常规超声及超声造影技术评价乳腺癌新辅助化疗疗效的比较分析

发布时间：2018-03-31 09:27

本文选题：常规超声　切入点：超声造影　出处：《新疆医科大学》2017年硕士论文

【摘要】：目的:比较常规超声及超声造影技术在评价乳腺癌新辅助化疗疗效中的价值,分析病灶的血流参数在化疗前、化疗后的变化特点。方法:选取我院接受新辅助化疗的乳腺浸润性导管癌患者42例,分别于化疗前、化疗后行常规超声、超声造影及病理学检查,将化疗后病理测量病灶最大径的测值分别减去常规超声测值、超声造影测值,将得到的差值进行比较;以病理评价化疗疗效为金标准,分别采用常规超声、超声造影评价化疗疗效,并做一致性检验;分析化疗前、化疗后常规超声及超声造影评价病灶内血流参数的变化特点,绘制超声造影定量参数预测化疗有效性的ROC曲线,寻找最佳诊断界值。结果:超声造影测值与病理测值的差值小于常规超声测值与病理测值的差值(P0.01);与病理学评估疗效相比,常规超声的Kappa值为0.481(P0.05),超声造影的Kappa值为0.745(P0.05);常规超声评价病灶内的血流分级化疗后较化疗前减低,差异有统计学意义(P0.01),超声造影评价病灶内的血流灌注定性参数化疗后较化疗前均有明显良性转归的特征(P0.05),化疗后病灶的达峰时间(TTP)、平均增强时间(MTT)均延长,但差异均无统计学意义(P0.05),化疗后病灶的峰值强度(PI)和曲线下面积(AUC)均低于化疗前,且差异有统计学意义(P0.05),根据公式计算出峰值强度变化率与曲线下面积变化率,分别构建预测化疗有效性的ROC曲线,得到峰值强度变化率的最佳诊断界值为0.354,曲线下面积变化率的最佳诊断界值为0.340,该值可预测化疗疗效。结论:超声造影对化疗后病灶最大径的测值更接近于病理的测值;超声造影评估疗效与病理学评估化疗疗效的一致性较高,常规超声及超声造影评价病灶内血流参数的变化可为预测化疗疗效提供依据。
[Abstract]:Objective: to compare the value of conventional ultrasound and contrast-enhanced ultrasound in evaluating the therapeutic effect of neoadjuvant chemotherapy for breast cancer and to analyze the changes of blood flow parameters before and after chemotherapy.Methods: 42 patients with invasive ductal carcinoma of breast who received neoadjuvant chemotherapy were examined by conventional ultrasound, contrast-enhanced ultrasound and pathology before and after chemotherapy.The difference was compared by subtracting the conventional ultrasound value from the maximum diameter of the lesion measured by pathology after chemotherapy and contrast-enhanced ultrasound.Contrast-enhanced ultrasound (CEUs) was used to evaluate the therapeutic effect of chemotherapy, and consistency test was made. The changes of blood flow parameters were analyzed before and after chemotherapy, and the ROC curves of quantitative parameters were plotted to predict the effectiveness of chemotherapy.To find the best diagnostic bounds.Results: the difference between contrast-enhanced ultrasound value and pathological value was lower than that between conventional ultrasound value and pathological value (P0.01).The Kappa value of conventional ultrasound was 0.481g P0.05, and the Kappa value of contrast-enhanced ultrasound was 0.745m P0.05.The blood flow grade chemotherapy was lower after conventional ultrasound than that before chemotherapy.The difference was statistically significant (P 0.01). The qualitative parameters of blood flow perfusion in the lesions were evaluated by contrast-enhanced echocardiography. Compared with those before chemotherapy, the qualitative parameters of blood flow perfusion were significantly benign (P0.05), and the peak time and mean enhancement time (MTT) of the lesions were prolonged after chemotherapy.But the difference was not statistically significant (P 0.05). The peak intensity and area under curve after chemotherapy were lower than those before chemotherapy, and the difference was statistically significant (P 0.05). According to the formula, the change rate of peak intensity and area under curve were calculated.ROC curves were constructed to predict the effectiveness of chemotherapy. The best diagnostic threshold of peak intensity change rate was 0.354, and the best diagnostic threshold value of area change rate under the curve was 0.340, which could predict the effect of chemotherapy.Conclusion: the value of the maximum diameter of the lesion after chemotherapy is closer to the pathological value, and the consistency between the evaluation of the curative effect of contrast-enhanced ultrasound and the pathological evaluation of the curative effect of chemotherapy is higher.The changes of blood flow parameters in the lesions were evaluated by conventional ultrasonography and contrast-enhanced echocardiography (CEUs), which can be used to predict the curative effect of chemotherapy.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R737.9

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