本文選題：乳腺腫瘤 + 超聲檢查��； 參考：《中國臨床醫(yī)學(xué)影像雜志》2017年11期

【摘要】：目的 :評估局部進(jìn)展期乳腺癌患者在新輔助化療(Neoadjuvant chemotherapy,NACT)前后癌灶最大徑、面積、體積及其縮小率與NACT病理反應(yīng)性分級的關(guān)系,進(jìn)而探討自動(dòng)乳腺全容積掃描(Automated breast volume scanner,ABVS)在NACT療效評價(jià)中的應(yīng)用價(jià)值。方法 :本研究為前瞻性研究。81例病例均根據(jù)術(shù)后病理反應(yīng)性結(jié)果 (MillerPayne分級)分為組織學(xué)顯著反應(yīng)(MHR)與組織學(xué)非顯著反應(yīng)(NMHR)2組,所有病例術(shù)前對2組NACT前、NACT第2周期后、NACT第4周期后均做ABVS測量癌灶最大徑、面積、體積及其縮小率分別進(jìn)行兩獨(dú)立樣本t檢驗(yàn)比較(非正態(tài)分布的數(shù)據(jù)進(jìn)行Mann-Whitney U檢驗(yàn));采用CCC分析3次ABVS測量的癌灶最大徑與面積、體積之間的一致性。利用受試者工作特征曲線(ROC)分析判斷ABVS測量的癌灶大小對NACT病理反應(yīng)性的評估價(jià)值。結(jié)果 :NACT前后,MHR組和NMHR組腫物最大徑、面積及體積分別組內(nèi)比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。MHR組和NMHR組最大徑、面積及體積組間比較,最大徑差異有統(tǒng)計(jì)學(xué)意義(P0.05),面積及體積差異無統(tǒng)計(jì)學(xué)意義(P0.05)。MHR組與NMHR組最大徑、面積及體積的第一次及第二次縮小率比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05),MHR組的縮小率高于NMHR組,而且MHR組中的第二次縮小率均明顯高于NMHR組。兩組組內(nèi)第一次與第二次縮小率比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05),各組第二次縮小率高于第一次縮小率,而且在MHR組中較NMHR組更明顯。以NACT后癌灶最大徑、面積和體積第一次和第二次縮小率為評估參數(shù)、術(shù)后病理反應(yīng)性為金標(biāo)準(zhǔn),第一次縮小率R0C曲線的曲線下面積(AUC)分別為0.696、0.693、0.723,第二次縮小率R0C曲線AUC分別為0.807、0.824、0.858,有一定診斷價(jià)值,三者評估效能無顯著性差異。結(jié)論:ABVS測量乳腺癌灶最大徑與面積、體積的一致性較好,對評估NACT療效有一定的應(yīng)用價(jià)值。NACT后,癌灶最大徑、面積與體積的縮小率可預(yù)測評估癌灶對NACT的病理反應(yīng)性。
[Abstract]:Objective: to evaluate the relationship between the maximum diameter, area, volume and size of neoadjuvant chemotherapy before and after neoadjuvant chemotherapy in patients with locally advanced breast cancer. To evaluate the value of automated breast volume scannerus (ABVS) in evaluating the curative effect of NACT. Methods: one hundred and eighty-one cases of prospective study were divided into two groups according to the results of pathological reactivity: histologic significant response (MHRs) and histologic nonsignificant response (NMHR2). All the patients were performed ABVS before and after the second cycle of NACT before and after the second cycle of NACT, and the maximum diameter and area of the lesion were measured by ABVS before and after the second cycle of NACT. The volume and the reduction rate were compared with two independent samples by t test (Mann-Whitney U test for non-normal distribution data, and CCC analysis for the consistency between the maximum diameter, area and volume of cancer focus measured by ABVS three times). The evaluation value of tumor focus size measured by ABVS on pathological reactivity of NACT was evaluated by ROC-based operating characteristic curve. Results the maximum diameter, area and volume of tumor in MHR group and NMHR group were significantly different before and after 1% NACT. There were significant differences between MHR group and NMHR group in maximum diameter, area and volume. There was no significant difference in area and volume between MHR group and NMHR group. The first and second reduction rates of maximum diameter, area and volume in MHR group were significantly higher than those in NMHR group. The second reduction rate in MHR group was significantly higher than that in NMHR group. There were significant differences in the first and second reduction rates between the two groups. The second reduction rate in each group was higher than that in the first reduction rate, and it was more obvious in the MHR group than in the NMHR group. The maximum diameter, area and volume of the tumor after NACT were used as the evaluation parameters, and the postoperative pathological reactivity was the gold standard. The area under the curve of the first reduction rate R0C curve was 0.696 and the AUC of the second R0C curve was 0.807 / 0.824 / 0.858, respectively. There was no significant difference in the evaluation efficacy among the three curves. Conclusion the measurement of the maximum diameter and area, volume and volume of breast cancer focus by NACT is of great value. After NACT, the maximum diameter, area and volume of breast cancer focus can be predicted to evaluate the pathological reactivity of tumor focus to NACT. [WT5HZ] [WT5 "HZ] [WT5" HZ] [WT5 "BZ] [WT5" BZ]
【作者單位】： 河北省滄州中西醫(yī)結(jié)合醫(yī)院;
【分類號】：R730.44;R737.9

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