發(fā)布時(shí)間：2018-03-18 13:06

  本文選題：乳腺癌　切入點(diǎn)：新輔助化療　出處：《天津醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 本研究旨在將常規(guī)超聲及聲脈沖輻射力彈性成像技術(shù)應(yīng)用于乳腺癌新輔助化療后療效的評(píng)價(jià),并與病理組織學(xué)進(jìn)行對(duì)照,可望對(duì)乳腺癌新輔助化療的療效進(jìn)行有價(jià)值的評(píng)價(jià),提高乳腺癌新輔助化療療效評(píng)價(jià)的準(zhǔn)確率,為乳腺癌患者選擇最佳的治療方案提供較為客觀的影像學(xué)依據(jù)。 方法 收集60例均經(jīng)病理學(xué)證實(shí)且經(jīng)臨床診斷為Ⅱb-Ⅲc期乳腺癌病例,患者行新輔助化療前后均進(jìn)行臨床評(píng)價(jià)(臨床觸診)、常規(guī)超聲及超聲彈性成像檢查,新輔助化療后切除病灶,根據(jù)病理學(xué)診斷標(biāo)準(zhǔn)判斷療效,并將化療前后乳腺腫瘤的變化與病理結(jié)果作對(duì)照研究。新輔助化療前后對(duì)60個(gè)病例分別在二維超聲模式下、彩色多普勒顯像條件下觀察乳腺腫瘤的各項(xiàng)影像學(xué)特征,分別進(jìn)行最長(zhǎng)徑測(cè)量和Alder半定量法分級(jí)；應(yīng)用聲脈沖輻射力成像技術(shù),分別測(cè)量腫瘤內(nèi)部、腫瘤邊緣處及對(duì)側(cè)正常腺體的橫向剪切波速度。應(yīng)用SPSS18.0統(tǒng)計(jì)分析軟件進(jìn)行數(shù)據(jù)分析,計(jì)量數(shù)據(jù)采用中位數(shù)表示,分析常規(guī)超聲、超聲彈性成像技術(shù)對(duì)于新輔助化療腫瘤反應(yīng)性的評(píng)價(jià)作用,主要從以下幾方面進(jìn)行比較分析：新輔助化療前后乳腺腫瘤的大小(以最長(zhǎng)徑表示)的差異性；新輔助化療前后乳腺腫瘤內(nèi)部血流信號(hào)的差異性；新輔助化療前后腫瘤內(nèi)部、腫瘤邊緣處組織和對(duì)照組正常腺體組織橫向剪切波速度的差異性。 結(jié)果 乳腺惡性腫瘤經(jīng)新輔助化療4個(gè)周期后,在病理判定有效組,新輔助化療前后在VTQ模式下測(cè)量腫瘤內(nèi)部及腫瘤邊緣處組織的橫向剪切波速度差異有統(tǒng)計(jì)學(xué)意義(P0.05)；在病理判定無變化組,新輔助化療前后腫瘤內(nèi)部及腫瘤邊緣處組織的橫向剪切波速度差異均不具有統(tǒng)計(jì)學(xué)意義(P0.05)。在對(duì)照組,新輔助化療前后腫正常腺體組織的橫向剪切波速度差異不具有統(tǒng)計(jì)學(xué)意義(P0.05)。臨床觸診評(píng)價(jià)原發(fā)腫瘤緩解的有效率為56.7%,常規(guī)超聲評(píng)價(jià)原發(fā)腫瘤緩解的有效率為66.7%,超聲彈性成像評(píng)價(jià)原發(fā)腫瘤緩解的有效率為71.7%。臨床觸診評(píng)價(jià)乳腺癌新輔助化療療效的靈敏度、特異度分別為47.8%、14.9%；常規(guī)超聲評(píng)價(jià)乳腺癌新輔助化療療效的靈敏度、特異度分別為71.7%、50.0%；超聲彈性成像的靈敏度、特異度分別為89.1%、85.7%。 結(jié)論 應(yīng)用聲脈沖輻射力彈性成像技術(shù)評(píng)價(jià)乳腺腫瘤內(nèi)部的及邊緣組織的軟硬度,為新輔助化療后乳腺腫瘤的變化提供了定量的影像學(xué)檢查方法。與常規(guī)超聲相結(jié)合可以更加客觀、全面的評(píng)價(jià)乳腺癌新輔助化療的療效,將新輔助化療后的效果信息及時(shí)反饋于臨床。
[Abstract]:objective
The purpose of this study was to evaluate the conventional ultrasound and acoustic radiation force impulse imaging technique is applied to the curative effect after neoadjuvant chemotherapy for breast cancer, and compared with histopathological evaluation has the effect of neoadjuvant chemotherapy for breast cancer can improve breast cancer, neoadjuvant chemotherapy efficacy evaluation accuracy, provide more objective imaging of breast cancer patients choose the best treatment basis.
Method
The collection of 60 cases were confirmed by pathology and clinical diagnosis of b- II stage C breast cancer patients before and after neoadjuvant chemotherapy were evaluated clinically (palpation), conventional ultrasound and ultrasound elastography, neoadjuvant chemotherapy after resection of the lesion, according to pathological diagnosis standard to judge the curative effect, and chemotherapy before and after the change of breast cancer with pathological results as control group. Before and after neoadjuvant chemotherapy in 60 cases respectively in two-dimensional ultrasound mode, characteristics of the imaging of breast tumors with color Doppler imaging conditions, respectively, the longest diameter measurement and Alder semi quantitative classification; the application of acoustic radiation force impulse imaging, tumor the measured transverse shear wave velocity at the edge of tumor and contralateral normal glands. Data were analyzed using SPSS18.0 statistical analysis software, the measurement data are expressed by median, conventional ultrasound analysis , ultrasound elastography for the evaluation of neoadjuvant chemotherapy of tumor reactive function, mainly analyzed from the following aspects: the size of breast cancer before and after neoadjuvant chemotherapy (with the longest diameter of said) difference; the difference before and after neoadjuvant chemotherapy breast tumor blood flow signal of tumor before and after neoadjuvant chemotherapy; at the edge of tumor tissue, the difference and control the transverse shear wave velocity group of normal gland tissue.
Result
Breast cancer after neoadjuvant chemotherapy after 4 cycles, determine the effective group in pathology, statistically significant differences of the transverse shear wave velocity before and after neoadjuvant chemotherapy in VTQ mode measurement of tissue tumor and tumor edge (P0.05); no change in pathology assessment group, a new auxiliary transverse shear wave velocity inside the tumor tissue and the margin of the tumor before and after chemotherapy can differences were not statistically significant (P0.05). In the control group before and after neoadjuvant chemotherapy, the transverse shear wave velocity difference of swollen normal gland tissue was not statistically significant (P0.05). Clinical palpation of the evaluation of the primary tumor remission rate was 56.7%, the evaluation of conventional ultrasound primary tumor remission efficiency of 66.7%, ultrasound elastography in the evaluation of the primary tumor remission rate sensitivity of neoadjuvant chemotherapy with 71.7%. clinical palpation evaluation of breast cancer, the specificity was 47.8%, 14.9%; The sensitivity and specificity of conventional ultrasound in the evaluation of neoadjuvant chemotherapy for breast cancer were 71.7% and 50%, respectively, and the sensitivity and specificity of ultrasound elastography were 89.1%, 85.7%. respectively.
conclusion
The hardness of the radiation force evaluation of elastography of breast tumor tissue and the internal edge of pulse sound, changes after neoadjuvant chemotherapy of breast cancer provides a quantitative imaging method. Combined with conventional ultrasound can be more objective and comprehensive evaluation of the efficacy of neoadjuvant chemotherapy for breast cancer, the information effect of neoadjuvant chemotherapy after the timely feedback to the clinic.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.9;R445.1

【引證文獻(xiàn)】

相關(guān)期刊論文 前1條

1 尤其琴;吳蓉;;聲脈沖輻射力彈性成像對(duì)BI-RADS 4類乳腺腫塊的診斷價(jià)值[J];解放軍預(yù)防醫(yī)學(xué)雜志;2016年06期

相關(guān)碩士學(xué)位論文 前1條

1 李嵩秀;超聲彈性成像技術(shù)評(píng)價(jià)正常人及2型糖尿病患者跟腱彈性[D];大連醫(yī)科大學(xué);2015年

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本文編號(hào)：1629700