二维超声和剪切波弹性成像对乳腺癌相关淋巴水肿的评估价值

Value of two-dimensional ultrasound and shear wave elastography in the evaluation of lymphedema associated with breast cancer

目的 探讨二维超声和剪切波弹性成像(SWE)诊断乳腺癌相关淋巴水肿(BCRL)和评估康复治疗效果的价值。方法 基于临床评估结果,将102例乳腺癌术后患者分为正常组、亚临床淋巴水肿组和临床淋巴水肿组。使用二维超声、SWE分别检测患者双上肢皮肤和皮下组织,获得相应厚度、硬度值。分析水肿组(亚临床淋巴水肿组和临床淋巴水肿组)患者皮肤、皮下组织的厚度和硬度与国际淋巴学会(ISL)分期的相关性;比较3组患者患肢与对侧肢皮肤、皮下组织的厚度与硬度;比较二维超声、SWE诊断亚临床淋巴水肿的效能;比较周径测量法、二维超声和SWE评估治疗效果的价值。结果 亚临床淋巴水肿组中,患肢前臂皮肤厚度、硬度和前臂皮下组织硬度均大于对侧肢,差异有统计学意义(P<0.05);临床淋巴水肿组中,患肢前臂、上臂皮肤和皮下组织的厚度、硬度均大于对侧肢,差异有统计学意义(P<0.05)。水肿组患者前臂皮肤厚度(r=0.443,P<0.001)、前臂皮肤硬度(r=0.275,P=0.024)均与ISL分期呈显著正相关。受试者工作特征曲线显示,二维超声、SWE诊断亚临床BCRL的曲线下面积分别为0.808、0.934。治疗后,亚临床淋巴水肿组的二维超声、SWE评估结果与治疗前比较,差异均有统计学意义(P<0.05),周径测量法评估结果与治疗前比较,差异无统计学意义(P=0.293)。结论 二维超声、SWE均具有较高的诊断BCRL和评估治疗效果的价值,且SWE相较于二维超声在BCRL的早期诊断中具有更优的诊断效能。

Objective To explore the application value of two-dimensional ultrasound and shear wave elastography(SWE)in diagnosing breast cancer-related lymphedema(BCRL)and evaluating the efficacy on rehabilitation.Methods According to the clinical assessment,a total of 102 patients were divided into normal group,subclinical lymphedema group and clinical lymphedema group.Two-dimensional ultrasoundand SWE were used to detect the skin and subcutaneous tissue of the upper limbs of the patients,and the corresponding thickness and hardness were obtained.The correlations of the thickness and hardness of the skin and subcutaneous tissue of the patients in the edema group(subclinical lymphedema group and clinical lymphedema group)with the International Society of Lymphology(ISL)classification were analyzed.The thickness and hardness of skin and subcutaneous tissue of affected limb and contralateral limb in the three groups were compared.The value of circumferential diameter measurement,two dimensional ultrasound and SWE in evaluating therapeutic effect was compared.Results In subclinical lymphedema group,the skin thickness,hardness and subcutaneous tissue The skin and subcutaneous tissue thickness and hardness ofthe forearm and upper arm of the affected limb in the clinical lymphedema group were significantly greater than those of the contralateral limb(P<0.05);forearm skin thickness(r=0.443,P<0.001)and forearm skin hardness(r=0.275,P=0.024)in the edema group were significantly positively correlated with ISL stage.The receiver operating characteristic curve showed that the area under the curve of two-dimensional ultrasound and SWE in diagnosis of subclinical BCRL was 0.808 and 0.934,respectively.the differences between the two-dimensional ultrasound and SWE assessment of the subclinical lymphedema group before and after treatment were statistically significant(P<0.05).There was no significant difference in the assessment results of circumference measurement before and after treatment(P=0.293).Conclusion Two-dimensional ultrasound and SWE are both of high value for the diagnosis and assessment of treatment effects of BCRL;in early diagnosis,the diagnostic efficacy of SWE is better than that of two-dimensional ultrasound.