声脉冲辐射力弹性成像技术评价乳腺癌新辅助化疗疗效的初步研究

发布时间：2018-03-18 13:06

本文选题：乳腺癌　切入点：新辅助化疗　出处：《天津医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的本研究旨在将常规超声及声脉冲辐射力弹性成像技术应用于乳腺癌新辅助化疗后疗效的评价,并与病理组织学进行对照,可望对乳腺癌新辅助化疗的疗效进行有价值的评价,提高乳腺癌新辅助化疗疗效评价的准确率,为乳腺癌患者选择最佳的治疗方案提供较为客观的影像学依据。方法收集60例均经病理学证实且经临床诊断为Ⅱb-Ⅲc期乳腺癌病例,患者行新辅助化疗前后均进行临床评价(临床触诊)、常规超声及超声弹性成像检查,新辅助化疗后切除病灶,根据病理学诊断标准判断疗效,并将化疗前后乳腺肿瘤的变化与病理结果作对照研究。新辅助化疗前后对60个病例分别在二维超声模式下、彩色多普勒显像条件下观察乳腺肿瘤的各项影像学特征,分别进行最长径测量和Alder半定量法分级；应用声脉冲辐射力成像技术,分别测量肿瘤内部、肿瘤边缘处及对侧正常腺体的横向剪切波速度。应用SPSS18.0统计分析软件进行数据分析,计量数据采用中位数表示,分析常规超声、超声弹性成像技术对于新辅助化疗肿瘤反应性的评价作用,主要从以下几方面进行比较分析：新辅助化疗前后乳腺肿瘤的大小(以最长径表示)的差异性；新辅助化疗前后乳腺肿瘤内部血流信号的差异性；新辅助化疗前后肿瘤内部、肿瘤边缘处组织和对照组正常腺体组织横向剪切波速度的差异性。结果乳腺恶性肿瘤经新辅助化疗4个周期后,在病理判定有效组,新辅助化疗前后在VTQ模式下测量肿瘤内部及肿瘤边缘处组织的横向剪切波速度差异有统计学意义(P0.05)；在病理判定无变化组,新辅助化疗前后肿瘤内部及肿瘤边缘处组织的横向剪切波速度差异均不具有统计学意义(P0.05)。在对照组,新辅助化疗前后肿正常腺体组织的横向剪切波速度差异不具有统计学意义(P0.05)。临床触诊评价原发肿瘤缓解的有效率为56.7%,常规超声评价原发肿瘤缓解的有效率为66.7%,超声弹性成像评价原发肿瘤缓解的有效率为71.7%。临床触诊评价乳腺癌新辅助化疗疗效的灵敏度、特异度分别为47.8%、14.9%；常规超声评价乳腺癌新辅助化疗疗效的灵敏度、特异度分别为71.7%、50.0%；超声弹性成像的灵敏度、特异度分别为89.1%、85.7%。结论应用声脉冲辐射力弹性成像技术评价乳腺肿瘤内部的及边缘组织的软硬度,为新辅助化疗后乳腺肿瘤的变化提供了定量的影像学检查方法。与常规超声相结合可以更加客观、全面的评价乳腺癌新辅助化疗的疗效,将新辅助化疗后的效果信息及时反馈于临床。
[Abstract]:objective
The purpose of this study was to evaluate the conventional ultrasound and acoustic radiation force impulse imaging technique is applied to the curative effect after neoadjuvant chemotherapy for breast cancer, and compared with histopathological evaluation has the effect of neoadjuvant chemotherapy for breast cancer can improve breast cancer, neoadjuvant chemotherapy efficacy evaluation accuracy, provide more objective imaging of breast cancer patients choose the best treatment basis.
Method
The collection of 60 cases were confirmed by pathology and clinical diagnosis of b- II stage C breast cancer patients before and after neoadjuvant chemotherapy were evaluated clinically (palpation), conventional ultrasound and ultrasound elastography, neoadjuvant chemotherapy after resection of the lesion, according to pathological diagnosis standard to judge the curative effect, and chemotherapy before and after the change of breast cancer with pathological results as control group. Before and after neoadjuvant chemotherapy in 60 cases respectively in two-dimensional ultrasound mode, characteristics of the imaging of breast tumors with color Doppler imaging conditions, respectively, the longest diameter measurement and Alder semi quantitative classification; the application of acoustic radiation force impulse imaging, tumor the measured transverse shear wave velocity at the edge of tumor and contralateral normal glands. Data were analyzed using SPSS18.0 statistical analysis software, the measurement data are expressed by median, conventional ultrasound analysis , ultrasound elastography for the evaluation of neoadjuvant chemotherapy of tumor reactive function, mainly analyzed from the following aspects: the size of breast cancer before and after neoadjuvant chemotherapy (with the longest diameter of said) difference; the difference before and after neoadjuvant chemotherapy breast tumor blood flow signal of tumor before and after neoadjuvant chemotherapy; at the edge of tumor tissue, the difference and control the transverse shear wave velocity group of normal gland tissue.
Result
Breast cancer after neoadjuvant chemotherapy after 4 cycles, determine the effective group in pathology, statistically significant differences of the transverse shear wave velocity before and after neoadjuvant chemotherapy in VTQ mode measurement of tissue tumor and tumor edge (P0.05); no change in pathology assessment group, a new auxiliary transverse shear wave velocity inside the tumor tissue and the margin of the tumor before and after chemotherapy can differences were not statistically significant (P0.05). In the control group before and after neoadjuvant chemotherapy, the transverse shear wave velocity difference of swollen normal gland tissue was not statistically significant (P0.05). Clinical palpation of the evaluation of the primary tumor remission rate was 56.7%, the evaluation of conventional ultrasound primary tumor remission efficiency of 66.7%, ultrasound elastography in the evaluation of the primary tumor remission rate sensitivity of neoadjuvant chemotherapy with 71.7%. clinical palpation evaluation of breast cancer, the specificity was 47.8%, 14.9%; The sensitivity and specificity of conventional ultrasound in the evaluation of neoadjuvant chemotherapy for breast cancer were 71.7% and 50%, respectively, and the sensitivity and specificity of ultrasound elastography were 89.1%, 85.7%. respectively.
conclusion
The hardness of the radiation force evaluation of elastography of breast tumor tissue and the internal edge of pulse sound, changes after neoadjuvant chemotherapy of breast cancer provides a quantitative imaging method. Combined with conventional ultrasound can be more objective and comprehensive evaluation of the efficacy of neoadjuvant chemotherapy for breast cancer, the information effect of neoadjuvant chemotherapy after the timely feedback to the clinic.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.9;R445.1

【引证文献】