超微血管成像技术在乳腺良恶性病变中的鉴别诊断及乳腺癌新辅助化疗疗效评估中的价值研究

Clinical Application Value of Ultrastructural Superb Microvascular Imaging in the Diagnosis and Differentiation of Benign and Malignant Breast Lesions and the Evaluation of Neoadjuvant Chemotherapy for Breast Cancer

目的:探讨超微血管成像技术(SMI)在乳腺良恶性病变中的鉴别诊断价值以及在乳腺癌新辅助化疗中的疗效评估价值。方法:回顾性分析2014年2月至2019年10月于长沙市第三医院行SMI检查的109例乳腺结节患者的临床资料,根据病理结果将其分为良性组和恶性组,比较两组患者SMI微血管形态分型分布差异,采用受试者工作特征曲线(ROC)分析SMI鉴别诊断乳腺良恶性病变的价值。乳腺癌患者经序贯新辅助化疗后再次接受SMI检查,比较新辅助化疗前后、不同疗效乳腺癌患者SMI血流分级差异。结果:良性组微血管形态分型以无血管型,线型,树枝型为主(97.83%),恶性组以残根型,蟹足型为主(80.99%),两组微血管形态分型分布差异有统计学意义(P<0.05)。以病理检查结果为金标准,SMI鉴别诊断乳腺良恶性病变的曲线下面积(AUC)为0.890,灵敏度为80.99%,特异度为97.83%,准确率为85.63%。68例乳腺癌患者完成新辅助化疗,新辅助化疗有效[完全缓解(CR)+部分缓解(PD)]47例,无效[稳定(SD)+进展(PD)]21例。化疗前SMI血流分级以Ⅱ、Ⅲ级为主(80.88%),化疗后以0、Ⅰ级为主(69.12%),有效组SMI血流分级以0、Ⅰ级为主(87.23%),无效组SMI血流分级以Ⅰ、Ⅱ级为主(85.71%),化疗前后、不同疗效组SMI血流分级差异均有统计学意义(P<0.05)。结论:SMI能有效检出乳腺结节病灶内微小血管形态和血流改变,对乳腺良恶性病变的鉴别诊断及新辅助化疗的疗效评估均有一定临床应用价值。

Objective:To investigate the value of ultrastructural superb microvascular imaging(SMI)in the diagnosis and differentiation of benign and malignant breast lesions and the evaluation of the efficacy of neoadjuvant chemotherapy for breast cancer.Methods:The clinical datas of 109 patients with breast nodules who underwent Changsha Third Hospital from February 2014 to October2019 were analyzed retrospectively.According to the pathological results,they were divided into benign group and malignant group,and the differences of SMI microvascular morphology and distribution in two groups were compared.The value of SMI in diagnosing benign and malignant breast nodules was analyzed by receiver operating characteristic curve(ROC).After pathological diagnosis,patients with breast cancer were given sequential neoadjuvant chemotherapy,and SMI was examined again after chemotherapy.SMI blood flow classification,different curative effects was compared among breast cancer patients before and after neoadjuvant therapy.Results:In benign group,the microvascular morphology was mainly non-vascular,linear and dendritic type(97.83%),while in malignant group,the residual root type and crab foot type were mainly(80.99%),there was significant difference in microvascular morphology distribution between the two groups(P<0.05).The pathological examination results were taken as the gold standard,the area under curve(AUC)of SMI in the diagnosis and differentiation of benign and malignant breast nodules was 0.890,the sensitivity was 80.99%,the specificity was 97.83%,and the accuracy was 85.63%.68 patients with breast cancer completed neoadjuvant chemotherapy,with 47 cases of effective neoadjuvant chemotherapy[complete response(CR)+partial response(PD)]and 21 cases of ineffective neoadjuvant chemotherapy[stable response(SD)+progression(PD)].Before chemotherapy,SMI blood flow classification was mainly grade Ⅱ and Ⅲ(80.88%),and after chemotherapy,it was mainly grade 0 and grade Ⅰ(69.12%),effective group SMI blood flow classification was mainly grade 0 and grade Ⅰ(87.23%),invalid group SMI blood flow classification was mainly grade Ⅰ and grade Ⅱ(85.71%),before and after chemotherapy and different therapeutic group of SMI blood flow classification were significant difference(P<0.05).Conclusion:SMI can effectively detect the changes of microvessel morphology and blood flow in breast nodules,which has certain clinical application value in the diagnosis and differentiation of benign and malignant breast lesions and the evaluation of neoadjuvant chemotherapy.