多模态超声联合磁共振成像预测钙化灶三阴性乳腺癌新辅助化疗的效果  

Value of multimodal ultrasound combined with magnetic resonance imaging in predicting the effect of neoadjuvant chemotherapy for triple-negative breast cancer with calcified foci

作　　者：董晓阳 左思阳 欧兴密 赵晓玲 马文珺 付晓燕 DONG Xiaoyang;FU Xiaoyan;ZUO Siyang;OU Xingmi;ZHAO Xiaoling;MA Wenjun(Department of Ultrasound,940th Hospital,Joint Logistic Support Force,Lanzhou 810000,China)

机构地区：[1]联勤保障部队第九四〇医院超声科,甘肃兰州810000

出　　处：《中国临床医生杂志》2025年第4期421-425,共5页Chinese Journal For Clinicians

基　　金：甘肃省科技计划基金资助项目(22JR5RA643)。

摘　　要：目的探究多模态超声联合磁共振成像(MRI)预测钙化灶三阴性乳腺癌(TNBC)新辅助化疗(NAC)的效果。方法回顾性分析联勤保障部队第九四〇医院2020年7月至2023年7月收治的78例行NAC治疗的钙化灶TNBC患者。患者在NAC治疗前均行多模态超声、MRI检查,收集患者临床资料及影像学检查结果。患者NAC 4~6个周期后进行手术治疗,根据术后病理检查结果将其分为术后病理完全缓解(pCR)组(27例)和非pCR组(51例)。分析患者pCR的影响因素,采用受试者操作特征(ROC)曲线分析多模态超声联合MRI对患者pCR的评估价值。结果非pCR组临床分期为Ⅲ期占比、钙化形态为细小多形性占比、钙化分布为簇状占比、肿瘤形态不规则占比、表观扩散系数(ADC)值、最大弹性模量值(E_(max))、周围放射状增强占比、峰值强度(PI)均高于pCR组,达峰时间(TTP)低于pCR组(P<0.05)。多因素logistic回归分析结果显示,钙化形态(OR=3.015,95%CI:1.616~5.623)、ADC值(OR=3.633,95%CI:1.460~9.038)、E_(max)(OR=2.684,95%CI:1.208~5.959)、PI(OR=4.414,95%CI:1.934~10.073)是影响患者pCR的独立危险因素(P<0.05)。ROC曲线分析显示,ADC、E_(max)、PI及三者联合预测患者pCR的敏感度分别为81.50%、77.80%、74.10%、88.90%,特异度分别为74.50%、76.50%、68.60%、60.20%,曲线下面积(AUC)分别为0.807、0.775、0.724、0.922,具有临床预测作用(P<0.05)。结论多模态超声联合MRI在钙化灶TNBC患者NAC后pCR中具有较好的预测价值。Objective To explore the value of multimodal ultrasound combined with magnetic resonance imaging(MRI)in predicting the effect of neoadjuvant chemotherapy(NAC)for calcified triple negative breast cancer(TNBC).Method A retrospective analysis was performed on 78 TNBC patients with calcified foci treated with NAC in the 940th Hospital of the Joint Logistics Support Force from July 2020 to July 2023.All patients underwent multimodal ultrasound and MRI examination before NAC treatment,and clinical data and imaging results were collected.The patients underwent surgery after 4-6 cycles of NAC chemotherapy.According to the results of postoperative pathological examination,they were divided into postoperative pathological complete response(pCR)group(27 cases)and non-pCR group(51 cases).The influence factors of patients’pCR were analyzed,and the value of multimodal ultrasound combined with MRI in the evaluation of patients’pCR was analyzed by the receiver operating characteristic(ROC)curve.Result The proportion of clinical stageⅢ,small pleomorphism of calcification,cluster of calcification,irregular tumor shape,apparent diffusion coefficient(ADC)value,maximum elastic modulus(E_(max)),peripheral radial enhancement and peak intensity(PI)in the non-pCR group were higher than those in the pCR group,and the time to peak(TTP)was lower than that in pCR group(P<0.05).Binary Logistic regression analysis showed that calcification morphology(OR=3.015,95%CI:1.616-5.623),ADC value(OR=3.633,95%CI:1.460-9.038),E_(max)(OR=2.684,95%CI:1.208-5.959)and PI(OR=4.414,95%CI:1.934-10.073)were independent risk factors for pCR(P<0.05).ROC curve analysis showed that the sensitivity of ADC,E_(max),PI and the combination of the three to predict pCR were 81.50%,77.80%,74.10%and 88.90%,respectively,and the specificity were 74.50%,76.50%,68.60%and 60.20%,respectively.The area under the curve(AUC)were 0.807,0.775,0.724 and 0.922,respectively,had a clinical predictive effect(P<0.05).Conclusion Multimodal ultrasound combined with MRI has good predictiv

关 键 词：磁共振成像 多模态超声 三阴性乳腺癌 钙化灶 病理完全缓解 预测价值 

分 类 号：R735.9[医药卫生—肿瘤]