彩色多普勒超声、超声弹性成像及超声造影在乳腺癌诊断及新辅助化疗疗效评估中的价值

The Value of Color Doppler Ultrasound,Ultrasound Elastography and Contrast-Enhanced Ultrasound in the Diagnosis of Breast Cancer and Evaluation of the Efficacy of Neoadjuvant Chemotherapy

目的探讨彩色多普勒超声(CDUS)、超声弹性成像(UE)及超声造影(CEUS)在乳腺癌诊断及新辅助化疗疗效评估中的价值。方法选取2020年5月-2022年3月郑州市第三人民医院诊治的106例疑似乳腺癌患者作为研究对象,经病理检查确诊为乳腺癌57例、良性病变49例,均予以CDUS、UE及CEUS检查;采用4格表法计算阳性、阴性预测值,采用ROC曲线模型分析CDUS、UE、CEUS联合诊断乳腺癌的AUC值、敏感度及特异度。并对病理确诊的乳腺癌患者予以新辅助化疗治疗,观察总缓解率,采用ROC曲线模型分析CDUS联合参数、UE评分、CEUS联合参数、3项联合预测疗效的AUC值、敏感度及特异度。结果106例疑似乳腺癌患者经CDUS检查后,阳性和阴性预测值分别为60.71%、54.00%,与金标准相比,一致性较差(Kappa=0.147,P>0.05)。经UE检查后,阳性和阴性预测值分别为71.43%、66.00%,与金标准相比,一致性一般(Kappa=0.375,P<0.05)。经CEUS检查后,阳性和阴性预测值分别为80.36%、76.00%,与金标准相比,一致性一般(Kappa=0.564,P<0.001)。恶性形态不规则、边界不清晰、血流信号Ⅱ级和Ⅲ级、钙化、后方回声衰减、纵横比≥1占比高于良性(P<0.05)。良性UE评分中的1、2分占比高于恶性,而4、5分占比低于恶性(P<0.05)。恶性的不均匀增强、增强边界不清晰、增强形态不规则占比高于良性(P<0.05)。经病理确诊的57例乳腺癌患者均接受新辅助化疗治疗,总缓解率71.93%,且化疗后RI、AT、TTP高于化疗前,而PSV、PI、UE评分低于化疗前(P<0.05)。ROC曲线分析显示,3项联合诊断乳腺癌的AUC值高于CDUS、UE、CEUS(Z=5.092,3.523、2.142,P<0.001);CDUS联合参数、UE评分、CEUS联合参数、3项联合预测疗效的AUC值分别为(0.779、0.798、0.778、0.896,P<0.05)。结论CDUS、UE及CEUS联合诊断乳腺癌和评估新辅助化疗疗效的效能高于单独使用CDUS、UE、CEUS。

Objective To investigate the value of color Doppler ultrasound(CDUS),ultrasound elastography(UE)and contrast-enhanced ultrasound(CEUS)in the diagnosis of breast cancer and the evaluation of the efficacy of neoadjuvant chemotherapy.Methods A total of 106 suspected breast cancer patients diagnosed and treated in Zhengzhou Third People's Hospital from May 2020 to March 2022 were selected as the study objects.A total of 57 cases of breast cancer and 49 cases of benign lesions were diagnosed by pathological examination.The positive and negative predictive values were calculated by the four-table method,and the ROC curve model was used to analyze the AUC value,sensitivity and specificity of CDUS,UE,and CEUS in the combined diagnosis of breast cancer.The pathologically diagnosed breast cancer patients were treated with neoadjuvant chemotherapy,the overall response rate was observed,and the ROC curve model was used to analyze the CDUS combined parameters,UE score,CEUS combined parameters,and the AUC value,sensitivity and specificity of the three combined predicting efficacy.Results After CDUS examination,the positive and negative predictive values of 106 suspected breast cancer patients were 60.71%and 54.00%,respectively,which showed poor consistency compared with the gold standard(Kappa=0.147,P>0.05).After UE examination,the positive and negative predictive values were 71.43%and 66.00%,respectively,with general consistency compared with the gold standard(Kappa=0.375,P<0.05).After CEUS examination,the positive and negative predictive values were 80.36%and 76.00%,respectively,with general consistency compared with the gold standard(Kappa=0.564,P<0.001).Irregular shape,unclear boundary,gradeⅡandⅢblood flow signal,calcification,attenuation of rear echo,aspect ratio≥1 accounted for a higher proportion than good(P<0.05).The proportion of benign UE score 1 and 2 was higher than that of malignant UE score,while the proportion of 4 and 5 was lower than that of malignant UE score(P<0.05).The proportion of non-uniform enhancement,borderless enhancement and irregular enhancement in malignant was higher than that in benign(P<0.05).All 57 breast cancer patients diagnosed by pathology were treated with neoadjuvant chemotherapy,and the total remission rate was 71.93%.After chemotherapy,RI,AT and TTP were higher than before chemotherapy,while PSV,PI and UE scores were lower than before chemotherapy(P<0.05).ROC curve analysis showed that the AUC values of CDUS,UE,CEUS and combined diagnosis of breast cancer were(0.574,0.688,0.782,0.905,P<0.05),respectively.The AUC values of CDUS combination parameter,UE score,CEUS combination parameter,and three combination predicted curative effect were(0.779,0.798,0.778,0.896,P<0.05).Conclusion The efficacy of CDUS,UE and CEUS combined in diagnosing breast cancer and evaluating the efficacy of neoadjuvant chemotherapy is higher than that of CDUS,UE and CEUS alone.