有重要意义。Objective:To explore the value of superb microvascular imaging(SMI)in improving tumor microvasculature imaging and the accuracy of ultrasound guided puncture biopsy in children with retroperitoneal neuroblastoma(NB).Methods:This retrospective study involved the analysis of the clinical data,tumor ultrasound imaging,and ultrasound-guided puncture biopsy results of 24 children with unresectable retroperitoneal NB in Xinhua Hospital,Shanghai Jiao Tong University School of Medicine from March 2015 to July 2021.The tumor microvasculature was assessed by measuring the percentage of tumor flow area within the region of interest blood flow area ratio(BFAR)by Image J software.The biopsy adequacy rate of SMI targeted biopsy was evaluated using biopsy histopathology as reference standard.The Expert Consensus on Diagnosing and Treating Neuroblastoma in Children(CCCG-NB-2015 Regimen),tumor biomarker and surgical histopathology after chemotherapy were used to assess the accuracy of SMI targeted biopsy.Results:The BFAR value of SMI was significantly higher than that of the color Doppler flow imaging and color Doppler energy imaging(14.74%,3.17%,5.88%,respectively,P<0.001).All 24 SMI targeted biopsy procedures successfully confirmed the diagnosis of NB,with 83.3%adequate for subtype classification and 100.0%adequate for MYCN gene amplification analysis.Among the 20 patients with tumor subtypes confirmed on biopsy,18 of them were categorized to partial response and 2 were categorized to stable disease.Among the 4 patients whose tumor subtype could not be confirmed on biopsy,2 of them were categorized to partial response and the rest 2 were categorized to stable disease.Conclusion:With significant improvement in the depiction of tumor vasculature,SMI guided puncture biopsy is of great importance in improving the accuracy of histopathology results,especially for tumor subtype classification and genetic alternation.

关 键 词：儿童 腹膜后神经母细胞瘤 超微血管成像 穿刺活检 

分 类 号：R735.4[医药卫生—肿瘤] R445.1[医药卫生—临床医学]