多模态超声技术在乳腺良恶性病灶诊断及乳腺癌新辅助化疗疗效评估中的应用

Diagnosis of benign and malignant breast lesions by multimodal ultrasound technology and its application in evaluation of neoadjuvant chemotherapy for breast cancer

目的:探究多模态超声技术在乳腺良恶性病灶诊断及乳腺癌新辅助化疗疗效评估中的应用。方法:选取某院就诊的60例女性乳腺病变患者临床资料进行回顾性分析,均在本院行常规超声(US)、超声造影(CEUS)、超声弹性成像(UE)、自动乳腺全容积成像(ABVS)检查与病理活检。分析多模态超声技术诊断乳腺良恶性病灶价值,针对乳腺癌患者给予新辅助化疗,通过多模态超声技术评估疗效。结果:60例患者中,诊断出病灶62个,其中恶性病灶28个,良性病灶34个。以病理结果作为金标准,US、CEUS、UE、ABVS诊断乳腺良恶性病灶与病理结果相比,Kappa值为0.641、0.609、0.583、0.607;多模态超声诊断乳腺良恶性病灶与病理结果相比,Kappa值为0.935。多模态超声诊断符合率明显高于其他检查方式(χ^(2)=6.960、8.052、9.177、5.052,P<0.05)。病理检查结果显示,28例乳腺癌患者新辅助化疗有效21例,无效7例。US检查新辅助化疗前病灶最大直径比较差异无统计学意义(t=1.797,P>0.05),CEUS检查辅助化疗前后平均渡越时间(MTT)、上升时间(RT)、达峰时间(TTP)比较差异无统计学意义(t=1.754、0.310、1.868,P>0.05),但新辅助化疗后AUC、峰值强度(PI)均低于新辅助化疗前(t=3.303、6.950,P<0.05),UE检查新辅助化疗后弹性模量平均值(E mean)、最大值(E_(max))、最小值(E_(min))及病变组织(E mean)与正常组织E mean的比值(EI)均低于新辅助化疗前(t=9.830、15.245、13.546、9.356,P<0.05),ABVS检查新辅助化疗后肿瘤体积、面积、厚、长、宽均低于新辅助化疗前(t=23.167、16.006、8.787、14.838、7.495,P<0.05)。以病理结果作为金标准,US、CEUS、UE、ABVS评估乳腺癌新辅助化疗疗效与病理结果相比,Kappa值为0.478、0.583、0.545、0.727;多模态超声评估乳腺癌新辅助化疗疗效与病理结果相比,Kappa值为0.900。结论:多模态超声技术在乳腺癌诊断与评估新辅助化疗疗效具有较高灵敏度与符合率,具有较好应用前景。

Objective:To explore the application of mulimodal ulrasound technology in the diagnosis of benign and malignant breast lesions and in the evaluation of the efficacy of neoadjuvant chemotherapy for breast cancer.Methods:Clinical data of 60 female breast lesions patients who were treated in a hospital were selected for retrospective analysis.US,CEUS,UE,ABVS examination and pathological biopsy were performned in the hospital.The value of multimodal ultrasound technology in diagnosing benign and malignant breast lesions was analyzed,neoadjuvant chemotherapy was employed in the treatment of breast cancer patients,and the efficacy was evaluated by mulimodal ultrasound technology.Results:Among the 60 patients,62 lesions were diagnosed,including 28 malignant lesions and 34 benign lesions.Taking the pathological results as the gold standard,when US,CEUS,UE,and ABVS were compared with the pathological results in the diagnosis of benign and malignant breast lesions,the Kappa values were 0.641,0.609,0.583,and 0.607;when multimodal ultrasound technology was compared with the pathological results in the diagnosis of benign and malignant breast lesions,the Kappa value was 0.935.The coincidence rate of multimodal ultrasound diagnosis was significantly higher than that of other examination methods(χ^(2)=6.960,8.052,9.177,5.052,P<0.05).The results of pathological examination showed that 21 cases of neoadjuvant chemotherapy in the 28 cases of breast cancer were effective and 7 cases were ineffective.There was no significant difference in the maximum diameter of lesions before and after neoadjuvant chemotherapy by US(t=1.797,P>0.05).The AUC and PI after neoadjuvant chemotherapy was lower than those before neoadjuvant chemotherapy(t=3.303,6.950,P<0.05).The EI value,Emin value,Emax value and Emean value after neoadjuvant chemotherapy were lower than those before neoadjuvant chemotherapy(t=9.356,13.546,15.245,9.830,P<0.05).The volume,area,thickness,length and width after neoadjuvant chemotherapy were lower than those before neoadjuvant chemotherapy(t=23.167,16.006,8.787,14.838,7.495,P<0.05).Taking pathological results as the gold standard,when US,CEUS,UE,and ABVS were compared with pathological results in the evaluation of the efficacy of neoadjuvant chemotherapy in breast cancer,the Kappa values were 0.478,0.583,0.545,and 0.727.When multimodal ultrasound technology was compared pathological results in the evaluation of the efficacy of neoadjuvant chemotherapy,the Kappa value was 0.900.Conclusion:Multimodal ultrasound technology has high sensitivity and coin-cidence rate in the diagnosis and evaluation of neoadjuvant chemotherapy in breast cancer,and has a good application prospect.