剪切波弹性成像在BCRL治疗随访中的应用初步研究

A preliminary study on the application of shear wave elastography in the follow-up of BCRL treatment

目的:初步研究超声剪切波技术在乳腺癌相关淋巴水肿不同分期相关治疗效果评估中的应用。资料与方法:本研究前瞻性收集2021年12月—2023年4月符合纳入标准的乳腺癌术后单侧上肢淋巴水肿的女性患者46例,记录患者的年龄、病程、淋巴水肿分期,测量双侧前臂及上臂周长。超声测量双侧上肢前臂及上臂皮肤和皮下组织厚度、剪切波速度。根据国际淋巴学会共识联合周长测量差异分为3组,分别对比超声测量值差异,评价超声及弹性成像对不同分期乳腺癌相关淋巴水肿在跟踪治疗进展中的作用。结果:在接受治疗后,0期乳腺癌相关淋巴水肿患者前臂皮肤剪切波速度有显著差异(P<0.001),Ⅰ期乳腺癌相关淋巴水肿患者前臂皮肤厚度、前臂皮肤剪切波速度及上臂皮肤剪切波速度有显著差异(P<0.05),Ⅱ期乳腺癌相关淋巴水肿患者在前臂皮肤厚度、前臂皮肤剪切波速度、前臂皮下组织剪切波速度、上臂皮肤厚度、上臂皮肤剪切波速度均有显著变化(均为P<0.001)。结论:剪切波弹性成像可以检测乳腺癌相关淋巴水肿患侧上肢不同层次的硬度变化,在前臂皮肤层测量可以正确反应淋巴水肿相关治疗的疗效,用于检测和监测淋巴水肿患者不同时期的硬度变化,是一种有效、快速且无创的方法,可作为常规测量工具在疗随访中应用。

Objective:To preliminarily study the application of ultrasound shear wave technology in the evaluation of therapeutic effect of breast cancer related lymphedema at different stages.Methods:This prospective study was conducted from December 2021 to April 2023.A total of 46 female patients with unilateral upper limb lymphedema after breast cancer surgery who met the inclusion criteria were enrolled.The age,disease duration,lymphedema stage of the patients were recorded,and the circumference of bilateral forearm and upper arm was measured.The thickness of skin and subcutaneous tissue and shear wave velocity of bilateral forearm and upper arm were measured by ultrasound.The patients were divided into three groups according to the International Society of Lymphology Consensus combined with the dfferences in circumference measurement.To evaluate the role of ultrasound and elastography in tracking the treatment progress of breast cancer-related lymphedema at different stages.Results:There were significant differences in forearm skin shear wave velocity in patients with stage 0 adenocarcinoma-related lymphedema(P<0.001).There were significant differences in forearm skin thickness,forearm skin shear wave velocity,and upper arm skin shear wave velocity in patients with stage I breast cancer lymphedema(P<0.05).Patients with stage II breast cancer-related lymphedema had significant changes in forearm skin thickness,forearm skin shear wave velocity,forearm subcutaneous tissue shear wave velocity,upper arm skin thickness and upper arm skin shear wave velocity after treatment(all P<0.001).Conclusion:Shear wave elastography can detect the changes of stiffness at different layers of the upper limb on the affected side of breast cancer related lymphedema.Skin measurement can correctly reflect the efficacy of lymphedema related treatment.It is an effective,rapid and non-invasive method to detect and monitor the changes of stiffness in patients with lymphedema at different periods.It can be used as a routine measurement tool in treatment follow-up.