彩色多普勒超声检查评价乳腺癌化疗疗效的价值分析

Value of color Doppler ultrasonography in breast cancer chemotherapy

目的研究彩色多普勒超声检查的声像学及血流动力学特征用于评价乳腺癌病人化疗疗效的临床价值。方法收集2016年4月至2018年4月在广州医科大学附属第五医院接受新辅助化疗(NAC)乳腺癌病人68例,于化疗周期结束1 d内行空芯针穿刺病理学检查及彩色多普勒超声检查,并以病理学检查结果为疗效标准将其分为有效组[47例,26例完全缓解(CR)+21例部分缓解(PR)]、无效组[21例,13例疾病稳定(PD)+8例疾病进展(SD)]。联合首诊超声监测资料,比较两组病人化疗前后的乳腺肿瘤体积、边界、恶晕征等声像学特征和血流丰富(AdlerⅡ级+Ⅲ级)率、血流阻力指数(RI)、收缩期峰值速度(PSV)等血流动力学特征差异。同时参照病理诊断结果计算彩色多普勒超声检查对NAC疗效评价的特异度、灵敏度、准确度。结果有效组病人乳腺肿瘤恶晕征减轻率、边界清晰率均优于化疗前(P<0.05),肿瘤体积则明显小于无效组,且较化疗前均显著下降(P<0.05)。无效组化疗前后各声像学特征比较均差异无统计学意义(P>0.05);有效组病人乳腺肿瘤血流丰富率、RI、PSV均明显低于无效组,且较化疗前均显著下降(P<0.05)。无效组化疗前后各血流动力学特征比较均差异无统计学意义(P>0.05);彩色多普勒超声检查评价乳腺癌病人NAC疗效的特异度、灵敏度、准确度分别为86.49%、51.61%、71.64%。结论彩色多普勒超声检查乳腺肿瘤的声像学特征与血流动力学特征可准确、客观地对乳腺癌病人NAC疗效进行评价,具有较大的临床推广应用价值。

Objective To explore the ultrasound imaging and hemodynamic characteristics of color Doppler ultrasonography in eval⁃uating the clinical value of chemotherapy efficacy in breast cancer chemotherapy.Methods Sixty-eight patients with breast cancer who underwent neoadjuvant chemotherapy(NAC)in The Fifth affiliated hospital of Guangzhou medical university from April 2016 to April 2018 were selected.The pathological examination and color Doppler ultrasonography were performed within 1 day after the end of the chemotherapy cycle.According to the results of pathological examination,they were assigned into effective group[47 cases,com⁃plete remission(CR,26 cases),partial remission(PR,21 cases)],and ineffective group[21 case,stable(PD,13 cases),evolve(SD,8 cases)].The volume,boundary,internal and posterior echo,blood flow richness(AdlerⅡ+Ⅲ)and blood flow resistance index(RI)of breast tumor before and after chemotherapy were compared between the two groups.The systolic peak velocity(PSV)and other hemody⁃namic characteristics were different.At the same time,the specificity,sensitivity and accuracy of color Doppler ultrasound in evaluat⁃ing the curative effect of NAC were calculated according to the pathological diagnosis results.Results The reduction rate of breast tu⁃mor malignant symptom and the rate of clear boundary in the effective group were better than those before chemotherapy(P<0.05),and the tumor volume was significantly smaller than that in the ineffective group,and both was significantly lower than that before chemotherapy(P<0.05).There was no significant difference in the sonographic features before and after chemotherapy in the ineffective group(P>0.05).The rate of breast tumor blood flow,RI and PSV in the effective group was significantly lower than that in the ineffective group,and they were significantly lower than before the chemotherapy(P<0.05).There was no significant difference in hemodynamic characteristics of the ineffective group before and after chemotherapy(P>0.05).The specificity,sensitivity and accuracy of hypercolor Doppler ultrasonography in evaluating the efficacy of NAC in patients with breast cancer were 86.49%,51.61%and 71.64%,respec⁃tively.Conclusion The sonographic and hemodynamic features of breast tumors by color Doppler ultrasonography can be accurately evaluated and the curative effect of NAC in patients with breast cancer can be evaluated objectively,which is of great value for clinical popularization and application.