二维超声与剪切波弹性成像评价乳腺癌新辅助化疗疗效的价值

发布时间：2018-06-17 11:30

本文选题：乳腺癌 + 新辅助化疗　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:本研究以病理结果为对照,应用二维超声评价乳腺癌新辅助化疗(NAC)疗效的价值,并应用剪切波弹性成像(SWE)技术观察乳腺癌NAC前及NAC后各周期病灶硬度值的变化趋势,探讨SWE技术早期预测NAC疗效的价值。方法:选取接受新辅助化疗的乳腺癌患者43例,共45个病灶,化疗前及化疗后2、4、6、8周期均行常规超声及剪切波弹性成像检查,以MillerPayne病理反应分级为标准,计算二维超声评价乳腺癌NAC疗效的敏感度、特异度、准确性及其与组织病理学判断乳腺癌NAC疗效的一致性。按照病理分级标准对病灶分为病理反应显著组(G3+G4+G5)和病理反应非显著组(G1+G2)。测量两组在化疗前及化疗后2、4、6周期末病灶的最大弹性值Emax及弹性值变化率ΔEmax,并比较两组的变化趋势。以病理反应是否显著为依据,绘制NAC 2周期末和4周期末病灶ΔEmax的ROC曲线,比较两者对NAC治疗反应的预测价值。结果:(1)按照病理分级标准,病理反应显著组病灶33个,病理反应非显著组病灶12个。(2)本组45个乳腺癌病灶NAC治疗前二维超声检查肿瘤最大径(3.7±1.8)cm,NAC结束后肿瘤最大径(2.0±1.4)cm,二者比较差异有统计学意义(t=5.846,p=0.000)。以病理结果为标准,二维超声测量肿瘤最大径评价乳腺癌NAC疗效的敏感度为78.78%,特异度为66.67%,准确性为75.56%,与组织病理学评价乳腺癌NAC疗效基本一致,Kappa值0.421。(3)随着化疗时间的延长,病理反应显著组和非显著组乳腺癌病灶Emax值均逐渐降低。病理反应显著组2周期末Emax值已明显降低(p0.05),非显著组4周期末Emax值明显降低(p0.05),6周期末与4周期末相比,两组下降程度差异均无统计学意义(p0.05)。(4)病理反应显著组与非显著组中随着化疗时间的延长,乳腺癌病灶?Emax均逐渐增加,其中病理反应显著组2、4、6周期末?Emax两两比较差异均有统计学意义(p0.05);病理反应非显著组4周期末、6周期末与2周期末比较差异均有统计学意义(p0.05),而6周期末与4周期末?Emax值相近,差异无统计学意义(p0.05)。各周期末两组间?Emax比较差异均有统计学意义,病理反应显著组?Emax大于反应非显著组(p0.05)。(5)病灶?Emax的ROC曲线显示,2周期末曲线下面积为0.808,4周期末曲线下面积为0.869,两者比较差异无统计学意义(Z=0.63,p=0.264)。结论:(1)二维超声在评价NAC疗效中仍具有重要作用。(2)SWE技术能为二维超声评价乳腺癌NAC疗效提供有价值的补充,病理反应显著组与非显著组在NAC中病灶Eamx值下降趋势不同。(3)乳腺癌病灶?Emax可早期预测NAC的疗效。
[Abstract]:Objective: to evaluate the therapeutic effect of neoadjuvant chemotherapy in breast cancer by two-dimensional ultrasound, and to observe the change trend of lesion hardness before and after NAC by using shear wave elastic imaging (SWE) technique. To explore the value of SWE technique in early prediction of NAC efficacy. Methods: Forty-three patients with breast cancer underwent neoadjuvant chemotherapy with 45 lesions. Routine ultrasound and shear wave elastography were performed before and after chemotherapy. MillerPayne's pathological grade was used as the standard. The sensitivity, specificity and accuracy of two dimensional ultrasound in evaluating the therapeutic effect of NAC in breast cancer were calculated, and the agreement between NAC and histopathology in evaluating the curative effect of NAC in breast cancer was evaluated. According to the pathological grading criteria, the lesions were divided into two groups: G 3 G 4 G 5 and G 3 G 4 G 5 (P < 0 05) and G 1 G 2 (P < 0 05). The maximum elastic value (Emax) and the change rate of elastic value (螖 Emax.) of the lesions were measured before chemotherapy and at the end of 2 weeks and 4 weeks after chemotherapy in both groups, and the trend of change was compared between the two groups. The ROC curves of 螖 E max at the end of 2 and 4 weeks of NAC were plotted on the basis of whether the pathological reaction was significant or not, and the predictive value of 螖 E max in NAC treatment was compared. Results according to the pathological grading standard, 33 lesions were found in the pathological reaction group. (2) before NAC treatment, 45 breast cancer lesions were examined by two-dimensional ultrasound for the maximum diameter of the tumor (3.7 卤1.8 cm). The maximum diameter of the tumor was 2.0 卤1.4 cm after the end of NAC. The difference between the two groups was statistically significant (P < 0.05). According to the pathological results, the sensitivity, specificity and accuracy of two dimensional ultrasound in evaluating the NAC effect of breast cancer were 78.78, 66.67 and 75.56, respectively. The Kappa value of NAC in breast cancer with histopathology was 0.421.3) with the prolongation of chemotherapy time. The E max value of breast cancer focus decreased gradually in both pathological response group and non-significant group. The Emax value at the end of 2 weeks was significantly decreased in the pathological response group, while that in the non-significant group at the end of 4 weeks was significantly lower than that at the end of the 6th week and the end of the 4th week in the non-significant group. There was no significant difference in the degree of decrease between the two groups (P 0.05). The Emax of breast cancer lesions increased gradually with the prolongation of chemotherapy time in the pathological reaction group and the non-significant group. There were significant differences in Emax between the two groups at the end of 6 weeks and the end of 4 weeks and 6 weeks respectively in the pathological reaction group, and the difference between the two groups was significant at the end of 4 weeks and 6 weeks and the end of 2 weeks, while the value of E max was similar at the end of 6 weeks and 4 weeks, and the difference was significant at the end of 4 weeks and 2 weeks, respectively. The difference was not statistically significant (P 0.05). There were significant differences in Emax between the two groups at the end of each week. The ROC curve showed that the area under the end of 2 weeks curve was 0. 808 and the area under the end of 4 weeks curve was 0. 869. There was no significant difference between the two groups. There was no significant difference between the two groups. Conclusion two dimensional ultrasound still plays an important role in evaluating the curative effect of NAC. SWE can provide a valuable supplement for evaluating the curative effect of NAC by two-dimensional ultrasound. In NAC, Emax could predict the curative effect of NAC early.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9;R445.1

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