双模态超声在评估乳腺癌新辅助化疗疗效中的应用价值

Application value of bimodal ultrasound in evaluating the efficacy of neoadjuvant chemotherapy for breast cancer

目的评价双模态超声(常规超声+超声造影检查)在评估乳腺癌新辅助化疗(NAC)疗效中的应用价值。方法应用前瞻性随机双盲对照试验方法,选择在2017年1月至2019年1月期间新疆医科大学附属肿瘤医院收治的180例接受NAC的单发乳腺癌患者作为研究对象,将所有患者化疗前、化疗6个周期后行常规超声检查、双模态超声检查,根据化疗结束后的病理学结果评估化疗疗效,比较化疗前、化疗6个周期后的超声造影的相关参数变化情况,并比较病理学有效组和无效组双模态超声造影参数。结果根据Miller and Payne病理反应分级标准,180例患者中NAC有效87.78%(158/180)。常规超声检查评估化疗疗效的特异度为45.45%(10/22),灵敏度为73.42%(116/158),阳性预测值为84.06%(116/138)。双模态超声检查结果显示,检查特异度为72.73%(16/22),灵敏度为93.04%(147/158),阳性预测值为96.08%(147/153)。双模态超声检查的特异度、灵敏度、阳性预测值均要高于对照组,差异有统计学意义(P<0.05)。NAC后的双模态超声造影参数峰值强度(PI)、曲线下面积(AUC)明显低于化疗前[(25.63±5.24)vs.(16.37±10.37)Db;(1352.68±542.81)Db*s vs.(811.62±182.56)Db*s,],差异有统计学意义(P<0.05),但达峰时间(TTP)、平均增强时间(MTT)比较[(55.27±22.69)vs.(62.35±14.38)s;(74.39±14.27)vs.(81.67±14.29)s],差异无统计学意义(P>0.05);NAC后有效组患者的峰值强度变化率明显高于无效组(0.592±0.144 vs.-0.039±0.03),差异有统计学意义(P<0.05),但曲线下面积变化率(0.501±0.193 vs.0.271±0.511)比较,差异无统计学意义(P>0.05)。结论相较于常规超声检查,双模态超声评估乳腺癌NAC的疗效更加可靠和准确,超声造影参数对化疗疗效也有一定评估价值,具有较高的临床实用性。

Objective To evaluate the application value of bimodal ultrasound(conventional ultrasound+contrast-enhanced ultrasound)in evaluating the efficacy of neoadjuvant chemotherapy for breast cancer.Methods Using a prospective randomized double-blind controlled trial method,180 patients with single breast cancer who received neoadjuvant chemotherapy admitted to our hospital between January 2017 and January 2019 were selected as the research subjects.All patients were selected before and after chemotherapy.Routine ultrasound examinations and bimodal ultrasound examinations were performed to evaluate the efficacy of chemotherapy based on the pathological results after chemotherapy,and compare the changes in related parameters of contrast-enhanced ultrasound before and after chemotherapy.The parameters of bimodal contrast-enhanced ultrasound in the pathologically effective and ineffective groups were compared.Results According to Miller and Payne's pathological response classification standard,neoadjuvant chemotherapy was effective 87.78%(158/180)among 180 patients.The results of routine ultrasound examination showed that its specificity was 45.45%(10/22),the sensitivity was 73.42%(116/158),and the positive predictive value was 84.06%(116/138).The results of bimodal ultrasound examination showed that its specificity was 72.73%(16/22),the sensitivity was 93.04%(147/158),and the positive predictive value was 96.08%(147/153).The results showed that the specificity,sensitivity,and positive predictive value of bimodal ultrasound were higher than those of the control group(P<0.05).After neoadjuvant chemotherapy,the peak intensity(PI)and area under the curve(AUC)of bimodal ultrasound contrast parameters were significantly lower than before chemotherapy[(25.63±5.24)vs.(16.37±10.37)Db;(1352.68±542.81)Db*s vs.(811.62±182.56)Db*s],the difference was statistically significant(P<0.05),but the time to peak(TTP)and mean enhancement time(MTT)were compared[(55.27±22.69)vs.(62.35±14.38)s;(74.39±14.27)vs.(81.67±14.29)s],the difference was not statistically significant(P>0.05).After neoadjuvant chemotherapy,the peak intensity change rate of the effective group was significantly higher than that of the ineffective group(0.592±0.144 vs.-0.039±0.03),the difference was statistically significant(P<0.05),but the change rate of the area under the curve was(0.501±0.193)vs.(0.271±0.511),the difference was not statistically significant(P>0.05).Conclusion Compared with conventional ultrasound examinations,bimodal ultrasound is more reliable and accurate in evaluating the efficacy of neoadjuvant chemotherapy for breast cancer.Contrast-enhanced ultrasound parameters also have a certain evaluation value for the efficacy of chemotherapy and have higher clinical practicability.