本文選題：乳腺癌 + 新輔助化療��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本研究以病理結(jié)果為對照,應(yīng)用二維超聲評價乳腺癌新輔助化療(NAC)療效的價值,并應(yīng)用剪切波彈性成像(SWE)技術(shù)觀察乳腺癌NAC前及NAC后各周期病灶硬度值的變化趨勢,探討SWE技術(shù)早期預(yù)測NAC療效的價值。方法:選取接受新輔助化療的乳腺癌患者43例,共45個病灶,化療前及化療后2、4、6、8周期均行常規(guī)超聲及剪切波彈性成像檢查,以MillerPayne病理反應(yīng)分級為標(biāo)準,計算二維超聲評價乳腺癌NAC療效的敏感度、特異度、準確性及其與組織病理學(xué)判斷乳腺癌NAC療效的一致性。按照病理分級標(biāo)準對病灶分為病理反應(yīng)顯著組(G3+G4+G5)和病理反應(yīng)非顯著組(G1+G2)。測量兩組在化療前及化療后2、4、6周期末病灶的最大彈性值Emax及彈性值變化率ΔEmax,并比較兩組的變化趨勢。以病理反應(yīng)是否顯著為依據(jù),繪制NAC 2周期末和4周期末病灶ΔEmax的ROC曲線,比較兩者對NAC治療反應(yīng)的預(yù)測價值。結(jié)果:(1)按照病理分級標(biāo)準,病理反應(yīng)顯著組病灶33個,病理反應(yīng)非顯著組病灶12個。(2)本組45個乳腺癌病灶NAC治療前二維超聲檢查腫瘤最大徑(3.7±1.8)cm,NAC結(jié)束后腫瘤最大徑(2.0±1.4)cm,二者比較差異有統(tǒng)計學(xué)意義(t=5.846,p=0.000)。以病理結(jié)果為標(biāo)準,二維超聲測量腫瘤最大徑評價乳腺癌NAC療效的敏感度為78.78%,特異度為66.67%,準確性為75.56%,與組織病理學(xué)評價乳腺癌NAC療效基本一致,Kappa值0.421。(3)隨著化療時間的延長,病理反應(yīng)顯著組和非顯著組乳腺癌病灶Emax值均逐漸降低。病理反應(yīng)顯著組2周期末Emax值已明顯降低(p0.05),非顯著組4周期末Emax值明顯降低(p0.05),6周期末與4周期末相比,兩組下降程度差異均無統(tǒng)計學(xué)意義(p0.05)。(4)病理反應(yīng)顯著組與非顯著組中隨著化療時間的延長,乳腺癌病灶?Emax均逐漸增加,其中病理反應(yīng)顯著組2、4、6周期末?Emax兩兩比較差異均有統(tǒng)計學(xué)意義(p0.05);病理反應(yīng)非顯著組4周期末、6周期末與2周期末比較差異均有統(tǒng)計學(xué)意義(p0.05),而6周期末與4周期末?Emax值相近,差異無統(tǒng)計學(xué)意義(p0.05)。各周期末兩組間?Emax比較差異均有統(tǒng)計學(xué)意義,病理反應(yīng)顯著組?Emax大于反應(yīng)非顯著組(p0.05)。(5)病灶?Emax的ROC曲線顯示,2周期末曲線下面積為0.808,4周期末曲線下面積為0.869,兩者比較差異無統(tǒng)計學(xué)意義(Z=0.63,p=0.264)。結(jié)論:(1)二維超聲在評價NAC療效中仍具有重要作用。(2)SWE技術(shù)能為二維超聲評價乳腺癌NAC療效提供有價值的補充,病理反應(yīng)顯著組與非顯著組在NAC中病灶Eamx值下降趨勢不同。(3)乳腺癌病灶?Emax可早期預(yù)測NAC的療效。
[Abstract]:Objective: to evaluate the therapeutic effect of neoadjuvant chemotherapy in breast cancer by two-dimensional ultrasound, and to observe the change trend of lesion hardness before and after NAC by using shear wave elastic imaging (SWE) technique. To explore the value of SWE technique in early prediction of NAC efficacy. Methods: Forty-three patients with breast cancer underwent neoadjuvant chemotherapy with 45 lesions. Routine ultrasound and shear wave elastography were performed before and after chemotherapy. MillerPayne's pathological grade was used as the standard. The sensitivity, specificity and accuracy of two dimensional ultrasound in evaluating the therapeutic effect of NAC in breast cancer were calculated, and the agreement between NAC and histopathology in evaluating the curative effect of NAC in breast cancer was evaluated. According to the pathological grading criteria, the lesions were divided into two groups: G 3 G 4 G 5 and G 3 G 4 G 5 (P < 0 05) and G 1 G 2 (P < 0 05). The maximum elastic value (Emax) and the change rate of elastic value (螖 Emax.) of the lesions were measured before chemotherapy and at the end of 2 weeks and 4 weeks after chemotherapy in both groups, and the trend of change was compared between the two groups. The ROC curves of 螖 E max at the end of 2 and 4 weeks of NAC were plotted on the basis of whether the pathological reaction was significant or not, and the predictive value of 螖 E max in NAC treatment was compared. Results according to the pathological grading standard, 33 lesions were found in the pathological reaction group. (2) before NAC treatment, 45 breast cancer lesions were examined by two-dimensional ultrasound for the maximum diameter of the tumor (3.7 鹵1.8 cm). The maximum diameter of the tumor was 2.0 鹵1.4 cm after the end of NAC. The difference between the two groups was statistically significant (P < 0.05). According to the pathological results, the sensitivity, specificity and accuracy of two dimensional ultrasound in evaluating the NAC effect of breast cancer were 78.78, 66.67 and 75.56, respectively. The Kappa value of NAC in breast cancer with histopathology was 0.421.3) with the prolongation of chemotherapy time. The E max value of breast cancer focus decreased gradually in both pathological response group and non-significant group. The Emax value at the end of 2 weeks was significantly decreased in the pathological response group, while that in the non-significant group at the end of 4 weeks was significantly lower than that at the end of the 6th week and the end of the 4th week in the non-significant group. There was no significant difference in the degree of decrease between the two groups (P 0.05). The Emax of breast cancer lesions increased gradually with the prolongation of chemotherapy time in the pathological reaction group and the non-significant group. There were significant differences in Emax between the two groups at the end of 6 weeks and the end of 4 weeks and 6 weeks respectively in the pathological reaction group, and the difference between the two groups was significant at the end of 4 weeks and 6 weeks and the end of 2 weeks, while the value of E max was similar at the end of 6 weeks and 4 weeks, and the difference was significant at the end of 4 weeks and 2 weeks, respectively. The difference was not statistically significant (P 0.05). There were significant differences in Emax between the two groups at the end of each week. The ROC curve showed that the area under the end of 2 weeks curve was 0. 808 and the area under the end of 4 weeks curve was 0. 869. There was no significant difference between the two groups. There was no significant difference between the two groups. Conclusion two dimensional ultrasound still plays an important role in evaluating the curative effect of NAC. SWE can provide a valuable supplement for evaluating the curative effect of NAC by two-dimensional ultrasound. In NAC, Emax could predict the curative effect of NAC early.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.9;R445.1

【參考文獻】

相關(guān)期刊論文 前10條

1 冷曉玲;黃國福;賈志鶯;郭云泉;馬富成;;超聲造影在乳腺癌新輔助化療療效評估中的應(yīng)用價值[J];中華超聲影像學(xué)雜志;2015年11期

2 張彥;陳翠京;史秀云;張紫杰;范雪;白玲;毛京寧;;超聲檢查早期評價乳腺癌新輔助化療療效的臨床研究[J];臨床腫瘤學(xué)雜志;2015年10期

3 周潔瑩;史憲全;王知力;唐杰;;剪切波彈性成像技術(shù)定量評價乳腺癌新輔助化療療效的價值[J];中華醫(yī)學(xué)超聲雜志(電子版);2015年09期

4 胡蕓;金朝林;王翔;張樹桐;謝元亮;李惠;;乳腺癌的磁共振強化方式與新輔助化療后退縮模式間的相關(guān)性及其臨床意義[J];中國腫瘤臨床;2014年22期

5 劉鋒;張艷;陳洋;常志偉;王玲云;王學(xué)清;張克敏;;彩色多普勒超聲在乳腺癌新輔助化療療效評價中價值[J];中華實用診斷與治療雜志;2014年10期

6 陳曼;汪登斌;費曉春;唐蕾;詹維偉;王文平;;常規(guī)超聲與動態(tài)增強MRI預(yù)測乳腺癌新輔助化療療效的應(yīng)用研究[J];中國超聲醫(yī)學(xué)雜志;2013年08期

7 宗瑜;吳佳毅;沈坤煒;;乳腺癌新輔助治療的國際共識與解讀[J];中華外科雜志;2013年01期

8 劉曉婷;馬靈芝;;彩色多普勒超聲在乳腺癌新輔助化療療效評價上的應(yīng)用價值[J];中國臨床醫(yī)學(xué)影像雜志;2011年12期

9 祁萌;李金鋒;解云濤;陸愛萍;劉毅強;林本耀;歐陽濤;;乳腺癌新輔助化療初期超聲評效預(yù)測病理評價的可行性[J];中華醫(yī)學(xué)雜志;2010年08期

10 許小云;杜聯(lián)芳;李凡;邢晉放;仇生龍;王建豐;;超聲造影在乳腺良惡性腫瘤鑒別診斷中的價值[J];中國超聲醫(yī)學(xué)雜志;2008年12期

，

本文編號：2030884